Q: While reviewing chest X-ray after floating Pulmonary Artery Catheter (PAC), you suspect possible knotting of catheter in right ventricle. Which one bedside trick may help in resolving knot before embarking on more invasive resolutions?
Answer: Inject about 20 mL of iced solution through the distal lumen
If knotting of swan-ganz catheter(PAC) is suspected, many times injecting about 20 mL of cold sterile saline or iced solution through the distal lumen stiffens the catheter and help in resolving the knot. Interestingly, this trick was described almost 40 years ago, even before swan-ganz catheters later became popular in 1980s and 1990s. If this trick does not work, patient needs to go to cardiac catheter laboratory for placement of a wire under fluoroscopy. Alternatively, Interventional Radiology (IR) or vascular surgical service need to be consulted. In all ultimate failed cases, cardiothoracic surgery may require to perform open extraction of PAC.
Mond HG, Clark DW, Nesbitt SJ, Schlant RC. A technique for unknotting an intracardiac flow-directed balloon catheter. Chest 1975; 67:731.