Balloon of PAC

Q: Why is it important to inflate the Balloon of the Pulmonary Artery Catheter (Swan-Ganz Catheter) as soon as it enters the Right Atrium?

Answer: During Pulmonary Artery Catheter insertion, care must be taken to inflate the balloon as soon as the atrial curve is noticed in the monitor, as it helps to avoid endocardial lesion in the tricuspid valve, as well as in the right atrium and ventricle, such as wall perforation.

#procedure

# hemodynamic

Further readings:

1. Ennala S, Melillo CA, Lane JE, Tonelli AR. Effect of pulmonary artery catheter balloon inflation on pulmonary hemodynamics. Cardiovasc Diagn Ther. 2022 Feb;12(1):37-41. doi: 10.21037/cdt-21-515. PMID: 35282667; PMCID: PMC8898684.

 2. Perforation of the Right Ventricle Induced by Pulmonary Artery Catheter at Induction of Anesthesia for the Surgery for Liver Transplantation: A Case Report and Reviewed of Literature, - Case Report Med. 2009; 2009: 650982. Published online 2009 December 31

Succinylcholine and contraindications

Q: Besides renal failure, name at least 5 conditions that may be risk factors for hyperkalemia with succinylcholine.

Answer: Conditions besides renal failure, having susceptibility to succinylcholine-induced hyperkalaemia are

• Burn
• Closed head injury
• CVAs
• Acidosis
• Guillain–Barré syndrome
• Drowning, and
• Massive trauma

#procedures

References:

1. Muñoz-Martínez T, Garrido-Santos I, Arévalo-Cerón R, Rojas-Viguera L, Cantera-Fernández T, Pérez-González R, Díaz-Garmendia E. Prevalencia de contraindicaciones a succinilcolina en unidades de cuidados intensivos [Contraindications to succinylcholine in the intensive care unit. A prevalence study]. Med Intensiva. 2015 Mar;39(2):90-6. Spanish. doi: 10.1016/j.medin.2014.07.002. Epub 2014 Sep 18. PMID: 25238994.

2. Blanié A, Ract C, Leblanc PE, Cheisson G, Huet O, Laplace C, Lopes T, Pottecher J, Duranteau J, Vigué B. The limits of succinylcholine for critically ill patients. Anesth Analg. 2012 Oct;115(4):873-9. doi: 10.1213/ANE.0b013e31825f829d. Epub 2012 Jul 4. PMID: 22763904.

3. Hager HH, Patel P, Burns B. Succinylcholine Chloride. 2025 Feb 15. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 29763160.

HD and HCV

Q: Patients with Hepatitis C virus (HCV) and on hemodialysis (HD) should have dedicated and isolated HD machines.

A) True

B) False

Answer: B

The universal standard hygienic precautions for diаlуѕiѕ machines are good for all patients, including HCV. The risk of virus transmission via the internal pathways of the ԁiаlyѕiѕ machine is extremely low.

This change in practice is based on evidence from 4.5 years of a multi-center European study (reference #2), which showed no single transmission case with only universal precautions. Moreover, after adjusting for confounding factors, neither the well-known Diаlysis Outcomes and Practice Patterns Study (DOPPS) - reference #1 - nor a study from Italy (reference #3) that included 3492 patients showed a decrease in HСV seroconversion with application of isolation measures.

#procedures

#nephrology

References:

1. Fissell RB, Bragg-Gresham JL, Woods JD, et al. Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: the DOPPS. Kidney Int 2004; 65:2335.

2. Jadoul M, Cornu C, van Ypersele de Strihou C. Universal precautions prevent hepatitis C virus transmission: a 54 month follow-up of the Belgian Multicenter Study. The Universitaires Cliniques St-Luc (UCL) Collaborative Group. Kidney Int 1998; 53:1022.

3. Petrosillo N, Gilli P, Serraino D, et al. Prevalence of infected patients and understaffing have a role in hepatitis C virus transmission in dialysis. Am J Kidney Dis 2001; 37:1004.