Pulmonary Artery Catheters

Patient selection for PA catheter placement largely comes down to institutional, anesthesia attending and surgeon preference based on patient pathology, case acuity and actual or anticipated hemodynamic instability. Note that it is rarely indicated to place them solely for management in the OR. Rather, the primary indication in institutions with high volume of PA catheter placement is for utilization in the ICU. The evidence base for use of this invasive monitor is contentious at best, and is one of the more polarizing subjects in cardiac anesthesia – up there with glucose control, crystalloid versus colloid, lung isolation technique and cerebral monitoring.

There are many kinds of PA catheters. When positioned appropriately, the tip rests in a proximal branch of the pulmonary artery. The primary difference between catheters is intermittent thermodilution versus continuous cardiac output capability (A and B), additional infusion ports, and pacing capability (C).