Length of insertion for pulmonary artery catheters to locate different cardiac chambers in patients undergoing cardiac surgery

Background. Although, guidelines related to length of insertionof a pulmonary artery catheter to reach a particular cardiacchamber are available, these are not backed by clinical studies.We measured the length of insertion of pulmonary artery cathetersto locate the right ventricle, pulmonary artery and pulmonarycapillary wedge positions in 300 adult patients undergoing electivecardiac surgery. Methods. The pulmonary artery catheters were inserted usinga standard technique through the right internal jugular vein.The right ventricle, pulmonary artery and wedge position ofthe catheter were confirmed by the characteristic waveforms,and the length of insertion to these points was measured. Results. The right ventricle was reached at 24.6 (3) cm (95%CI 24.2–24.9 cm), pulmonary artery at 36 (4) cm (95% CI35.6–36.5 cm) and wedge position at 42.8 (5.7) cm (95%CI 42.2–43.5 cm). The length of catheter to reach theright ventricle, pulmonary artery and wedge position was significantlymore in patients undergoing valve surgery as compared with thoseundergoing coronary artery bypass grafting [26 (3.8) and 24(2.5) cm; 38.5 (4.6) and 35 (3.2) cm; and 47.8 (6.9) and 41.2(4.1) cm, respectively, P<0.001]. The length of insertionto reach pulmonary artery and pulmonary capillary wedge positionwas directly related to height of the patient (Pearson’scorrelation 0.157 and 0.15, respectively). Conclusions. We have provided the norms related to length ofinsertion of pulmonary artery catheter, which should be usefulin accurate placement of the catheter and minimize complicationsrelated to coiling of the catheter.