Transthoracic echocardiography assists appropriate pulmonary artery catheter placement: An observational study

Table 5 Situations where utilisation of transthoracic echocardiogram for pulmonary artery catheter positioning may be of assistance

Timing	Utility
Pre-insertion	Identify RV dilation, suggesting a longer than standard PAC insertion distance until the MPA/RPA is reached by the PAC balloon
	Identify small calibre MPA/RPA dimensions, usually associated with hypovolemia, and possibly predisposing to shorter depths of insertion from RV to “wedge”
	Quantify RA, TV and PV abnormalities and/or degree of regurgitation prior to PAC insertion
Insertion	Establish absence of the body of the PAC within the RVOT, suggesting PAC coiling or failure of passage past the TV
	Establish presence of the body of the PAC within the RVOT, confirming that the PAC balloon (1) is not coiled in the RV and (2) must be either in or distal to the MPA/RPA
	Visualisation of an “un-wedged” PAC balloon by the appearance of “to-and-fro” movement of the echogenic air-filled PAC balloon in the MPA or RPA
	Imply a wedge position and/or “too distal” placement of the PAC balloon if (1) the body of the PAC is seen within the RVOT and (2) the PAC balloon is not seen in the MPA or RPA
	Optimise final PAC balloon position to distal MPA/proximal RPA
Post-insertion	Repetition of the above TTE signs to identify proximal or distal migration of the PAC from the initial insertion point
	When in doubt, confirmation of the PAC balloon inflation status by visualisation of the “to-and-fro” movement of the echogenic air-filled PAC balloon
	Quantify possible contribution of decline in RV/TV/PV function with presence of the PAC

TTE: Transthoracic echocardiogram; BMI: Body mass index; PAC: Pulmonary artery catheter; MPA: Main pulmonary artery; RPA: Right pulmonary artery; RV: Right ventricle; PA: Pulmonary artery; RVOT: Right ventricular outflow tract.