Removal of a pulmonary artery catheter in the presence of implanted leads.

Kathleen Epping is a nurse practitioner on the cardiothoracic surgery service at Zablocki VA Medical Center, Milwaukee, Wisconsin. Beth Hammer is the program manager for nursing excellence at Zablocki VA Medical Center. She is also a nurse practitioner on the cardiology/electrophysiology service. and defibrillation leads are typically implanted transvenously, using the subclavian or cephalic veins as a portal to the right side of the heart. Leads placed in the right atrium and right ventricle have screws at the distal end to secure them into the endocardium (see Figure). Left ventricular pacing leads are actually located in a coronary vein, thus they are not screwed in and may dislodge more readily than screw-in leads would dislodge. Practice guidelines for pulmonary artery catheters describe potential complications during their removal: ventricular dysrhythmias, knotting or snaring of the catheter, and valvular damage. Studies designed to evaluate complications during removal of pulmonary artery catheters indicate that ventricular dysrhythmias are the most frequent complication. Cardiac dysrhythmias occurring while a pulmonary artery catheter is being removed are presumed to be caused by the mechanical irritation of the endocardium as it passes through the right ventricle. Rountree evaluated the safety and complications of 215 pulmonary artery catheter removals by nurses and reported that the most frequent complication was the occurrence of ventricular dysrhythmias, with an overall complication rate of 5%. Of AKathleen Epping, RN, MSN, ACNP-BC, and Beth Hammer, RN, MSN, ANP-BC, reply: