Guidelines for the Use of Pulmonary Artery Catheters in Cardiac Surgery Patients
The routine use of PA catheters for patients undergoing cardiac surgery is NOT indicated
with the following exceptions. Please note that at least one 8.5 or 9.0 Fr introducer
catheter will be placed for ALL patients undergoing cardiac surgery procedures.
1.
Measurement of cardiac filling pressures in any instance where the CVP may
be a poor indication of LV filling pressure:
a. Valvular disease
i. Mitral stenosis
ii. Severe tricuspid insufficiency
iii. Severe mitral insufficiency
iv. Severe aortic stenosis/aortic insufficiency
b. Left ventricular ejection fraction < 40%
N.B.: PA catheters will not be placed in patients with valvular disease
who exhibit LV ejection fraction > 40% and normal PA pressures.
2.
Cardiac and lung transplant patients
3.
Patients with known pulmonary hypertension (PA systolic pressure > 50 mm
Hg)
4.
Patients with end-stage renal disease or severe chronic renal insufficiency
5.
Patients who develop significant hemodynamic instability intraoperatively
(e.g., patients who are difficult to wean from cardiopulmonary bypass)
6.
Patients who require a mechanical ventricular assist device (e.g., intra-aortic
balloon pump or VAD)
7.
Patients with a documented acute myocardial infarction within 7 days of
surgery
8.
Patients enrolled in clinical research trials that require PA catheters as part of
the research protocol
The criteria for off-pump CABG patients are the same as for on-pump CABG.
February 1, 2003