Management of an unusual complication during placement of a pulmonary artery catheter.

We describe an unusual complication during flotation of a pulmonary artery catheter through a preexisting percutaneous introducer sheath. A malfunctioning pulmonary artery catheter, which was placed through an introducer sheath in the right internal jugular vein, was removed. Attempts at repositioning a second pulmonary artery catheter met with resistance, and we were unable to either advance or withdraw it. Chest radiograph showed a bent introducer sheath going from the right internal jugular vein into the right subclavian vein and a pulmonary artery catheter loop. Under continuous fluoroscopy, the introducer sheath and the pulmonary artery catheter were withdrawn as one unit, which resulted in relaxation of the acute angulation in the introducer sheath and allowed the pulmonary artery catheter to unfold, thus facilitating their complete extraction. We conclude that complications may occur during placement of a pulmonary artery catheter through a well positioned introducer sheath and that fluoroscopy is a valuable tool for safe management of such a complication.