A Tale of Two Pulmonary Artery Catheters.
Jeremy C Durack, Leon L Chen, Saira Imran and 1 others
PMID 34818292WHAT IT FOUND
A single man with bilateral pulmonary emboli had two pulmonary artery alteplase infusion catheters, intravenous heparin and planned inferior vena cava filter placement.
After 24 hours, heart rate normalized and right ventricular size decreased; catheters were removed, and he was discharged two days later.
Key findings
01The management plan included catheter-directed thrombolysis and inferior vena cava filter placement, and the patient received alteplase at 0.5mg/hour through each of two pulmonary artery infusion catheters plus intravenous heparin at 500 units/hour.
02The patient was transferred to the ICU for monitoring of catheter insertion sites, coagulation and hematologic laboratory parameters, signs of systemic bleeding, and respiratory and neurological changes.
0324 hours after insertion, the heart rate was normalized and echocardiography showed decreased right ventricular size and mildly improved function, so the catheters were removed; he was discharged two days later.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a single case report with no comparison group, so it cannot show that the treatment worked. The patient had ulcerative colitis, metastatic rectal cancer, bilateral deep vein thrombosis and was on long-term rivaroxaban, so his course may not apply to other patients. The supplied text says the decision was made to place an inferior vena cava filter, but it does not state whether the filter was placed. The report gives no formal outcome measures, follow-up beyond discharge, or comparison of the catheter types. The catheter-type differences are described in the discussion, not tested in the patient.
Declared interests
No funding or conflict-of-interest declaration is provided in the supplied text.
The easy way to misread this
Do not conclude that catheter-directed thrombolysis or these catheters improve outcomes in pulmonary embolism. This is one case report, and the patient also received intravenous heparin and the management plan included inferior vena cava filter placement, so the contribution of any single component cannot be separated.