Thanks for your help/code suggestions!
PROCEDURES:
1. Right heart catheterization.
2. Pulmonary angiography.
3. EKOS catheter to the left pulmonary artery.
4. EKOS catheter to the right pulmonary artery.
APPROACH:
Right common femoral vein x2.
INDICATIONS:
Large bilateral pulmonary emboli.
The risks and benefits of right heart catheterization and EKOS catheter
placement were discussed with the patient. She is agreeable to the
procedure. Consent was obtained.
PROCEDURE IN DETAIL:
The patient was prepped and draped in the normal fashion. Ultrasound
was used to visualize the right common femoral vein. With ultrasound
guidance, the common femoral vein was accessed and a 6-French sheath
was introduced x2.
Right heart catheterization was performed using a 6-French balloon-tipped
PA catheter. The mean RA pressure 10 mmHg, RV 43/5 and PA pressure
44/14 mmHg. The mean pulmonary artery pressure is 26 mmHg. Pulmonary
angiogram showed the catheter in good placement.
The Swan-Ganz catheter was exchanged over a guidewire. An EKOS catheter
was placed in the right and left pulmonary artery. TPA infusion at
1 mg/hour was initiated while in
the cath lab. EKOS catheters were sutured in place. The patient was
transferred back to the intensive care unit in stable condition.