The patient's position influences the incidence of dysrhythmias during pulmonary artery catheterization

Abstract

To determine the influence of a patient's position on the incidence of dysrhythmias during pulmonary artery catheterization, 34 adult patients scheduled for elective coronary artery bypass graft surgery and pulmonary artery catheterization were studied. All introducers were inserted via the right internal jugular vein using the Seldinger technique with the patient in the Trendelenburg position. For each patient, the pulmonary artery catheter was advanced twice: once while the patient was in the Trendelenburg (T) position with a 5-10° head-down tilt and antoher with a 5° head-up and right lateral tilt (R) position. In 13 of the 68 pulmonary artery catheter passages, no dysrhythmias were noted. In 13 patients, a change in dysrhythmia classification was noted between the two positions. In 11 of the 13 patients, the dysrhythmia classification changed from malignant in the Trendelenburg position to benign or absent in the right lateral tilt position. Although the incidence of dysrhythmias was similar in both groups, the Trendelenburg position was associated with a significantly higher incidence of malignant dysrhythmias than the right tilt position (P < 0.05). The authors conclude that the head-up and right lateral tilt position appears superior to the Trendelenburg position for passage of the pulmonary artery catheter in the awake patient scheduled for elective coronary bypass surgery.