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Case Presentation
A 71-year-old woman with a past medical history of hypertension, morbid obesity (body mass index 41 kg/m2), diabetes mellitus, chronic obstructive pulmonary disease (COPD), stage 3 chronic kidney disease, advanced longstanding peripartum cardiomyopathy, and left ventricular ejection fraction 25% status post cardiac resynchronization therapy with defibrillator presented to the emergency department with worsening dyspnea on exertion and lower extremity swelling. She was started on intravenous (IV) furosemide infusion, and a repeat echocardiogram showed a left ventricular ejection fraction of less than 20% and a left ventricular outflow tract velocity time integral of 9 cm. She was started on IV milrinone 0.375 µg/kg/min infusion after frequent central venous oxygen saturation (ScvO2) via a central venous catheter (CVC). She was in stage D heart failure with multiple relative contraindications for a heart transplant and advanced heart failure therapies, including age (71 years of age), renal failure (creatinine 2.5 mg/dL), obesity, moderate COPD, high panel-reactive antibody, and frailty. After 6 days of hospitalization, she was found to be euvolemic on the examination. Her central venous pressure was 9 mmHg, ScvO2 was 68% with calculated Fick cardiac output of 5.2 L/min, and cardiac index was 2.6 L/min/m2. In this case, CVC helps assess central venous pressure and ScvO2 and estimate Fick cardiac output and cardiac index.
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KEY POINTS
Vascular catheters are essential tools in the management of critically ill cardiac patients, allowing clinicians to administer treatment, monitor vital signs, and obtain diagnostic information in real time.
Antibiotic-impregnated catheters have recently been introduced to prevent risk of catheter-associated bloodstream infection.
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In managing patients in the cardiac care unit, various devices are used to manage patients optimally. These devices serve various purposes, including interventional, diagnostic, and therapeutic. These devices are crucial in the management of critically sick patients and have evolved over the years to improve the prognosis and offer better management options to medical staff all over the world.
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This chapter provides an overview of various miscellaneous devices used in cardiac critical care, including lines and catheters. These devices monitor and support critically ill cardiac patients and provide them with the necessary care and treatment. This chapter will cover the importance of different types of lines and catheters, such as central lines, arterial lines, urinary catheters, vascular catheters, dialysis catheters, pleural drains, pericardial drains, and others commonly used in cardiac critical care (Table 11-1). This chapter will also cover some devices under development, providing an update on current research and prospects. Through this chapter, the readers will gain an understanding of the various lines and catheters used in cardiac critical care and the role they play in the management and treatment of critically ill cardiac patients.
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