The dark side of the swan

Excerpt

A 55-year-old man was admitted to the intensive care unit after cardiac transplantation surgery. Evolution of his condition allowed extubation and withdrawal of inotropes and vasoactives in the first hours of the postoperative period while maintaining a low dose of isoproterenol. The patient subsequently presented severe fluid refractory hypotension episodes that required norepinephrine perfusion, followed by a severe hypertension phase that forced cessation of the norepinephrine therapy. This clinical course, in addition to a dampened waveform in the Swan–Ganz catheter, led to the suspicion of catheter malfunction. We catheterized the right subclavian vein in an attempt to remove the Swan–Ganz catheter, but a stoppage in the last portion impeded this procedure. A second thorax X-ray showed a knot in the last portion of the pulmonary artery catheter that was pulling on the subclavian catheter. Following verification with two-dimensional echography that this stoppage was indeed a simple knot (see video in Electronic Supplementary Material) and after withdrawing the subclavian catheter without complications, we carefully removed the Swan–Ganz catheter (Fig. 1).

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