Two cases with endotracheal bleeding after Swan-Ganz catheter use

CASE 1:

This is the short description of the incident:

Patient for mitral replacement because of severe mitral regurgitation. Monitoring with Swan Ganz PA-catheter. At the end of cardiopulmonary bypass suddenly blood in the endotracheal tube. Because of normal hemodynamics no evidence for left heart failure. No major hemorrhage. Spontaneus resolving of bleeding. Chest X-ray after the procedure showed a patchy sign in the right middle segment of the lung. A post-operative angiogram confirmed the hypothesis of a lesion of the pulmonary artery tree. The SG-catheter had been unblocked situated in the wedge-position during bypass.  

Short description of the management of incident:

Since the bleeding stopped by itself, no further action was required. .

outcome : prolongation of the hospitalisation.

CASE 2:

This is the short description of the incident:

Patient with severe mitral regurgitation and aortic stenosis scheduled for valve replacement of both valves. Monitoring with SG pulmonary artery catheter. After cannulation of the right atrium for cardio-pulmonary bypass it was no longer possible to manipulate the SG-catheter, because the upper canula of the cpb-pump was so tight fitted in the right atrium. Consequently the catheter remained in this position for the whole bypass-period. After restitution of a spontaneous circulation suddenly blood in the endotracheal tube. The chest X-ray after the operation showed a small, light shadow at the tip of the catheter, suggesting a pseudo-aneurysm of the pulmonary artery.

This is the description of the management:

Since the bleeding stoped spontaneously, a pulmonary angiogram was performed 7 days later, showing no aneurysm.

The outcome of this incident was prolonged hospitalisation.

See the recommendations out of the literature.