• W Everett Fox, Michael Marshall, Susan M Walters, Venkat R Mangunta, Michael Ragosta, Amanda M Kleiman, and John S McNeil.
• W. Everett Fox is an anesthesiology resident, Department of Anesthesiology, University of Virginia Health System (UVA Health), Charlottesville, Virginia.
• Crit Care Nurse. 2023 Aug 1; 43 (4): 9189-18.

BackgroundPulmonary artery catheters provide important information about cardiac function, mixed venous oxygenation, and right-sided pressures and potentially provide temporary pacing ability.ObjectiveTo provide bedside clinicians with guidance for techniques to insert right heart monitors and devices, describe risk factors for difficult insertion and contraindications to placement, and provide updates on new technologies that may be encountered in the intensive care unit.MethodsAn extensive literature review was performed. Experienced clinicians were asked to identify topics not addressed in the literature.ResultsAdvanced imaging techniques such as transesophageal echocardiography or fluoroscopy can supplement traditional pressure waveform-guided insertion when needed, and several other techniques can be used to facilitate passage into the pulmonary artery. Caution is warranted when attempting insertion in patients with right-sided masses or preexisting conduction abnormalities. New technologies include a pacing catheter that anchors to the right ventricle and a remote monitoring device that is implanted in the pulmonary artery.DiscussionBedside clinicians should be aware of risk factors such as atrial fibrillation with dilated atria, decreased ventricular function, pulmonary hypertension, and right-sided structural abnormalities that can make pulmonary artery catheter insertion challenging. Clinicians should be familiar with advanced techniques and imaging options to facilitate placement.ConclusionThe overall risk of serious complications with right heart catheter placement and manipulation is low and often outweighed by its benefits, specifically pressure monitoring and pacing.©2023 American Association of Critical-Care Nurses.

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