Systemic coagulation changes caused by pulmonary artery catheters: Laboratory findings and clinical correlation

David R. King, Stephen M. Cohn, Ara J. Feinstein, Kenneth G. Proctor, Michael Shapiro, Martin A. Schreiber, Jeffrey H. Levine, Faran Bokhari, Kimberly Nagy

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Background: A higher rate of pulmonary embolism has been associated with pulmonary artery (PA) catheters; however, no mechanism has been described. Conventional tests of coagulation reveal no changes related to PA catheterization. The purpose of this study was to determine whether PA catheterization resulted in a hypercoagulable state detectable by thrombelastography (TEG). Methods: Animal: Healthy, anesthetized, swine (n = 19) underwent PA catheterization. Samples were drawn from TF femoral arterial catheters before and two hours after PA catheterization, at 5 mL/ min, and analyzed (native whole blood, n = 15, kaolin activated blood, n = 4) by TEG (Hemoscope, Niles, IL) at precisely two minutes. Human: An IRB-approved prospective, observational trial was conducted in critically ill patients (n = 19). Samples were drawn from 22-gauge radial artery catheters, before and three hours after PA catheterization. Kaolin-activated TEG samples were analyzed at precisely five minutes. Data are mean ± SE; Groups were compared with analysis of variance and significance was assessed at the 95% confidence interval. Results: In both animals and patients, PA catheterization truncated R times (time to initial fibrin formation). In swine, the R times were 17.6 ± 1.3 minutes (native) and 3.8 ± 04 (kaolin) before PA catheterization, and decreased to 6.3 ± 1.0 minutes (p = 0.002) and 1.9 ± 0.5 minutes (p = 0.010) afterward. There were no changes in pH or temperature during the experiment. In patients, 4 of 19 were excluded for protocol violations. The R time was 6.3 ± 1.0 minutes (kaolin) before and 3.0 ± 0.3 minutes after catheterization (p = 0.003). No changes were observed in conventional coagulation parameters, temperature or pH. Conclusion: In healthy swine, and critically ill patients, PA catheters may enhance thrombin formation and fibrin polymerization, indicating a systemic hypercoagulable state. This may explain why PA catheters are associated with an increased risk of pulmonary emboli.

Original languageEnglish (US)
Pages (from-to)853-859
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Issue number4
StatePublished - Oct 2005
Externally publishedYes


  • Coagulation
  • Pulmonary Artery Catheter
  • Pulmonary Embolism
  • Swine
  • Thromboelastography

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine


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