Pulmonary artery catheter knot in a liver transplantation, a rare complication

The pulmonary artery catheter (PAC) measures hemodynamic parameters in real time, providing valuable data for the management of the critical patient. Nevertheless, its use is associated with several complications. Knot formation is a rare complication related to PAC insertion. A 51-year-old patient with complicated ethanolic liver cirrhosis underwent orthotopic liver transplantation. Invasive hemodynamic monitoring was performed using a Swan–Ganz pulmonary artery catheter (PAC) inserted through the right internal jugular vein. Chest X-ray in the immediate postoperative period showed the presence of a possible knot adjacent to the tip of the sheath in the internal jugular vein. The patient was then referred to the hemodynamics room, where, through fluoroscopy, a true knot was successfully removed after femoral vein dissection. The medical team should weigh the risk and benefit of using the PAC, taking into account the patient's clinical conditions, the benefits, and possible complications of the procedure.