A percutaneous technique for catheterization of the pulmonary artery without fluoroscopy.

The measurement of pressures in the chambers of the right side of the heart or pulmonary artery and withdrawal of blood samples for gas analysis pro-vide invaluable information for the study of patients with cardiac or pulmonary disease. If these patients are severely ill, it may be a risky procedure to move them to the catheterization laboratory, and a technique which allows these measurements to be made at the bedside, has been developed, and is described. TECHNIQUE A femoral or cubital vein is entered percutaneously with a Coumand needle (No. 160) and a catheter is inserted by the Seldinger technique (1953). Following insertion of the needle, a nylon cord (diameter 0 7 mm.) is passed into the vein. The needle is thereupon with-drawn and two teflon catheters are successively passed over the nylon cord guide, after enlarging the skin puncture with a small knife blade (Fig. 1). The vein may thus be entered with a catheter of larger diameter than the needle. The nylon cord and the inner teflon catheter are withdrawn after advancing the larger teflon catheter approximately 20 cm. into the vein. A polyethylene catheter (PE 50, outer diameter 1 0 mm. or PE 60 outer diameter 1-2 mm.) is then passed through the teflon catheter. The polyethylene catheter is connected to a pressure transducer and is advanced, the position of its tip being confirmed by observation of the pressure pulse on an oscilloscope or recorder. A special adaptor (Fig. 2) is used to flush the teflon catheter to keep its lumen free of blood. An outer catheter of teflon is preferred, because it is easy to pass through the tissues and can be sterilized, for use again, by boiling. The tips of the catheters must be adapted carefully, so that there are no sharp edges which might prevent the catheters passing easily through the skin, subcutaneous tissues, and vessel wall. This ma

Arm Blood Flow and Oxygenation on the Transition from Arm to Combined Arm and Leg Exercise in Humans

The cardiovascular response to exercise with several groups of skeletal muscle implies that work with the legs may reduce arm blood flow. This study followed arm blood flow (Q̇arm) and oxygenation on the transition from arm cranking (A) to combined arm and leg exercise (A+L). Seven healthy male subjects performed A at ∼80 % of maximum work rate (Wmax) and A at ∼80 % Wmax combined with L at ∼60 % Wmax. A transition trial to volitional exhaustion was performed where L was added after 2 min of A. The Q̇arm was determined by constant infusion thermodilution in the axillary vein and changes in biceps muscle oxygenation were measured with near-infrared spectroscopy. During A+L Q̇arm was lowered by 0.38 ± 0.06 l min−1 (10.4 ± 3.3 %, P < 0.05) from 2.96 ± 1.54 l min−1 during A. Total (HbT) and oxygenated haemoglobin (HbO2) concentrations were also lower. During the transition from A to A+L Q̇arm decreased by 0.22 ± 0.03 l min−1 (7.9 ± 1.8 %, P < 0.05) within 9.6 ± 0.2 s, while HbT and HbO2 decreased similarly within 30 ± 2 s. At the same time mean arterial pressure and arm vascular conductance also decreased. The data demonstrate reduction in blood flow to active skeletal muscle during maximal whole body exercise to a degree that arm oxygen uptake and muscle tissue oxygenation are compromised