INTRODUCTION: PAC’s provide invasive monitoring of many hemodynamic parameters. Here we report one of the rarer complications of PAC knotting and its method of removal.

CASE REPORT: A 60years old female patient suffering from a triple vessel coronary artery disease was posted for CABG. Preoperative ECHO showed RWMA and ejection fraction of approximately 35%. Intraoperativelymonitoring was done by arterial lines, pulmonary artery catheter and transesophageal echocardiography. Surgery was uneventful and patient was shifted to ITU. All invasive monitoring lines were kept in-situ on the day of surgery. After patient was hemodynamically stable, attempt was made to remove the pulmonary artery catheter but we failed. The CXR was done and knotting of catheter was present . Attempt was made to release the knot by inserting a guidewire but failed.Help was sought from an interventional cardiologist in cathlab . PAC was approached through the femoral vein and the catheter was cut just above the knot. The upper cut part was removed by simply pulling out through the IJV. The lower cut part was pulled and brought upto the femoral vein and with a small incision on the femoral vein the knotted part was removed and the vein was immediately repaired.

CONCLUSION: Pulmonary artery catheters provide essential hemodynamic measurements both in OT and ICU. The clinician should always keep in mind the associated complications and try to avoid them by utilizing the available information regarding the successful application