A postplacement chest radiograph should always be obtained after placement of a pulmonary artery catheter (PAC) (Fig. 66.1). The postplacement radiograph serves several purposes. It checks for complications of introducer catheter placement such as pneumothorax or hemothorax. It confirms that the PAC has not been advanced too far into the periphery of the pulmonary arterial system and it also rules out kinking or coiling of the PAC.

The risk of kinking the PAC can be lessened by halting advancement of the catheter if any resistance is felt upon insertion. It should be noted that appropriate waveform changes, such as from right atrial to right ventricular or from right ventricular to pulmonary artery, should occur every 15 cm as the PAC is advanced (see Figure 65.1). If these changes are not readily observed, the PAC should be withdrawn. Minimizing insertion time and using a slow but steady insertion rate can take advantage of flow-directed positioning of the PAC (i.e., a “float” as opposed to a “push”) and reduce the likelihood of the catheter kinking or coiling.