Comparison among pulmonary artery (PA) catheter insertion sites

Insertion site	Distance (cm) to:			Advantages	Disadvantages
	RA	RV	PA
Internal jugular (IJ)	15 to 20	30	40	Easy to float, esp from right	Puncture of carotid relatively common
				Easy to cannulate	Risk of pneumothorax
				Easy to see and compress on ultrasound	Higher likelihood of contamination with respiratory secretions
Subclavian	15 to 20	30	40	Easy to float, esp from left	Higher risk of pneumothorax than with IJ approach
				Easy to cannulate
Femoral	45	55	65	Easy to cannulate	More difficult to float catheter (may require fluoroscopy) Higher risk of infection Higher risk of DVT
				Fewer major complications
Brachial
Right	40	50	60	Few major complications	More time-consuming
Left	50	60	70	Safer if bleeding diathesis or coagulopathy	Difficult to float catheter
				May be easiest in morbidly obese patients	Lower rate of successful cannulation
					Limited to 72 hour duration due to phlebitis and infection risk

RA: right atrium; RV: right ventricle; PA: pulmonary artery; DVT: deep vein thrombosis.

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