(A) Straight body pigtail catheter and tip deflecting wire. (1) The pigtail catheter is
placed in the right atrium. (2) The wire is deflected to point toward the right ventricle.
(3) The wire is fixed, and the catheter is advanced over it into the right ventricle. (4) The
tip deflection is released. (5) Counterclockwise rotation of the catheter swings the
pigtail anteriorly. Simultaneous advancement of the catheter places it into the main
pulmonary artery. Advancing the catheter further usually takes it into the left main
pulmonary artery. The tip deflecting wire is utilized to direct the catheter downward and
to the right for right main pulmonary artery catheterization.
(B) Angled pigtail catheter. (1) The pigtail catheter is place in the right atrium.
(2) Advancing the catheter places the tip in the right ventricle. (3) Clockwise rotation,
with simultaneous advancement places the tip in the main pulmonary artery.
(C) Balloon catheter. The balloon is inflated under fluoroscopic guidance in the
common iliac vein. It is advanced under observation through the right heart and into the
main pulmonary artery. Selection of right and left pulmonary arteries is assisted with
conventional or tip-deflecting wires. If a pigtail catheter is needed after use of a balloon
catheter, 260 cm Rosen wire is used for the exchange.
Figure 3-5. Techniques for pulmonary artery catheterization.