The challenge of treating older, obese patients with various comorbidities has become a mainstay of anesthetic practice. In order to monitor and provide anesthesia safely, the nurse anesthetist must weigh the risks and benefits of all types of monitoring when these patients undergo major invasive procedures. One such option is the Swan-Ganz pulmonary artery catheter. During the last decade an estimated 2 million pulmonary artery (Swan-Ganz) catheters were sold annually in the United States. Although the pulmonary artery catheter is a useful and popular monitoring tool, the potential for complications does exist, with some estimates suggesting a mortality rate of 0.02% to 1.5%. These figures, along with other complications, warrant consideration when evaluating the risks and benefits of this method of monitoring. The following case report describes one potential complication, a knot, and its management by the anesthesia care team in coordination with interventional radiology.