Guidewire-induced asystole complicating a right internal jugular catheter placement in a patient with pre-existing left bundle branch block: A case report

Abstract

Internal jugular venous catheters are widely used for hemodialysis as permanent vascular access in patients with severe peripheral vascular disease or transiently for acute hemodialysis. The Seldinger technique is the most widely used technique in catheter insertion. The guidewire-related complications are rare but sometimes it has significant morbidity and mortality. In this case report, we have a patient who developed asystole during catheter insertion which required transvenous pacemaker insertion.

Common errors in temporary hemodialysis catheter insertion

“…These include guidewire embolization, central vein perforation and, more commonly, guidewire‐induced arrhythmias (GIA). Arrhythmias vary from supraventricular tachycardia to ventricular tachycardia and even asystole . The main risk factor for GIA is the length that the guidewire is inserted, although catheter insertion in the context of AKI is itself associated with increased risk of GIA (relative to the risk of GIA in end‐stage kidney disease patients)…”

Arrhythmia during central catheter placement: Avoiding complications and increasing optimal tip placement

“…Although early or late severe complications are very rare, they may cause hemodynamic disturbances, lifethreatening events (myocardial perforation), and fatal outcomes. 4,5 IC-ECG reduces the risk of arrhythmias during the procedure and ensures a correct tip position. 1,6 Traditional CICC placement techniques instruct the operator to limit wire advancement to 15 cm, however TTE view should be strongly considered to support length of insertion along with direct visualization of wire advancement from the superior vena cava (SVC) to the right atrium (RA) (Figure 1(b)).…”

“…Although early or late severe complications are very rare, they may cause hemodynamic disturbances, life-threatening events (myocardial perforation), and fatal outcomes. 4,5…”