Incidence of arrhythmia with central venous catheter insertion and exchange

Abstract

The risk of complication during the insertion or exchange of central venous catheters has been well documented. The majority of complications involve mechanical problems associated with insertion. Although cardiac arrhythmia has been acknowledged as a possible complication, its incidence has never been quantified. We performed cardiac monitoring on patients during 51 central venous catheter insertions or exchanges to determine the incidence of cardiac arrhythmias during guidewire insertion. Forty-one percent of procedures resulted in atrial arrhythmias and 25% produced some degree of ventricular ectopy, 30% of these were ventricular couplets or greater. Ventricular ectopy was significantly more common in shorter patients (160 +/- 8 vs 168 +/- 11 cm, p less than 0.05) and when the catheter was inserted from the right subclavian position (43% ventricular ectopy vs 10% at the other sites). Other variables such as age, cardiac history, serum potassium, type of procedure, and catheter brand were not significant. It is our conclusion that over-insertion of the wire causes this cardiac stimulation. Despite the absence of morbidity or mortality in this study, this incidence of ventricular ectopy indicates that there is a distinct possibility of a malignant arrhythmia being precipitated by a guidewire. Some modification of the current protocol for these procedures seems indicated.

Acute Complications of Hemodialysis

“…Ventricular ectopia was seen in 43% of the cases when catheters were being placed in the right subclavian vein while it was seen in 10% of the cases when catheters were being placed in other areas. The patient's age and cardiac disease history, the procedure type or the levels of potassium did not affect the development of arrhythmia, but it was demonstrated that over-insertion of the guide wire triggered arrhythmia depending on the body structure of the patient (Stuart et al,1990). The most important factor in preventing development of arrhythmia is to avoid overinsertion during catheter placing (Fiaccadori et al,1996).…”

Cardiac Arrest Ritm Occurance During Guide-wire Insertion: Torsades de Pointes

“…(9) Santral venöz kateterizasyon sırasında gelişen atriyal aritmiler % 41 sıklıkta gö-rülürken, ventriküler kaynaklı aritmiler % 25 sıklıkta izlenmektedir. (10) Bu aritmilerin bir kısmı kendiliğinden düzelirken bir kıs-mı hastanın kullandığı medikasyonlara, elektrolit bozukluklarına ve bradikardi, konjestif kalp yetmezliği ya da miyokard enfarktüsü gibi altta yatan kardiyak nedenlere bağlı olarak gelişmekte olup, mü-dahale gerektirmektedir. (5,6) Kılavuz telin ilerletilmesi sonrasında "torsade de pointes" gelişen olgumuzda ise altta yatan herhangi bir kardiyak patoloji olmaması-na rağmen, bir arrest ritmi gelişmiş ve resüsitasyon endikasyonu oluşmuştur.…”

Induction of life-threatening supraventricular tachycardia during central venous catheter placement: an unusual complication

“…In adults, the reported incidence of arrhythmias ranges from 23% to 25% for ventricular arrhythmias and 6% to 40% for atrial arrhythmias [8,9]. In children, the overall incidence of arrhythmias is 30%, whereas the rate of atrial arrhythmias is only 3% [6].…”