Article

Incidence of arrhythmia with central venous catheter insertion and exchange.

New England Deaconess Hospital, Harvard Medical School, Boston, Massachusetts.
Journal of Parenteral and Enteral Nutrition (Impact Factor: 2.49). 01/1990; 14(2):152-5. DOI: 10.1177/0148607190014002152
Source: PubMed

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.

0 Bookmarks
 · 
243 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Catheterization of central veins is a routine technique which is widely used in emergency department and medical intensive care units. Seldinger's technique is widely used to place central venous and arterial catheters and is generally considered safe. The technique does have multiple potential risks. Guide wire-related complications are rare but potentially serious. We describe a case of a lost guide wire during central venous catheter (CVC) insertion followed by a review of the literature of this topic. Measures which can be taken to prevent such complications are explained in detail as well as recommended steps to remedy errors should they occur.
    Journal of surgical technique and case report. 07/2013; 5(2):78-81.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Transient bradycardia in the critical care setting is frequently caused by hypoxemia or oropharyngeal manipulation. Central lines have been associated with a variety of cardiac arrhythmias, but sinus arrest and asystole have not been previously reported. A 38-year-old woman with multisystem organ failure had several episodes of prolonged sinus arrest, slow junctional escape rhythm, and periods of asystole lasting over 6 seconds. The cause of the repetitive bradyarrhythmia was evaluated by clinical observation including the response to parasympatholytic agents, by detailed analysis of rhythm strips, and review of cardiac imaging studies. The episodes of bradycardia did not coincide with orotracheal manipulation, were not prevented by escalating doses of glycopyrrolate, and were not accompanied by AV conduction disturbance as is frequently seen during a transient increase in vagal tone. Review of the patient's chest X-ray and chest CT revealed that the tip of a peripherally inserted central catheter migrated to the vicinity of the sinoatrial node. Removal of the catheter resulted in prompt resolution of the episodes of sinus arrest. This case demonstrates that migration of a peripherally inserted central catheter to the sinoatrial node can provoke prolonged sinus bradycardia, sinus arrest and asystole.
    Annals of Noninvasive Electrocardiology 11/2013; · 1.08 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Safe and reliable venous access is mandatory in modern health care, but central venous catheters (CVCs) are associated with significant morbidity and mortality, This paper describes current Swedish guidelines for clinical management of CVCs The guidelines supply updated recommendations that may be useful in other countries as well. Literature retrieval in the Cochrane and Pubmed databases, of papers written in English or Swedish and pertaining to CVC management, was done by members of a task force of the Swedish Society of Anaesthesiology and Intensive Care Medicine. Consensus meetings were held throughout the review process to allow all parts of the guidelines to be embraced by all contributors. All of the content was carefully scored according to criteria by the Oxford Centre for Evidence-Based Medicine. We aimed at producing useful and reliable guidelines on bleeding diathesis, vascular approach, ultrasonic guidance, catheter tip positioning, prevention and management of associated trauma and infection, and specific training and follow-up. A structured patient history focused on bleeding should be taken prior to insertion of a CVCs. The right internal jugular vein should primarily be chosen for insertion of a wide-bore CVC. Catheter tip positioning in the right atrium or lower third of the superior caval vein should be verified for long-term use. Ultrasonic guidance should be used for catheterisation by the internal jugular or femoral veins and may also be used for insertion via the subclavian veins or the veins of the upper limb. The operator inserting a CVC should wear cap, mask, and sterile gown and gloves. For long-term intravenous access, tunnelled CVC or subcutaneous venous ports are preferred. Intravenous position of the catheter tip should be verified by clinical or radiological methods after insertion and before each use. Simulator-assisted training of CVC insertion should precede bedside training in patients. Units inserting and managing CVC should have quality assertion programmes for implementation and follow-up of routines, teaching, training and clinical outcome. Clinical guidelines on a wide range of relevant topics have been introduced, based on extensive literature retrieval, to facilitate effective and safe management of CVCs.
    Acta Anaesthesiologica Scandinavica 04/2014; · 2.36 Impact Factor