Incidence of arrhythmia with central venous catheter insertion and exchange
Harvard University, Cambridge, Massachusetts, United StatesJournal of Parenteral and Enteral Nutrition (Impact Factor: 3.15). 03/1990; 14(2):152-5. DOI: 10.1177/0148607190014002152
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.
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- "Cardiac dysrhythmias most often premature atrial or ventricular contractions are occasionally reported during subclavian or IJ CVC insertion. The arrhythmias are typically short lived, resulting from the guide wire touching the endocardium, and resolve when the tip is pulled backa few centimeters. "
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.
Article: 28 VASCULAR AND PERITONEAL ACCESS[Show abstract] [Hide abstract]
ABSTRACT: Arteriovenous Access The prevalence of end-stage renal disease (ESRD) in the United States has increased steadily since 1980, rising from 271 to nearly 1,400/million. It is estimated that by 2030, there may be 2.24 million patients with ESRD. Almost 60% of these patients are expected to be diabetic, half to be 65 or older, and half to be nonwhite. 1 Extracorporeal dialysis of blood was introduced in 1943 by Kolff and associates 2 ; however, application of this approach was hindered by the requirement for repeated and routine access to the circulation. The full potential of hemo-dialysis for patient salvage was realized only after the intro-duction of the external arteriovenous (AV) shunt by Quinton and colleagues in 1960 3 and of the autogenous AV access by Brescia and coworkers in 1966. 4 The subsequent intro-duction of synthetic vascular prostheses has permitted con-tinued access in patients who have exhausted peripheral venous sites. 5 The optimal vascular access route permits a fl ow rate that is adequate for the dialysis prescription (³ 300 ml/min), can be used for extended periods, and has a low complication rate. Compared with other access types, an autogenous AV access has the best long-term patency, gives rise to the fewest complications, and requires the fewest interventions once fully mature. 6 In 1997, the National Kidney Foundation Dialysis Outcome and Quality Initiative (NKF-DOQI) 7 organized multidisciplinary work groups that evaluated all available data and concluded that quality of life and overall outcome could be improved signifi cantly for hemodialysis patients if two primary goals were achieved: 1. Insertion of an autogenous AV access in at least 50% of long-term access patients. 2. Detection of dysfunctional access before thrombosis of the access route occurs. This report, which contains evidence-based clinical practice guidelines, was last updated in 2000. 8 Similar guidelines have also been published in Canada. 9 preoperative evaluation At least 4 to 6 weeks—preferably 3 to 4 months—is required for an autogenous AV access to heal and mature before it can be used. Therefore, access planning should be done early in the course of progressive renal failure. Patients should be referred for surgical treatment when creatinine clearance approaches 15 to 20 ml/min, the serum creatinine level reaches 300 to 500 µmol/L, or dialysis is likely to be necessary within 1 year. Every effort should be made not to puncture forearm veins, particularly the cephalic veins of the nondominant arm; the dorsal hand veins may be used for venipuncture. Subclavian vein catheterization should also be avoided because of the risk of central vein stenosis, which may preclude the use of any part of the ipsilateral arm for vascular access.
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