Position dependent ventricular tachycardia in two children with peripherally inserted central catheters (PICCs)

Area of Science:

• Pediatric Cardiology
• Medical Device Complications
• Electrophysiology

Background:

• Peripherally inserted central catheters (PICCs) are widely used in pediatric patients for long-term venous access.
• Ventricular tachycardia (VT) is a rare but serious complication in pediatric patients, especially those with underlying cardiac conditions or undergoing invasive procedures.

Observation:

• Two pediatric cases presented with sustained ventricular tachycardia (VT) shortly after the insertion of peripherally inserted central catheters (PICCs).
• The VT episodes were temporally associated with specific patient positioning (left lateral decubitus) and arm flexion, involving the limb with the inserted PICC.
• The cardiac rhythm disturbances were consistently resolved upon withdrawal of the peripherally inserted central catheter.

Findings:

• The findings suggest a potential mechanical trigger for VT related to PICC manipulation in pediatric patients.
• The left lateral position and arm flexion may exacerbate mechanical irritation or displacement of the PICC, leading to arrhythmogenesis.
• Catheter tip position and movement appear to be critical factors in the development of VT in these cases.

Implications:

• Clinicians should maintain a high index of suspicion for cardiac complications, including VT, in pediatric patients with PICCs, particularly after manipulation or repositioning.
• Further investigation into the mechanical effects of PICC placement and movement on cardiac electrophysiology in children is warranted.
• This observation may inform best practices for PICC insertion, management, and monitoring in pediatric populations to mitigate the risk of potentially life-threatening arrhythmias.