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Incidence of arrhythmia with central venous catheter insertion and exchange
R K Stuart1, S A Shikora, P Akerman
1New England Deaconess Hospital, Harvard Medical School, Boston, Massachusetts.
Insights
Cardiac arrhythmias, including atrial and ventricular ectopy, are common during central venous catheter insertion, particularly in shorter patients and with right subclavian placement. Guidewire over-insertion may cause this stimulation, suggesting protocol modifications are needed.
Area of Science:
- Cardiology
- Medical Devices
- Patient Safety
Background:
- Central venous catheter insertion is associated with mechanical complications.
- Cardiac arrhythmias are a known but unquantified risk during these procedures.
Purpose of the Study:
- To quantify the incidence of cardiac arrhythmias during central venous catheter insertion or exchange.
- To identify factors associated with the occurrence of arrhythmias.
Main Methods:
- Cardiac monitoring was performed during 51 central venous catheter insertions/exchanges.
- Patient characteristics and procedural details were recorded.
Main Results:
- Atrial arrhythmias occurred in 41% of procedures.
- Ventricular ectopy occurred in 25%, with 30% being couplets or greater.
- Ventricular ectopy was more frequent in shorter patients and with right subclavian insertion.
Conclusions:
- Guidewire over-insertion is implicated as the cause of cardiac stimulation.
- The incidence of ventricular ectopy suggests a risk of malignant arrhythmias.
- Modifications to current insertion protocols may be indicated.
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.