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Arrhythmias in Children with Peripherally Inserted Central Catheters (PICCs)
Santokh S Dhillon1, Bairbre Connolly2, Omid Shearkhani2
1Division of Cardiology, Department of Pediatrics, IWK Health Centre/Dalhousie University, Halifax, NS, B3K 6R8, Canada. santokh.dhillon@iwk.nshealth.ca.
Pediatric Cardiology
|December 20, 2019
Summary
Cardiac arrhythmias are uncommon in children with peripherally inserted central catheters (PICCs), occurring in 1% of cases. Deeper PICC tip placement in the superior vena cava or right atrium increases arrhythmia risk.
Area of Science:
- Pediatric Cardiology
- Vascular Access Devices
- Cardiac Electrophysiology
Background:
- Peripherally inserted central catheters (PICCs) are widely used in pediatric patients.
- Cardiac arrhythmias are a potential complication of central venous catheterization.
- Understanding risk factors for PICC-associated arrhythmias in children is crucial for patient safety.
Purpose of the Study:
- To determine the prevalence, types, and risk factors of cardiac arrhythmias in children with PICCs.
- To investigate the association between PICC tip position and the occurrence of arrhythmias.
- To evaluate the management and outcomes of these arrhythmias.
Main Methods:
- A retrospective, case-control study of 3180 pediatric patients (<18 years) with PICCs from 2009-2013.
- New-onset arrhythmias were identified and confirmed via ECGs and physician records.
- PICC tip position was measured in rib units (RU) and vertebra units (VU) from chest X-rays; cases were matched 1:1 to controls.
Main Results:
- Thirty-one children (1%) developed arrhythmias, predominantly atrial (71%).
- Arrhythmias were more frequent when the PICC tip was positioned deeper than 6.25 RU (Odds Ratio 4.5).
- Underlying structural heart disease was present in 45% of cases versus 29% of controls.
Conclusions:
- The prevalence of PICC-associated arrhythmias in children is low.
- Deeper PICC tip placement is a significant risk factor for developing arrhythmias.
- Arrhythmias were manageable with medical therapy or PICC repositioning.
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