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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
PubMed

Insights

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.

Keywords:
ChildrenNeonatesPeripherally inserted central cathetersTachycardia

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