Cardiac arrhythmias during central venous catheter procedures in acute renal failure: a prospective study

To define the frequency and risk factors of cardiac arrhythmias during central venous catheter procedures in acute renal failure, continuous electrocardiographic monitoring with permanent recording was performed before and during 201 guidewire insertions in 171 patients requiring a central venous catheter for parenteral nutrition and/or dialysis access (121 procedures in 107 patients with acute renal failure; 39 procedures in 31 patients with normal renal function; 41 procedures in 33 patients with ESRD on chronic hemodialysis). No differences in cardiac arrhythmia frequencies were found during baseline recording. New arrhythmias were documented in 85 cases (85/201; 42%) during the catheter procedure. Ventricular arrhythmia frequencies increased significantly in all groups, as compared with baseline values (P < 0.05 for the control group, P < 0.01 for the chronic hemodialysis group, P < 0.001 for the acute renal failure group); the most noteworthy increase was observed in the acute renal failure group. Statistically significant differences among frequencies of total ventricular arrhythmias, advanced ventricular arrhythmias, and ventricular tachycardia during central venous catheter procedures were found between the acute renal failure group and both the normal renal function group (P < 0.05 to P < 0.001), and the chronic hemodialysis group (P < 0.05 to P < 0.01). All arrhythmias resolved spontaneously soon after partial guidewire withdrawal; nine episodes were symptomatic (in one case, ventricular tachycardia, followed by 10 s asystolia); no death directly related to the catheter procedure was observed. BUN and serum creatinine levels, as well as guidewire length remaining inside the patient, were significantly higher (P < 0.01) in patients with cardiac arrhythmias during central venous catheter procedures as compared with patients without arrhythmias; differences in other variables known as possible risk factors for arrhythmias (anatomical position, preexistent cardiac disease, utilization of proarrhythmogenic drugs, hypoxemia, acid-base status, and serum electrolytes, etc.) were not significant. Our study suggests that (1) patients with acute renal failure are at increased risk for cardiac arrhythmias during central venous catheter procedures; (2) an important risk factor is also represented by guidewire overinsertion, a technical error that should be avoided.