Reducing arrhythmias associated with central venous catheter insertion or exchange.
A recent study demonstrated that the incidence of new arrhythmias occurring during central venous catheter insertion or exchange was 41% atrial and 25% ventricular arrhythmias (12% couplets or greater). Over-insertion of the guidewire, causing direct stimulation to the right side of the heart, has been postulated to be the causative factor. A new technique that allows the operator to control the length of guidewire inserted was developed. With this technique on a population of hospitalized patients, similar to those in the previous study, the incidence of atrial arrhythmias decreased to 32% and the incidence of ventricular arrhythmias to 6% (single premature ventricular contractions only). Although this new technique has limitations, there was a dramatic improvement in the incidence of cardiac arrhythmias. These results indicate a need for modifications in the available equipment to avoid the infrequent but life-threatening complication of malignant arrhythmia.
Stuart
R K
RK
New England Deaconess Hospital, Harvard Medical School, Boston, Massachusetts.
Baxter
J K
JK
Shikora
S A
SA
Akerman
P
P
Apovian
C
C
Champagne
C
C
Jennings
A
A
Bistrian
B R
BR
D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000517:prevention & control*; D001827:Body Height; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D006801:Humans; D010289:Parenteral Nutrition, Total