Induction of life-threatening supraventricular tachycardia during central venous catheter placement: an unusual complication.
Cardiac arrhythmias during central venous catheter (CVC) insertion are typically transient events with no hemodynamic repercussions. Pediatric reports on this condition are scarce and fail to describe potentially life-threatening complications.


METHODS
A 14-day-old boy was admitted to the pediatric intensive care unit presenting with septic shock. During CVC insertion, the patient developed supraventricular tachycardia (SVT), which was unresponsive to vagal maneuvers or adenosine. Chest roentgenogram control revealed the tip of the catheter positioned in the midportion of the superior vena cava. After 30 minutes, the patient had a heart rate of 215 beats/min (bpm) and signs of hemodynamic compromise. The SVT eventually reverted to a sinus rhythm with synchronized cardioversion. The patient was discharged in good health.


CONCLUSIONS
Awareness of this potential complication of CVC insertion warrants a high level of concern by pediatric surgeons performing these procedures. Patients with sepsis and/or cardiac dysfunction who present SVT during catheter insertion can represent a therapeutic challenge for surgeons.
da Silva
Paulo Sergio Lucas
PS
Pediatric Intensive Care Unit, Department of Pediatrics, Hospital do Servidor Público Municipal, São Paulo 01050-904, Brazil. psls.nat@terra.com.br
Waisberg
Jaques
J
D000367:Age Factors; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D004554:Electric Countershock; D004562:Electrocardiography / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D013902:Radiography, Thoracic / Q000706:statistics & numerical data; D012772:Shock, Septic / Q000601:surgery; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000209:etiology*; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging; D016748:Venous Cutdown / Q000379:methods