INTRODUCTION
Complications related to peripherally inserted central venous catheters
(PICCs), such as arterial puncture, pneumothorax, hemothorax, and
infections, are reported to occur less frequently than with other
central venous catheters,1, 2 and PICC use has
increased in many clinical settings including the perioperative period.
Consequently, more patients have been undergoing surgery under general
anesthesia with PICCs inserted before operation. PICC usage has become
more widespread also due to newly introduced and more convenient
insertion techniques, such as those adopting passive magnet tracking and
electrocardiogram (ECG)-guided tip confirmation system
(TCS),3 that facilitates catheter placements at the
bedside without confirmatory fluoroscopy and/or chest X-ray radiography
and insertions performed by trained nurse practitioners. It has been
well known that guidewires used during PICC placement may cause
disturbances of cardiac rhythm when progressed too far into the right
atrium (RA).4 There are limited case reports on
positional change-related arrhythmias due to too far insertion of PICCs
in awake patients5, 6; however, arrythmias that
occurred during general anesthesia and were induced by a catheter
inserted with the TCS-guided technique have not been reported.
We present a case of nonsustained ventricular tachycardia (VT) that
developed upon change in patient’s position under general anesthesia.
Discussion on factors related to positional change-related arrhythmias
in patients with preoperatively inserted PICCs using TCS is carried out
and possible solutions are suggested.
A written consent was obtained from the patient for publication of this
case report and the accompanying images in compliance with the hospital
institutional review board regulations.