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.