Arrhythmias in Children with Peripherally Inserted Central Catheters (PICCs).

Abstract

To analyze the prevalence, types, and risk factors for cardiac arrhythmias associated with peripherally inserted central catheters (PICCs) in children. This is a case-control single center retrospective study. From 3180 PICCs inserted in children (< 18years old) between 2009 and 2013, cases with new onset arrhythmias were identified. Demographics, type and timing of arrhythmias, and possible risk factors were analyzed. ECGs, rhythm strips, physicians' records, and anti-arrhythmic management were confirmatory. The level of the PICC's tip in the superior vena cava (SVC) or right atrium (RA) was ascertained from chest X-rays and counted in rib units (RU) and vertebra units (VU). Cases were matched (1:1 ratio) to controls by weight and date of insertion. Descriptive statistics were performed. A two-sided p value < 0.05 was considered significant. Thirty-one children (1%) developed arrhythmias, 16/31 (56%) were males, and 24/31 (77%) were < 1-year age. Arrhythmias were atrial 22 (71%), ventricular 4 (13%), and undetermined 5 (16%). Median PICC dwell time was 16days. 14/31 (45%) cases and 9/31 (29%) controls had underlying structural heart disease. PICCs central tip position was lower among cases than controls (RU 6 vs 5). Odds Ratio for developing arrhythmia was 4.5 (95% CI 0.98-20.83) if the tip lays below 6.25RU. Arrhythmias were resolved with anti-arrhythmic agents in 52% (16/31) and with PICC exchange/manipulation in 32% (10/31) cases. Two children died unrelated to arrhythmia. Prevalence of arrhythmias associated with PICCs in children is low (1%). Arrhythmias are 4.5 times more likely when PICC's central tip position is deeper than 6.25RU.