CARDIAC-ARRHYTHMIAS DURING CENTRAL VENOUS CATHETER PROCEDURES IN ACUTE-RENAL-FAILURE - A PROSPECTIVE-STUDY

To define the frequency and risk factors of cardiac arrhythmias during central venous catheter procedures in acute renal failure, continuous electrocardiographic monitoring with permanent recording was performe d before and during 201 guidewire insertions in 171 patients requiring a central venous catheter for parenteral nutrition and/or dialysis ac cess (121 procedures in 107 patients with acute renal failure; 39 proc edures in 31 patients with normal renal function; 41 procedures in 33 patients with ESRD on chronic hemodialysis). No differences in cardiac arrhythmia frequencies were found during baseline recording. New arrh ythmias were documented in 85 cases (85/201; 42%) during the catheter procedure. Ventricular arrhythmia frequencies increased significantly in all groups, as compared with baseline values (P < 0.05 for the cont rol group, P < 0.01 for the chronic hemodialysis group, P < 0.001 for the acute renal failure group); the most noteworthy increase was obser ved in the acute renal failure group, Statistically significant differ ences among frequencies of total ventricular arrhythmias, advanced ven tricular arrhythmias, and ventricular tachycardia during central venou s catheter procedures were found between the acute renal failure group and both the normal renal function group (P < 0.05 to P < 0.001), and the chronic hemodialysis group (P < 0.05 to P < 0.01). All arrhythmia s resolved spontaneously soon after partial guidewire withdrawal; nine episodes were symptomatic (in one case, ventricular tachycardia, foll owed by 10 s asystolia); no death directly related to the catheter pro cedure was observed. BUN and serum creatinine levels, as well as guide wire length remaining inside the patient, were significantly higher (P < 0.01) in patients with cardiac arrhythmias during central venous ca theter procedures as compared with patients without arrhythmias; diffe rences in other variables known as possible risk factors for arrhythmi as (anatomical position, preexistent cardiac disease, utilization of p roarrhythmogenic drugs, hypoxemia, acid-base status, and serum electro lytes, etc.) were not significant. Our study suggests that (1) patient s with acute renal failure are at increased risk for cardiac arrhythmi as during central venous catheter procedures; (2) an important risk fa ctor is also represented by guidewire overinsertion, a technical error that should be avoided.