What are some special considerations when placing a central line in a patient with an AICD?
An AICD (automatic implantable cardioverter-defibrillator) is inserted into either subclavian vein, through the SVC and into the heart. While placing a central line catheter with Seldinger technique, the metal guidewire may contact the ICD leads and create sufficient “noisy artifact” to induce an inappropriate shock. 
One report details a 22-week pregnant physician who was passing the guidewire during a subclavian line placement when the AICD fired and she experienced a mild shock to the hands. 
-femoral approach is the safest
-contralateral subclavian or IJ vein can be [cautiously] used. Consider placement under fluoro
-consider deactivating the ICD during central line placement
- Beyerbach DM, Rottman JN. “Pacemakers and Implantable Cardioverter-Defribillators.” Medscape. May 2014.
- Tennessee Valley Cardiology Center. http://www.tvccpc.com/
- Doehring MC. “An unexpected complication of central line placement.” Acad Emerg Med. 2001 Aug;8(8):854.
- Sullivan, MS. “What to do when a pacemaker delivers repeated shocks.” ACEP News. Jun 2008. http://www.acep.org/Clinical—Practice-Management/What-to-Do-When-a-Pacemaker-Delivers-Repeated-Shocks/