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. [1]

[2]

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. [3]
Special considerations:

-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

[4]

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Sources:

  1. Beyerbach DM, Rottman JN. “Pacemakers and Implantable Cardioverter-Defribillators.” Medscape. May 2014.
  2. Tennessee Valley Cardiology Center. http://www.tvccpc.com/
  3. Doehring MC. “An unexpected complication of central line placement.” Acad Emerg Med. 2001 Aug;8(8):854.
  4. 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/