**4. Practical tips to minimize the arrhythmic complications**


which leads to more advancement of PICC line. This can be avoided by using rope method of measurements (can use a nasogastric tube or any flexible tubes) along the course of veins applicable to lower and upper extremity veins.

be due to the migration of catheter until proved otherwise. So check for migration, verify the external length and immediately withdraw the catheter. Confirm the position with an X-ray, check for kinking, curving and looping which is potentially dangerous as it can

Central Venous Catheter-Induced Cardiac Arrhythmias in Neonates

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**12.** Vigilantly look for catheter migration whenever the critical neonates are on high-frequency

**13.** Take precautions while handling for ultrasonography, daily weight check, the neonatal transfer for any cause, pre and post-operative periods and any invasive procedures which

**14.** Ultrasound-guided insertion of central lines (PICC or UVC) is more reliable, safe and

**15.** While inserting the PICC line turn the head of the neonate toward the ipsilateral side of

Central line insertion is a very common bedside procedure in NICU setup, it is not uncommon to encounter complications. Although there are various complications related to PICC line insertion, arrhythmic complications are preventable by exact measurements along the venous course, avoidance of willful over advancement of the catheter, prevention of migration and early detection of migration and adjusting the catheter tip properly. Ultrasoundguided insertion of catheter and placement of catheter tip using real-time ultrasonography is a welcoming advancement to minimize arrhythmic complications. Worldwide, the reported

insertion as it prevents the entry of PICC line into the jugular veins.

incidence of arrhythmic complications published in the literatures are few.

induce pericardial tamponade.

need more manipulation of neonates.

effective when compared with the blind procedure.

ventilation.

**5. Conclusion**

**Abbreviations**

CVC central venous catheter

UVC umbilical venous catheter

SVT supraventricular tachycardia NICU neonatal intensive care unit

AF atrial flutter

IVC inferior vena cava SVC superior vena cava

PICC peripherally inserted central catheter


The interaction between the neonatal posture, and radiological catheter position is well explained in advances in neonatal care.



**Table 5.** Ideal positions for X-rays pertaining to different sites of PICC line [10].

be due to the migration of catheter until proved otherwise. So check for migration, verify the external length and immediately withdraw the catheter. Confirm the position with an X-ray, check for kinking, curving and looping which is potentially dangerous as it can induce pericardial tamponade.

