What should be considered when placing a central venous catheter in a patient with an implantable cardioverter-defibrillator (ICD)?

Updated: Feb 13, 2017
  • Author: Daniel M Beyerbach, MD, PhD; Chief Editor: Jeffrey N Rottman, MD  more...
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Answer

Answer

Pacemaker or implantable cardioverter-defibrillator (ICD) leads placed in the venous system often have surrounding thrombosis, with 20% of patients having complete occlusion at 2 years. [66] If a metal guidewire contacts the lead system during central line placement, there may be enough noisy artifact to trigger an inappropriate shock.

Consideration should be given to either avoid a metal guidewire or deactivate the ICD during central line placement. Although the contralateral subclavian or internal jugular vein can be cannulated with care, femoral vein access is a much safer option.


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