Arrhythmia induced by right internal jugular vein catheterization: a case report

BACKGROUND: Central venous catheterization is crucial for managing critically ill patients, with common sites being the internal jugular, subclavian, and femoral veins. The right internal jugular vein is often preferred due to its direct route to the superior vena cava.Transient arrhythmias often occur during central venous catheterization, and most can be resolved by adjusting the guidewire. However, arrhythmias rarely occur frequently after the procedure is completed. This paper reports a clinical case of frequent arrhythmias following central venous catheterization, a rare complication. It aims to provide clinicians with a more comprehensive understanding of the complications associated with central venous catheterization. CASE PRESENTATION: A 60-year-old previously healthy male was admitted to the ICU with worsening toothache, fever, and jaundice. He had a history of herbal medicine use and self-medicated with indomethacin. Symptoms included jaundice, lower back pain, and reduced urine output. Initial bloodwork indicated liver and renal issues. On November 19, 2023, he underwent ultrasound-guided placement of a dual-lumen hemodialysis catheter in the right internal jugular vein, and its position was confirmed by X-ray. Post-procedure, he developed frequent premature ventricular contractions and persistent arrhythmias despite antiarrhythmic treatments. On November 28, the catheter was removed, leading to a significant reduction in arrhythmias and overall improvement. He then transitioned to intermittent hemodialysis and was moved to a general nephrology ward. CONCLUSION: This case suggests that arrhythmias following central venous catheter placement may result not only from guidewire insertion but also from catheter depth. Clinicians should consider catheter-related factors in managing arrhythmias post-catheterization.