Pulseless Electrical Activity Following Subclavian Central Line Removal in a Patient with Cervical Spine Injury

Abstract

Protocolised removal of central venous catheter is of paramount importance, as the procedure is implicated with numerous complications which are witnessed as well as reported in literature. Unprecedented events like bradycardia, arrhythmias, cardiac arrest as a result of air embolism, carotid sinus hypersensitivity, embolisation from the vascular end of the catheter, dislodgment of an atherosclerotic plaque or thrombus in the carotid artery precipitated during central line removal have been highlighted. Following is a brief account of cardiac arrest following Subclavian central line removal in a patient with cervical spine injury. In addition to above factors is pertinent to note that patients with High Spinal Cord Injury, above fourth dorsal vertebra have a decreased sympathetic outflow, leading to parasympathetic dominance, which may have resulted in baroreceptor mediated vagal stimulation and reflex bradycardia which progressed to junctional rhythm and pulseless electrical activity. Being aware of these serious potential complications while removing the central venous catheters and prevention of the same is of vital importance. The trainees and nursing staff should be educated regarding being vigilant and monitoring these patients.