Background: The novel case report of a temporary arrhythmia that developed after a positional change in a patient under general anesthesia emphasizes the possibility of potentially lethal cardiac arrhythmias that may develop owing to caudal movement of the peripherally inserted central venous catheter tip when changing patient positions.Case presentation: We present a case of temporary arrhythmia that developed after a positional change in a 44-year-old female patient scheduled for laparoscopic adrenalectomy under general anesthesia. She had undergone preoperative insertion of a peripherally inserted central venous catheter using an electrocardiogram-guided tip confirmation system. Conclusion: The case report discusses the optimal tip confirmation system and emphasizes vigilant electrocardiogram monitoring, suggesting measures to prevent these arrhythmias under general anesthesia.