Cerebral air embolism from a Central Venous Catheter: A timely reminder of the importance of rapid diagnosis

Abstract

Cerebral air embolism (CAE) is a rare, avoidable and potentially fatal iatrogenic complication. Here, we report a case of CAE associated with a central venous catheter in the internal jugular vein that resulted in neurological deficits and generalised epileptic seizures. A 64-year-old man admitted for fasciotomy for compartment syndrome developed CAE with left-sided neurological deficits. The suspected origin was retrograde air flow from the right internal jugular venous catheter. The air spontaneously resorbed without the need for specific therapy, and he made a good recovery. CAE is an infrequent iatrogenic complication that requires prompt diagnosis to avoid significant morbidity and mortality. This case serves as a timely reminder that adverse outcome such as stroke, seizures or death can be avoided by a high index of suspicion and prompt diagnosis. Hyperbaric oxygen is the prime therapeutic measure, but high-quality evidence on its clinical value is lacking.

Be on the alert again for the risk of pulmonary air embolisation in paediatric patients during the insertion of a central venous catheter under general anaesthesia with spontaneous respiration

“…Considering the pitfall of the anaesthetic management in this case and the fact that air embolism is reported as a very rare but a well-known possible complication during central ve nous catheter insertion [1,2], we recommend general anaesthetic management using positive pressure mecha-nical ventilation with PEEP when inserting a Hickman/Broviac catheter as well as a central venous catheter in paediatric patients, in order to prevent unexpected deep breathing in a spontaneous respiration, and to maintain a continuous positive intrathoracic pressure during the entire procedure from a risk management point of view, even though suspected pulmonary air embolisation cases during Hickman catheter insertion in paediatric patients have not been reported and its maker was unaware of such cases.…”

“…Dear Editor, Air embolism is a very rare but wellknown and potentially fatal complication of central venous catheter insertion [1,2]. We experienced a paediatric case of suspected pulmonary air embolisation during insertion of a Hickman catheter with a peel-off sheath system (Medicon Inc., Osaka, Japan).…”

Pulmonary Air embolism Associated with Pneumocephalus: A Case Report

“…Although the specific incidence is not available in the literature, a review article on air embolism by Brull et al reported at least 700 instances of air embolism on a search from an FDA mandatory device reporting database from 2011 to 2016 [1]. Central venous access has been frequently reported as a source of cerebral venous air embolism [2,3,4]. The proposed mechanism is that once air gains access to the venous system; ascension against blood flow is possible given the low specific gravity relative to blood [5].…”

Mortality in patients with hepatic gas on point‐of‐care ultrasound in cardiac arrest: Does location matter?

“…This leads to the potential to precipitate gas in the hepatic veins, among other sites, due to slow flow within this system 8 . An additional mechanism of introduction of gas into the venous system could be due to the insertion of a femoral central line 14,15 . Similar to vascular air embolisms, gas could be introduced through disruption in the integrity of the venous circulation that occurs during insertion of ventral venous catheters 14 .…”