Evaluation of Various Maneuvers for Prevention of Air Embolism During Central Venous Catheter Placement

Wysoki, Michael G.; Covey, Anne M.; Pollak, Jeffrey; Rosenblatt, Melvin; Aruny, John E.; Denbow, Neil

doi:10.1016/s1051-0443(07)61451-1

Cited by 45 publications

(19 citation statements)

References 6 publications

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“…The gradient between external atmospheric pressure and the intravascular central venous pressure (CVP) is especially increased by hypovolemia or during inspiration by creating a negative intrathoracic pressure, which can enhance the possibility of air entry. As CVP may be sub-atmospheric at baseline in up to 40% of patients [7], those patients in an upright position or those undergoing IR procedures such as hemodialysis catheter placements are particularly susceptible.…”

Section: Discussionmentioning

confidence: 99%

Air Embolism: Diagnosis, Clinical Management and Outcomes

et al. 2017

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Air embolism is a rare but potentially fatal complication of surgical procedures. Rapid recognition and intervention is critical for reducing morbidity and mortality. We retrospectively characterized our experience with air embolism during medical procedures at a tertiary medical center. Electronic medical records were searched for all cases of air embolism over a 25-year period; relevant medical and imaging records were reviewed. Sixty-seven air embolism cases were identified; the mean age was 59 years (range, 3–89 years). Ninety-four percent occurred in-hospital, of which 77.8% were during an operation/invasive procedure. Vascular access-related procedures (33%) were the most commonly associated with air embolism. Clinical signs and symptoms were related to the location the air embolus; 36 cases to the right heart/pulmonary artery, 21 to the cerebrum, and 10 were attributed to patent foramen ovale (PFO). Twenty-one percent of patients underwent hyperbaric oxygen therapy (HBOT), 7.5% aspiration of the air, and 63% had no sequelae. Mortality rate was 21%; 69% died within 48 hours. Thirteen patients had immediate cardiac arrest where mortality rate was 53.8%, compared to 13.5% (p = 0.0035) in those without. Air emboli were mainly iatrogenic, primarily associated with endovascular procedures. High clinical suspicion and early treatment are critical for survival.

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Section: Discussionmentioning

confidence: 99%

Air Embolism: Diagnosis, Clinical Management and Outcomes

et al. 2017

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“…The gradient between external atmospheric pressure and the intravascular low central venous pressure (CVP) is especially increased by hypovolemia or during inspiration by creating a negative intrathoracic pressure which enhances the possibility of air entry. As CVP may be sub-atmospheric at baseline in up to 40% of patients [4], those patients in an upright position or those undergoing IR procedures such as hemodialysis catheter placements are particularly susceptible.…”

Section: Etiology Of Air Embolismmentioning

confidence: 99%

“…Though this appears to be a large amount of air not easily introduced to the vascular system, it has been shown that a 14-gauge needle can transmit 100 cc of air per second with a pressure gradient of 5 cm H 2 0. In addition, a 15 French (5 mm diameter) peel-away sheath used during placement of a tunneled hemodialysis catheter can allow 300 cc of air to enter the vascular system in just 0.5 s [4]. When a large bolus of air lodges in the right ventricular outflow tract (RVOT), this can result in pulmonary hypertension followed by circulatory collapse.…”

Section: Etiology Of Air Embolismmentioning

confidence: 99%

Air Embolism: Practical Tips for Prevention and Treatment

McCarthy

Behravesh

Naidu

et al. 2016

JCM

102

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Air embolism is a rarely encountered but much dreaded complication of surgical procedures that can cause serious harm, including death. Cases that involve the use of endovascular techniques have a higher risk of air embolism; therefore, a heightened awareness of this complication is warranted. In particular, central venous catheters and arterial catheters that are often placed and removed in most hospitals by a variety of medical practitioners are at especially high risk for air embolism. With appropriate precautions and techniques it can be preventable. This article reviews the causes of air embolism, clinical management and prevention techniques.

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“…During the process she suffered an air embolism that led to severe bronchospasm, reintubation, and another 2 days of mechanical ventilation. The intern did not know that central lines should only be removed when patients were supine, during a Valsalva maneuver (60,61). The attending intensivist was not present in the patient's room when the catheter was removed.…”

Section: Examplementioning

confidence: 99%