Infusion-Related Air Embolism

Abstract

Vascular air embolism as a medically induced complication may be associated with numerous treatments and therapies. In infusion therapy, the risk is associated with venous and arterial catheterization as well as various other invasive procedures and much of the equipment used for them. The manner of air entry and the presentation of symptoms may vary greatly. Appropriate treatment options are dependent on air entry routes. Nurses need to be aware of the common and seldom-considered causes of air embolism to be able to guard against this complication, yet adequately support the patient if it occurs.

Complications of Peripheral Venous Access Devices: Prevention, Detection, and Recovery Strategies

“…The sheer pervasiveness of use of PVADs demands attention to prevention of complications and reduction of harm. Unfortunately, many experts 4,8,16,33 suspect that PVAD complications are underrecognized among health care providers, partly because of persistent overestimation of the safety of these devices.…”

“…Fatal volume of air in humans is generally accepted as 50 mL (or 3-5 mL/kg), but up to 20 mL in adults can be lethal if delivered rapidly. 49 The lungs can filter up to 0.35 mL/kg of air per minute, but higher volumes or the presence of a patent foramen ovale (occurring, often asymptomatically, in 10%-35% of adults and in neonates) 16,49 permits Phlebitis, which occurs with both SPCs and PICCs, can develop up to 48 hours after a device is removed.…”

“…Because of the risk, intravenous infusion of any volume of air should be considered "potentially consequential" 49 and should be judiciously avoided. 16,49 In a detailed review of infusion-related air embolism, Cook 16 reports challenges associated with recognition and treatment of this complication. Specifically, clinicians may not readily recognize the reason for air entry, the diagnosis may not be intuitive, and even if air embolism is suspected, immediate interventions may seem ineffective.…”

“…16,45 Air embolism is uncommon (the true incidence is poorly defined) 41 but highly lethal, with a mortality greater than 30%. 46,47 The Centers for Medicare and Medicaid Services consider device-associated air embolism a preventable, nonreimbursable serious reportable (or "never") event.…”

“…Table 1 provides basic definitions and signs and symptoms of these complications. [11][12][13][14][15] Signs and symptoms vary widely, may be subtle or catastrophic, and onset varies widely, from insidious to abrupt Local pain, swelling, tenderness, and local and/or streaking erythema Venous cording (rigidity and firmness) may be palpable in severe cases 3 Sudden dyspnea, cough, wheezing, chest and/or shoulder pain, agitation, sense of impending doom, tachypnea, tachycardia, hypotension, and/or neurological findings consistent with cerebrovascular accident 16 A harsh systolic murmur may be present…”