Pulsed saline lavage causing venous air embolism in a patient with Paget's disease

Abstract

Pulsed saline lavage is used to prepare bony surfaces during joint replacement surgery. A patient is described in whom a venous air embolism occurred as a result of a combination of the increased vascularity of bone seen in Paget's disease and possible air entrainment in the lavage equipment.

Successful resuscitation of a patient who developed cardiac arrest from pulsed saline bacitracin lavage during thoracic laminectomy and fusion

“…Venous air embolism due to pulse lavage irrigation is a complication that could generate cardiovascular compromise [4,5]. The pathophysiology involves entrainment of air into the wound.…”

“…However, all of these patients had additional risk factors for the development of air embolism, such as Paget's disease, pelvic fracture trauma, and debridement of a large vascular tissue surface [4,5]. Our patient's risk factors included prone positioning and an operative field that involved noncollapsible epidural veins.…”

Pulsatile lavage systems and their potential to penetrate soft tissue

“…In an in vitro study in contaminated human tibial fractures, high-pressure pulsatile lavage resulted in significant damage to the bone and intramedullary bacterial seedings [15]. Also, cases of air embolisms during pulsed saline lavage of pelvic fractures exist [16][17][18]. Furthermore, air that is pushed into the muscle can cause perioperative complications [19].…”