Arterial fast bolus flush systems used routinely in neonates and infants cause retrograde embolization of flush solution into the central arterial and cerebral circulation

Weiß, Markus; Balmer, Christian; Cornelius, Anita; Frey, Bernhard; Bauersfeld, Urs; Baenziger, Oskar

doi:10.1007/bf03021037

Cited by 6 publications

(6 citation statements)

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“…A volume of air of 1.6 mL injected in the radial artery under high pressure was sufficient to evoke neurologic and hemodynamic reactions in an adult patient. It has been demonstrated in infants that rapid flushing not only results in retrograde embolization of flush solution, but also causes local arterial vasospasm, transient elevation of arterial blood pressure and intracranial/intraventricular pressure [ 22 ]. This can be related to the small size of the patient, but also to the immaturity of cardiovascular and nervous system.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic cerebral arterial gas embolism from flushing of the arterial line in two calves

et al. 2018

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BackgroundMeasurement of invasive blood pressure as reflection of blood flow and tissue perfusion is often carried out in animals during general anesthesia. Intravascular cannulation offers the potential for gas to directly enter the circulation and lead to arterial gas embolism. Cerebral arterial gas embolism may cause a spectrum of adverse effects ranging from very mild symptoms to severe neurological injury and death. Although several experimental models of arterial gas embolism have been published, there are no known published reports of accidental iatrogenic cerebral arterial gas embolism from flushing of an arterial line in animals.Case presentationA 7-day-old Red Holstein–Friesian calf (No. 1) and a 28-day-old Holstein–Friesian calf (No. 2) underwent hot iron disbudding and sham disbudding, respectively, under sedation and cornual nerve anesthesia. Invasive arterial blood pressure was measured throughout the procedure and at regular intervals during the day. Before disbudding, a sudden and severe increase of blood pressure was observed following flushing of the arterial line. Excitation, hyperextension of the limbs and rapid severe horizontal nystagmus appeared shortly thereafter. Over the following minutes, symptoms ameliorated and blood pressure normalized in both cases. Prompt diagnosis was missed in calf 1; supportive fluid therapy was provided. Severe deterioration of neurologic status occurred in the following 24 h and culminated with stupor. The calf was euthanized for ethical reasons and the histological examination revealed extensive cerebral injury. Treatment of calf 2 consisted of supportive fluid and oxygen therapy; furosemide (1 mg/kg IV) was injected twice. Calf 2 appeared clinically normal after 2 h and showed no neurologic sequelae on a 3-month-follow up period.ConclusionsThere are no known reports of cerebral arterial gas embolism following flushing of the auricular arterial line in calves. The injection of a small amount of air at high pressure in a peripheral artery may lead to a significant cerebral insult. The clinical presentation is non-specific and can favour misdiagnosis and delay of therapy.

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Section: Discussionmentioning

confidence: 99%

Iatrogenic cerebral arterial gas embolism from flushing of the arterial line in two calves

et al. 2018

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“…However, the two accompanying papers in the Journal 10,11 confirm that as our specialty changes adverse outcomes still occur, often in new forms.…”

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“…10 This is an example of how monitoring used to improve patient care is accompanied by the risk of adverse events.…”

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“…Toutefois, les deux articles du Journal sur le sujet 10,11 confirment que des complications surviennent encore dans notre spécialité, souvent sous d'autres formes. Ainsi, les systèmes de rinçage artériel par bolus rapide peuvent causer une embolisation dans la circulation artérielle cérébrale et centrale.…”

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“…Ainsi, les systèmes de rinçage artériel par bolus rapide peuvent causer une embolisation dans la circulation artérielle cérébrale et centrale. 10 Cet exemple démontre comment la surveillance utilisée pour améliorer les soins est accompagnée de risque d'événements indésirables.…”

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