Bubbles in the Brain Veins as a Complication of Daily Management of a Scalp Vein Catheter

Abstract

Recently, it has been suspected that venous dural sinus air embolisms could occur as a result of scalp vein infusion. The possible mechanism for this complication has not been documented to date, and procedures to avoid venous dural sinus air embolism have not been presented. We report a preterm neonate who demonstrated venous dural sinus air embolism following daily management of a scalp vein catheter. The air embolism disappeared in a few days without complications. Clinicians should avoid injecting air into a scalp vein catheter and leaving it open to air. Following careful examination and review of the infant's case, we were able to conclude that positioning the infant in either supine or Trendelenburg position during daily management of scalp venous infusions and using an air-occlusive dressing once the catheter is removed could limit the risk of venous dural sinus air embolisms caused by scalp vein infusions.

Ultrasonographic detection of air in the superior sagittal sinus in a neonate with transposition of the great arteries

“…CT has been used to detect retrograde cerebral venous air emboli in both the pediatric and adult populations. Additional reports have described antegrade cerebral venous air emboli in neonates after scalp vein cannulation in which air was introduced into the intracranial venous sinuses via the epicranial emissary veins [4] , [5] . Two cases were detected with CT at 4 and 12 weeks of age [4] , and one was detected with ultrasonography at day 5 [5] .…”

Accidental Cerebral Venous Gas Embolism in a Young Patient With Congenital Heart Disease

“…1,6 Every venous gas embolism has the potential to develop into an arterial gas embolism; such an occurrence is called paradoxical C erebral gas embolism is an unusual event that is mainly an iatrogenic problem occurring in association with cardiac surgery, hemodialysis, angiography, pulmonary barotrauma, or entry of air through an intravenous catheter. [1][2][3][4][5] Generally, the entry of gas is mainly into the venous system. The lungs work as a filter, protecting the systemic and coronary circulation from air emboli.…”

“…The patient did not undergo any other medical procedures known to cause cerebral venous gas embolism, which include neurosurgery, hemodialysis, central venous catheterization, or scalp vein infusion. 1,5 When the bubbles occlude the brain vasculature, intracranial pressure increases and a pathological redistribution of the blood flow causes hyperemia and ischemia. In the vascular wall, microbubbles irritate and lead to breakdown of the blood−brain barrier and activation and adhesion of polymorphonuclear leukocytes in the damaged area of the brain.…”