Cerebral Air Embolism after Central Venous Catheter Self-Extraction

Abstract

Cerebral air embolism associated with central venous catheter insertion and removal is a rare but serious complication. There are many hypotheses on how air bubbles might be transported from the venous system to intracranial vessels. The literature has described how intra-cardiac defects 1,2 , transpulmonary passage 3,4 , and even retrograde flow of gas bubbles 5,6 can explain this phenomenon. We present a case that illustrates the devastating effects of cerebral air embolism after a patient selfextracted his central venous catheter. CASEAn 83-year-old male presented to hospital with malnutrition and acute kidney injury. A catheter was placed into his right internal jugular vein for hydration and electrolyte replacement. The patient tolerated the procedure well and after six days was scheduled to have his intravenous catheter removed.Hours before the planned removal, the patient was found by the medical staff seated upright yet unresponsive to verbal or painful stimuli. His neurological exam demonstrated flaccid