Evaluation of Catheter Placement in the Treatment of Venous Air Embolism

Sink, James D.; Comer, Paul B.; James, Paul M.; Loveland, S. R.

doi:10.1097/00000658-197601000-00012

Cited by 19 publications

(4 citation statements)

References 21 publications

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“…While right ventricular aspiration significantly enhanced air recovery in our study, Sink et al [29] found no differences in air recovery rates via a Swan-Ganz-catheter placed within the pulmonary artery, right ventricle, or right atrium in dogs, possibly due to its small inner diameter. In our study, aspiration catheters had similar and high flow rates, approximately 10 times greater than that of a pulmonary artery catheter.…”

Section: Discussioncontrasting

confidence: 75%

Cardiac air transit following venous air embolism and right ventricular air aspiration*

et al. 2009

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SummaryUsing intra-cardiac echocardiography in anaesthetised swine we tested the hypotheses that embolised air (i) passes immediately through the right atrium into the ventricle; (ii) persists in the right ventricle for a long time; (iii) is detectable for longer within the right ventricle or main pulmonary artery than the right atrium, and (iv) right ventricular aspiration recovers more air than right atrial aspiration. Following intravenous injection of different air volumes the air appeared in the right atrium in a mean (95% CI) of 3 s (2.5-3.5 s) and almost simultaneously in the right ventricle after 5 s (3.9-6.0 s), but air persisted for longer in the right ventricle (420 s; (367-473 s)) and pulmonary artery (541 s; (475-606 s)) than in the right atrium (404 s (353-457 s)), particularly with larger air volumes and in the semi-upright position. More air was recovered via a right ventricular catheter than an atrial catheter (52% vs 25%, p < 0.01).

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Section: Discussioncontrasting

confidence: 75%

Cardiac air transit following venous air embolism and right ventricular air aspiration*

et al. 2009

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“…Studies in dogs and humans have showed that left lateral decubitus positioning may improve survival by allowing air to rise toward the right ventricular apex, thereby relieving the obstruction of pulmonary outflow tract 8,9 . Some authors have attempted to aspirate air from the right ventricle using a PAC with unclear benefit 10,11 . Hyperbaric oxygen may be considered if there are neurological changes evident on physical examination 1 …”

Section: Discussionmentioning

confidence: 99%

Echocardiographic Diagnosis of Air Embolism Associated with Central Venous Catheter Placement: Case Report and Review of the Literature

et al. 2006

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Transthoracic echocardiography (TTE) is a valuable tool in the evaluation of patients with suspected air embolism. This report describes the presentation and evaluation of a critically ill woman with spontaneous air embolism occurring during a central venous catheter replacement. Bedside TTE established the diagnosis of air embolism, allowing prompt initiation of appropriate therapy. This case report highlights this uncommon but potentially life-threatening complication of central line placement and the utility of echocardiography in its evaluation.

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“…Evacuation of air from central venous catheter (CVC) is recommended if possible and occasionally up to 50% of entrained air can be removed with proper placement of CVC [55,68]. The optimal position of CVC for aspiration of air is at 2 cm below the junction of right atrium and superior vena cava [55,69]. Fluid resuscitation will increase CVP thereby preventing further entry of gas into the venous circulation [70].…”

Section: Managementmentioning

confidence: 99%

Gas embolism during endoscopic retrograde cholangiopancreatography: diagnosis and managementn

Lanke¹

2019

aog

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Air embolism is rarely diagnosed and is often fatal. The diagnosis is often not made in a timely manner given the rapid and severe clinical deterioration that often develops, frequently leading to cardiac arrest. Many patients are only diagnosed post-mortem. With the increasing use of endoscopic retrograde cholangiopancreatography, air embolism should be considered in the differential diagnosis in patients who experience sudden clinical deterioration during or immediately after the procedure. Clinical suspicion is key in the diagnosis and management of air embolism. Use of precordial Doppler ultrasound and transesophageal echocardiogram can aid in the diagnosis of air embolism. Once the diagnosis is made, supportive management of airway, breathing and circulation is pivotal. Advanced cardiac life support should be initiated when necessary. Fluid resuscitation and vasopressors can improve cardiac output. Hyperbaric oxygen therapy should be considered when possible in cases of suspected cerebral air embolism cases to improve neurological outcome. A multidisciplinary team approach and effective communication with experts, potentially including an anesthesiologist, cardiologist, intensivist, radiologist and surgeon, can improve the outcome in air embolism.

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Evaluation of Catheter Placement in the Treatment of Venous Air Embolism

Cited by 19 publications

References 21 publications

Cardiac air transit following venous air embolism and right ventricular air aspiration*

Cardiac air transit following venous air embolism and right ventricular air aspiration*

Echocardiographic Diagnosis of Air Embolism Associated with Central Venous Catheter Placement: Case Report and Review of the Literature

Gas embolism during endoscopic retrograde cholangiopancreatography: diagnosis and managementn

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