Massive Air Embolism After Central Venous Catheter Removal

Abstract

A 66-year-old patient had a left central venous catheter in place for 8 days. The catheter, which had to be removed, was withdrawn while the patient was in a 180°supine position during a Valsalva maneuver, with positive pressure during removal. A massage at the site of puncture was performed for 3 minutes, and a compressive plaster was applied. Several minutes after removal, the patient, still supine, needed to cough. He immediately became sweaty and breathless, with progressive improvement after 5 to 10 minutes.However, after Ϸ20 minutes, the patient was still coughing and became more breathless and somnolent, with an O 2 saturation of 93% despite O 2 administration of 10 L/min. A strange sound marked by the heart beat was perceived by the medical staff and even heard by the patient. This burbling noise ("bruit de rouet" or "bruit de moulin,"* so called as an analogy to the sound produced by a waterwheel 1 ) was described many years ago and is specifically related to massive air embolism. To the best of our knowledge, this typical sound has only been described as being heard by a stethoscope.In our patient, massive air embolism in the right heart cavities was confirmed by transthoracic echocardiography ( Figure 1A and Data Supplement Movie), which was performed immediately. Firm pressure was applied to the infusion site, and the patient was laid on his left side. Echocardiography was repeated Ϸ45 minutes later ( Figure 1B). The ECG showed signs of right heart strain ( Figure 2). The patient improved slowly until his condition normalized completely after Ϸ7 hours.This case of real-time documentation of air embolism after central venous catheter removal illustrates the potentially life-threatening consequences of this apparently benign procedure. 2 Air aspiration through the residual perfusion channel during or after central venous catheter removal is a probably not-so-rare and well-known complication. 3 This is, to the best of our knowledge, the first real-time documentation of air arrival in the right side of the heart. Correspondence to Professor Luc De Roy, Cliniques Universitaires UCL Mont-Godinne, Avenue Dr G. Therasse, 1, 5530 Yvoir, Belgium. E-mail deroy@card.ucl.ac.be *"Bruit de rouet" corresponds to a specific murmur heard with a stethoscope in massive and severe air embolism. This French description makes an analogy to the noise produced by a waterwheel. This term is used in most French textbooks to describe massive air embolism ("bruit de rouet" or "bruit de moulin").(Circulation. 2007;116:e516-e518.)

In reply:

“…2 The expected physical examination findings on auscultation for intracardiac air would be the "bruit de moulin" (water wheel sound) as blood splashes and mixes with air during chamber filling and contraction. 3 It is pathognomonic for intracardiac air but has sometimes been incorrectly associated with intrapericardial air. Since there is no mixing of fluid and air in the pericardium alone, it would not present with a succussion splash on auscultation.…”

“…In December 2020, based on increasing antimicrobial resistance and concerns for antibiotic stewardship, the Centers for Disease Control and Prevention updated sexually transmitted infection guidelines to recommend doxycycline for nonpregnant patients when chlamydia cannot be ruled out. 3 The switch from single-dose azithromycin to a 7-day regimen that carries risks for pill esophagitis and pregnancy exclusion complicates the calculus of the authors' treatment threshold. Additionally, applying a generalized gonorrhea prevalence to every ED creates an ecological fallacy that overestimates the treatment benefits in low-prevalence areas.…”

Hydrostatic Pressure Effect on Micro Air Bubbles Deposited on Surfaces with a Retreating Tip

“…10,11 Their presence in the cardiovascular system, often described as air embolism, can engender cardiac arrests in some situations. 12 Interestingly, excess drought can also cause air embolism to appear in the transport system of plants, resulting in them drying up and wilting. 13 When they are small enough, gas bubbles can stably exist on solid surfaces due to the action of surface tension notwithstanding buoyancy.…”

“…They have been harnessed for applications such as enhancing heat and mass transfer, propulsion, providing a platform for biochemical synthesis, enhancing cell lysis, drug delivery, improving contrast in ultrasonic imaging, and enhancing or reducing the attachment of liquid drops on surfaces. , In some cases, however, bubbles are a nuisance. They clog microfluidic channels and deteriorate the performance of microchannel based fuel cells. , Their presence in the cardiovascular system, often described as air embolism, can engender cardiac arrests in some situations . Interestingly, excess drought can also cause air embolism to appear in the transport system of plants, resulting in them drying up and wilting …”