PICC entrapment and air embolism on veno-venous extracorporeal membrane oxygenation: A case report

Hekmatjah, Natan; Escallier, Krisztina E.; Singh, Sumit

doi:10.1177/11297298211039651

J Vasc Access

2021

DOI: 10.1177/11297298211039651

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PICC entrapment and air embolism on veno-venous extracorporeal membrane oxygenation: A case report

Natan Hekmatjah

Krisztina E. Escallier

Sumit Singh

Abstract: Extracorporeal membrane oxygenation (ECMO) is an incredible, life-sustaining intervention for patients suffering from a variety of cardiopulmonary insults. However, its use comes with a unique set of risks and potentially devastating complications, including air entrainment and embolism. We present a case of recurrent air entrainment in a patient on veno-venous ECMO after her peripherally inserted central catheter became entrapped within the lumen of her bi-caval, dual lumen ECMO cannula. We briefly discuss co… Show more

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Cited by 2 publications

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The effect of excessive gas to blood ratios in an ECMO oxygenator

Shaw,

Cross,

Richardson

et al. 2024

Perfusion

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Introduction Oxygenators for paediatric Extracorporeal Membrane Oxygenation (ECMO) are required to operate over a wide range of flow rates, in a patient group ranging from neonates through to fully grown adolescents. ECMO oxygenators typically have a manufacturer’s stated maximum gas: blood flow rate (GBFR) ratio of 2:1, however, many patients require greater ratios than this for adequate CO2 removal. Mismatches in GBFR in theory could result in high gas phase pressures. These increased pressures in theory could cause the formation of gross gaseous microemboli (GME) placing the child at higher risk of neurological injury. Methods We evaluated 6 paediatric and 6 adult A.L.ONE™ ECMO oxygenators and assessed their gas phase pressures and GME release, in an ex vivo setting, in GBFR ratios up to greater than 2, across a range of gas flow (1L – 10 L/min) rates with a fraction of inspired oxygen (FiO2) content of 50% and 100%. Results There were no increases above 10 mmHg observed in gas phase pressures in GBFR >= 2:1 in either adult or paediatric oxygenators. Laboratory examination of GME activity demonstrated a small increase in post-membrane GME release over the study period. GME release was unaffected by FiO2 setting or gas flow rate, with a maximum volume of < 6 µL in both paediatric and adult oxygenators. Conclusions In an ex vivo setting, increasing GBFR above 2:1 in a paediatric oxygenator, and to a GBFR of 2:1 in an adult oxygenator did not significantly increase gas phase pressures, and no oxygenator membrane rupture was observed. There were no associations between gas flow rates and GME production.

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The effect of excessive gas to blood ratios in an ECMO oxygenator

Shaw,

Cross,

Richardson

et al. 2024

Perfusion

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Bedside placement of tunneled femorally inserted central catheters in pediatric patients on extracorporeal life support: A case series and discussion

Weber,

Conlon,

Connelly

et al. 2023

J Vasc Access

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Background: Pediatric patients requiring extracorporeal life support (ECLS) often need central venous access for extended periods of time. In this population, the placement of an upper extremity peripherally inserted central catheter (PICC) can be challenging due to the location and size of the venous ECLS cannula. Bedside placement of a tunneled femorally inserted central catheters (T-FICC) can be a viable alternative to a traditional PICC. Methods: In this case series we present five children who were on ECLS and had a T-FICC placed at the bedside. Results: In this series of five patients we successfully placed T-FICCs while the patients were on ECLS. The T-FICCs dwelled from 15 to 182 days. There were no events of central line associated blood stream infections or deep vein thrombosis. There was only one unintentional line dislodgement noted. Conclusion: The use of T-FICCs placed at the bedside is a safe and reliable alternative for secure long-term venous access in children who are on ECLS.

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PICC entrapment and air embolism on veno-venous extracorporeal membrane oxygenation: A case report

Cited by 2 publications

References 14 publications

The effect of excessive gas to blood ratios in an ECMO oxygenator

The effect of excessive gas to blood ratios in an ECMO oxygenator

Bedside placement of tunneled femorally inserted central catheters in pediatric patients on extracorporeal life support: A case series and discussion

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