Pressurized Intravenous Fluid Administration in the Professional Football Player

Abstract

Venous air embolism (VAE) is a potentially life-threatening event that is most commonly associated with certain surgical procedures, although this theoretical complication of pressurized rapid infusion of intravenous (IV) fluids has been described. This series of cases describes 4 athletes who presented with continuous coughing and other chest complaints after peripheral IV infusion of normal saline through manual pressurized infusion. Symptoms resolved within 20 minutes, and these incidences did not interfere with resuming athletic competition with no recurrence of symptoms or complications. These cases are most consistent with varying degrees of VAE and reveal the risk of VAE associated with pressurized peripheral IV fluid administration along with the unique clinical presentation of more modest forms of VAE in an awake patient. Becoming more knowledgeable about IV infusion technique and understanding potential pitfalls can be helpful in reducing future incidences of VAE.

Safety concern regarding the risk of air embolism secondary to pressure bag infused fluids

“…I appreciate the opportunity to bring this matter to the attention of the readers. Venous air embolus (VAE) is infrequently reported in the human and veterinary literature . Air embolus occurs when a pressure gradient favoring air entry into the circulation exists, and air is inadvertently introduced into the vasculature .…”

“…Air embolus occurs when a pressure gradient favoring air entry into the circulation exists, and air is inadvertently introduced into the vasculature . Clinical manifestations of VAE include coughing, breathlessness, hypotension, bronchospasm, hypoxemia, and cardiac arrhythmias . In people, it has been reported that 3–5 mL/kg of air can be fatal .…”

“…The delivery of as little 20 mL/s can cause symptoms, and 70–150 mL/s can be fatal . Standard commercial 1‐L fluid bags contain anywhere from 50–70 mL of air instilled by the manufacturer for the purpose of transport, and accidental delivery of this air could have severe consequences in small animal patients …”

“…Self‐collapsible fluid bags are preferred in human medicine for their reportedly added margin of safety against inadvertent air embolus . However, VAE occurring with use of pressure bags has been infrequently reported . In 2 case reports it was suspected that additional air had been introduced into the fluid bag when fluid lines were changed during the infusion .…”

“…In 2 case reports it was suspected that additional air had been introduced into the fluid bag when fluid lines were changed during the infusion . It is possible that the true incidence of VAE is under‐recognized, due to the varying sensitivities of detection methods, as well as the possibility of unrecognized subclinical VAE . VAE has been described in the veterinary literature secondary to improper flushing of fluid lines and in one case report secondary to the malfunction of a volumetric infusion pump .…”