Does this patient have air embolism?
Symptoms depend on amount, speed, and site of introduced air, as well as patient’s position
Sitting position – venous emboli in cerebral circulation
Impaired right ventricular function (decreased cardiac output and hypotension)
Microemboli to pulmonary vasculature (dyspnea, dry cough, chest tightness or pain, hypoxia, respiratory failure)
Sudden cardiac arrest (> 50 mL)
Left trendelenburg position
Lower extremity venous occlusion, and arterial ischemia from increased outflow resistance.
What tests to perform?
Diagnosis suspected by clinical judgment
Pulse oximetry or arterial blood gas
Foam may be visible in the extracorporeal circuit line.
How should patients with air embolism be managed?
Clamp venous blood line
Stop blood pump
Place patient in the left Trendelenburg position
High flow oxygen administration
Aspirate air from right ventricle using percutaneously-inserted needle or right atrial dialysis catheter
Consider hyperbaric oxygenation treatment if available
Aspirate blood and flush with saline before connection
Perform good priming of extracorporeal circuit including dialyzer (there should be no residual air bubbles)
Check dialysis machine’s air detector
Avoid the use of the arterial line during dialysis for additional infusions
What happens to patients with air embolism?
Acute respiratory failure
Sudden cardiac arrest
How to utilize team care?
Specialty consultations – Cardiology for emergent transthoracic echocardiography and possible aspiration of air from right ventricle; Pulmonology/critical care medicine for supportive care and to provide hyperbaric oxygenation therapy if indicated
Nurses – Adherence to proper techniques for gaining access to the vascular access (e.g., central venous dialysis catheter)
Are there clinical practice guidelines to inform decision making?
ICD-10-CM diagnosis code T80.0XXA: Air embolism following infusion, transfusion and therapeutic injection, initial encounter
What is the evidence?
Palmon, SC, Moore, LE, Lundberg, J, Tuong, T. “Venous Air Embolism: A Review”. J Clin Anesth. vol. 9. 1997. pp. 251-257.
Mirski, MA, Lele, AV, Fitzsimmons, L, Tuong, T. “Diagnosis and Treatment of Vascular Air Embolism”. Anesthesiology. vol. 106. 2007. pp. 164-77.
Orebaugh, SL. “Venous air embolism: Clinical and experimental considerations”. Crit Care Med.. vol. 20. 1992. pp. 1169-77.
Gordy, S, Rowell, S. “Vascular air embolism”. Int J Crit Illn Inj Sci. vol. 3. 2013. pp. 73-76.
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- Does this patient have air embolism?
- What tests to perform?
- How should patients with air embolism be managed?
- What happens to patients with air embolism?
- How to utilize team care?
- Are there clinical practice guidelines to inform decision making?
- Other considerations