Which clinical history findings suggest venous air embolism (VAE)?

Updated: Dec 30, 2017
  • Author: Brenda L Natal, MD, MPH; Chief Editor: Erik D Schraga, MD  more...
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Answer

Because of the lack of specific signs and symptoms of VAE, a high index of suspicion is necessary to establish the diagnosis and institute the appropriate treatment. The number of procedures that place patients at risk for VAE has increased, and these procedures occur across almost all clinical specialties. This must be considered to aid in the confirmation or ruling out of VAE.

If VAE is suspected, obtain the following key historical elements:

  • Recent surgical procedures especially neurosurgical, otolaryngological, cardiovascular, or orthopedic
  • Scuba diving trips and a history of decompression injuries or decompression sickness
  • Blunt or penetrating trauma to the head, face, neck, thorax, and/or abdomen
  • Invasive therapeutic and/or diagnostic procedures such as central venous catheterization; lumbar puncture; high-pressure infusion of medications, blood products, and/or IV contrast agents
  • Patients with hemodialysis access catheters or other indwelling central venous catheters
  • Patients on positive pressure ventilation
  • Peripartum/postpartum orogenital sex (air may enter veins of the myometrium) [4, 7]
  • Ingestion of hydrogen peroxide (rare)

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