How is venous air embolism (VAE) treated in the presence of a catheter?

Updated: Dec 30, 2017
  • Author: Brenda L Natal, MD, MPH; Chief Editor: Erik D Schraga, MD  more...
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Any procedure posing a risk for VAE, if in progress, should be aborted immediately once VAE is suspected.

During central venous catheter (CVC) insertion/removal, one attempt at aspirating air back from line may be useful. Prior to aspiration, the tip of the CVC should be optimally placed 2 cm below the junction of the superior vena cava and the right atrium; however, it may have to be advanced to optimize results.

The placement of a CVC (multiorifice) or PA catheter to attempt aspiration of air, if not already done, has been recommended by several authors. [1, 4, 18, 22, 41] When appropriately placed, it may be possible to aspirate approximately 50% of the entrained air with a right atrial catheter.

Catheter removal should be performed with the patient supine or in a Trendelenburg position while holding his/her breath at the end of inspiration or during a Valsalva maneuver. [2, 14, 22]

In the event of circulatory collapse, cardiopulmonary resuscitation (CPR) should be initiated in order to maintain cardiac output. CPR may also serve to break large air bubbles into smaller ones and force air out of the right ventricle into the pulmonary vessels, thus improving cardiac output. [18]

If an arrest is refractory to CPR, an immediate thoracotomy in the emergency department (ED) may be indicated. An emergency thoracotomy with clamping of the hilum of the injured lung is currently recommended for SAE-associated with unilateral lung injury. This prevents continued passage of air into the coronary, cerebral, and other systemic arteries. [11, 18]

Other measures include cross-clamping the aorta, cardiac massage, and aspirating air from the left ventricle, aortic roots, and pulmonary veins. [11]

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