How is venous air embolism (VAE) prevented during mechanical ventilation and central line insertion/removal/manipulation?

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

Measures to reduce the risk of air embolism during mechanical ventilation and central line insertion/removal/manipulation should be taken. With regard to these two procedures, the following interventions should be implemented:

  • Prevent barotraumas by minimizing airway pressures during mechanical ventilation
  • Avoid positive end-expiratory pressure (PEEP); it impairs hemodynamic performance, does not protect against air embolism, and probably increases the risk of paradoxic emboli
  • Avoid and treat hypovolemia prior to catheter placement
  • Occlude the needle hub during catheter insertion/removal
  • Maintain all connections to the central line closed/locked when not in used (use Luer-Lok syringes for blood draws from catheters)
  • During catheter insertion/removal, place the patient in the supine position with head lowered (insertion site should be 5 cm below right atrium); if the patient is awake he or she may assist by holding his or her breath or by doing a Valsalva maneuver, both of which can increase the central venous pressure

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