Air Embolism

Etiology
Can be venous or less commonly, arterial
Three vulnerable areas of air entry in dialysis patients:
Between patient and blood pump, due to high negative pressure and leaks in the
circuit in this segment
Air in the dialysate fluid (uncommon, mostly gets trapped in venous chamber)
uring central venous catheter insertion or removal
!pright body position and hypovolemia, both by reducing venous pressure, are significant
contributing factors

Treatment
"revent further air entry by clamping and disconnecting the circuit
#lat supine position may be better over traditionally advocated left lateral (uran$s
position) and Trendelenburg position
%,&
'(ygen with #i'& %))*
+yperbaric o(ygen
,
(prevents cerebral edema)
!se of -uer.lock syringes for blood draw from catheters

Prevention
Test machine prior to use to ensure that the air detector alarm system is working
effectively
Catheter insertion or removal should be in a head low position (insertion site / cm below
right atrium)0 "atient can assist by holding their breath or doing a 1alsalva maneuver that
will increase central venous pressure
2
0

Back to 3ntradialytic Complications 4e(t
References:
%0 1esely T50 Air embolism during insertion of central venous catheters0 J Vasc Interv
Radiol %&:%&6%.%&6/, &))%
&0 5uth C5, 7hank 870 9as embolism0 N Engl J Med ,2&:2:;.2<&, &)))
,0 Baskin 7#, =o>ni>k ?#0 +yperbaric o(ygenation in the treatment of hemodialysis.associated
air embolism0 N Engl J Med &6,:%<2.%</, %6:/
20 "almon 7C, 5oore -8, -undberg @, Toung T0 1enous air embolism: A review0 J Clin
Anesth 6:&/%.&/:, %66:
Air Embolism
Introduction of enough air into extracorpeal system to
stop circulation
Causes:
Empty IV bag
Air leak in blood lines
Air detector not armed
Loose connections
eparation of blood lines
!atient inhales "hile central #ascular catheter is open to
air
!re$safety checks not done or done improperly
igns and ymptoms of Air igns and ymptoms of Air
Embolism
Extracorpeal ystem:
Ai k f % i k& i li Air poc
ket or
foam
%
pink& in #enous line
!atient:
Coughing' shortness of breath
Ch i est pain or pressure
(achycardia
)istended neck #eins
Cyanosis*+ray color Cyanosis*+ray color
light paralysis on one side of body %cerebral&
Confusion' con#ulsions' coma
!ossible cardiac*respiratory arrest
(reatment of Air Embolism
Clamp blood lines and stop blood pump
!lace patient in trendelenburg position !lace patient in trendelenburg position
turning them on their LE,( side
(reat symptoms: (reat symptoms:
-xygen to address shortness of breath and chest
pain
.ormal saline to support blood pressure