Air embolism primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

  • There are many different techniques that physician can use to prevent air embolism during a invasive procedure.
  • Deep sea divers can prevent air embolism with adequate monitoring of their dive.

Primary Prevention

During Venous catheter placement:[1]

  • Place patient in Trendelenburg position
    • this increases the CVP
  • Adequate hydration [2]
  • Avoid placement during inspiration
  • Flush catheter lumens

During Venous catheter removal:[3] [4]

  • Place patient in Trendelenburg position
  • Remove Catheter during valsalva or expiration
  • Cover site and apply pressure for 5-10 minutes
  • Patient should remain supine for 30 minutes post procedure

During other Invasive procedures:[5]

  • Use of a flush in a closed system
  • Prime tubing with saline
  • No air should be present in syringes
  • Intra operative use of precordial doppler
  • Avoid use of Nitrous oxide during abdominal procedures
  • "park bench position" should be used for surgeries performed in the sitting position[6]
  • Use of Reverse Trendelenburg position during Cesarian section[7]

During deep sea diving monitoring gas levels and rate of ascent can help prevent DCS.

References

  1. Colin J. McCarthy, Sasan Behravesh, Sailendra G. Naidu & Rahmi Oklu (2016). "Air Embolism: Practical Tips for Prevention and Treatment". Journal of clinical medicine. 5 (11). doi:10.3390/jcm5110093. PMID 27809224. Unknown parameter |month= ignored (help)
  2. C. M. Domaingue (2005). "Neurosurgery in the sitting position: a case series". Anaesthesia and intensive care. 33 (3): 332–335. PMID 15973915. Unknown parameter |month= ignored (help)
  3. Colin J. McCarthy, Sasan Behravesh, Sailendra G. Naidu & Rahmi Oklu (2016). "Air Embolism: Practical Tips for Prevention and Treatment". Journal of clinical medicine. 5 (11). doi:10.3390/jcm5110093. PMID 27809224. Unknown parameter |month= ignored (help)
  4. P. Ingram, Linda Sinclair & Toby Edwards (2006). "The safe removal of central venous catheters". Nursing standard (Royal College of Nursing (Great Britain) : 1987). 20 (49): 42–46. doi:10.7748/ns2006.08.20.49.42.c4483. PMID 16939143. Unknown parameter |month= ignored (help)
  5. Colin J. McCarthy, Sasan Behravesh, Sailendra G. Naidu & Rahmi Oklu (2016). "Air Embolism: Practical Tips for Prevention and Treatment". Journal of clinical medicine. 5 (11). doi:10.3390/jcm5110093. PMID 27809224. Unknown parameter |month= ignored (help)
  6. T. Mammoto, Y. Hayashi, Y. Ohnishi & M. Kuro (1998). "Incidence of venous and paradoxical air embolism in neurosurgical patients in the sitting position: detection by transesophageal echocardiography". Acta anaesthesiologica Scandinavica. 42 (6): 643–647. PMID 9689268. Unknown parameter |month= ignored (help)
  7. J. Fong, F. Gadalla & M. Druzin (1991). "Venous emboli occurring caesarean section: the effect of patient position". Canadian journal of anaesthesia = Journal canadien d'anesthesie. 38 (2): 191–195. PMID 2021988. Unknown parameter |month= ignored (help)



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