Recognising air embolism as a complication of vascular access.

The insertion and maintenance of advanced vascular access devices is increasingly becoming the remit of advanced nurses. Understanding the potential for air embolism as a complication of this procedure, recognising and managing the signs and symptoms, and being able to apply preventative measures, are imperative to enhance patient safety. A range of outcomes can present from air embolism depending on the rate and volume of air entrained, from sub-clinical to death, so the application of expert knowledge and vigilance is essential to minimise risk. According the the available literature, supplemental oxygen administration appears to be the most effective treatment.

Devastating cerebral air embolism after central line removal.

BACKGROUND: Air embolism is a well-published complication arising from central venous catheter use. Literature and case studies provide information regarding clinical sequelae. Preventable mistakes still occur despite following what is considered appropriate protocol. This case report describes the neurological complications likely caused by a cerebral air embolism related to central venous catheter removal. CASE: An 84-year-old man was admitted to the neuroscience critical care unit with acute stroke symptoms and seizures after removal of a central venous catheter. CONCLUSION: There is an abundance of literature describing best practice, complications, and treatment of venous air embolism associated with central line catheter use. Utilization of central venous catheters is increasing. With increased utilization comes the responsibility to improve commonplace knowledge and ensure that practice guidelines and protocols are dependable and consistent.

Complications of central venous catheters: nursing care.

There are increasing numbers of patients, both at home and in the hospital, receiving intravenous therapy via long-term central venous catheters. Although fairly commonplace, there are many potential complications associated with the insertion and use of these catheters. This article describes the insertion and postinsertion-related complications of these devices. The article will give the nurse the information and confidence required for observing, detecting, preventing and/or treating promptly any complication to ensure the best possible nursing care.

Clinical dilemmas in neuroanesthesia.

Clinical dilemmas that frequently challenge intraoperative neurosurgical anesthetic management include the use of the sitting position, and the application of monitoring strategies for the detection of venous air embolism. Familiarity with the physiological consequences of anesthetic administration and patient positioning, and the physiological consequences of VAE will enable the anesthetist to choose appropriate alternatives for anesthetic management.

Carbon dioxide embolism during laparoscopy: a case report.

A 28-year-old female with a diagnosis of multiparity was scheduled for laparoscopic tubal ligation. The patient had an unremarkable medical history, except that she had been a pack-a-day smoker for the past 10 years and had experienced a recent upper respiratory infection. General anesthesia was accomplished without incident, and insufflation of the abdomen with carbon dioxide (CO2) gas was begun. During insufflation the end tidal carbon dioxide (ETCO2) level dropped dramatically, ECG changes were noted, and vital signs deteriorated with the subsequent development of cardiac arrest. The patient was successfully resuscitated, fully awake, and extubated approximately 1 hour after the incident. A CO2 embolus caused by CO2 insufflation was suspected. In laparoscopic procedures, the use of CO2 gas is an efficient and inexpensive means of improving visualization of the abdominal cavity. The effect of CO2 insufflation on the patient should be given special consideration in these cases. Although serious complications associated with the use of CO2 gas are rare, such procedures must not be viewed with complacency. A protocol for the management of emergency situations should be developed and reviewed.

Subclavian catheter removal. Nursing implications to prevent air emboli.

Incorrect technique in subclavian catheter removal may result in fatal air emboli. This article discusses the pathophysiologic development and consequence of air emboli and outlines preventive nursing measures and emergency treatment.