eMedicine Specialties > Emergency Medicine > Cardiovascular

Venous Air Embolism: Follow-up

Author: Brenda Liz Natal, MD, Clinical Assistant Instructor and Staff Physician, Department of Emergency Medicine, Kings County Hospital and State University of New York Downstate, Brooklyn
Coauthor(s): Christopher I Doty, MD, FACEP, FAAEM, Assistant Professor of Emergency Medicine, Residency Program Director, Department of Emergency Medicine, Kings County Hospital Center, State University of New York Downstate Medical Center
Contributor Information and Disclosures

Updated: Jul 27, 2009

Follow-up

Further Inpatient Care

  • Admit patients to the intensive care unit (ICU), as they may develop cardiopulmonary distress/failure following venous air embolism (VAE).

Transfer

  • Consider transfer to a hyperbaric medicine center for symptomatic venous air embolism.

Deterrence/Prevention

The optimal management of venous air embolism (VAE) is prevention. 

  • Minimizing the pressure gradient between the site of potential entry and the right atrium is essential in prevention of VAE.
  • 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 PEEP as it impairs hemodynamic performance, does not protect against air embolism, and probably increases risk of paradoxical 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-lock 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

Miscellaneous

Medicolegal Pitfalls

  • Failure to identify high-risk procedures and implement adequate measures to prevent venous air embolism (VAE) during these procedures
  • Failure to recognize early signs and symptoms of venous air embolism
  • Failure to provide optimal treatment for suspected/confirmed venous air embolism
  • Failure to consider, diagnose, or treat VAE-associated complications, especially paradoxical embolism, which can lead to arterial embolism
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Andrew G Wittenberg, MD, MPH, Allison J Richard, MD, and Steven A Conrad, MD, PhD, to the development and writing of this article.



More on Venous Air Embolism

Overview: Venous Air Embolism
Differential Diagnoses & Workup: Venous Air Embolism
Treatment & Medication: Venous Air Embolism
Follow-up: Venous Air Embolism
References
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Further Reading

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Keywords

VAE, venous air embolism, embolus, air embolism, venous air embolism causes, venous air embolism symptoms, venous air embolism treatment, AGE, arterial gas embolism, systemic air embolism, air embolism, gas embolism, paradoxical embolism, air lock

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Contributor Information and Disclosures

Author

Brenda Liz Natal, MD, Clinical Assistant Instructor and Staff Physician, Department of Emergency Medicine, Kings County Hospital and State University of New York Downstate, Brooklyn
Brenda Liz Natal, MD is a member of the following medical societies: American College of Emergency Physicians and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Christopher I Doty, MD, FACEP, FAAEM, Assistant Professor of Emergency Medicine, Residency Program Director, Department of Emergency Medicine, Kings County Hospital Center, State University of New York Downstate Medical Center
Christopher I Doty, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Daniel J Dire, MD, FACEP, FAAP, FAAEM, Clinical Associate Professor, Department of Emergency Medicine, University of Texas-Houston
Daniel J Dire, MD, FACEP, FAAP, FAAEM is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, and Association of Military Surgeons of the US
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

David Eitel, MD, MBA, Associate Professor, Department of Emergency Medicine, York Hospital
David Eitel, MD, MBA is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

David FM Brown, MD, Assistant Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital
David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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