Venous Air Embolism Follow-up

  • Author: Brenda Liz Natal, MD; Chief Editor: David FM Brown, MD   more...
 
Updated: Jul 27, 2009
 

Further Inpatient Care

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

  • Consider transfer to a hyperbaric medicine center for symptomatic venous air embolism.
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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
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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, State University of New York Downstate Medical Center

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.

Specialty Editor Board

Daniel J Dire, MD  FACEP, FAAP, FAAEM, Clinical Professor, Department of Emergency Medicine, University of Texas Medical School at Houston; Clinical Professor, Department of Pediatrics, School of Medicine, University of Texas Health Sciences Center San Antonio

Daniel J Dire, MD 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: Talecris Biotherapeutics Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David Eitel, MD, MBA  Associate Professor, Department of Emergency Medicine, York Hospital; Physician Advisor for Case Management, Wellspan Health System, York

David Eitel, MD, MBA is a member of the following medical societies: American College of Emergency Physicians, American Society of Pediatric Nephrology, Society for Academic Emergency Medicine, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

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  Associate 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.

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.

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