Arterial gas embolism

Background

• Due to negative intrathoracic pressure from spontaneous breathing
• May be fatal when air entry reaches 200-300 mL (pressure gradient of 5 mmHg across 14 ga catheter entrains air at 100 mL/sec)
• Prevention is most important
  • Positive pressure mechanical ventilation reduces positive pressure gradient
  • Trendelenburg for insertion/removal of IJV and subclav lines
  • Reverse Trendelenburg for femoral

Clinical Features

• Acute dyspnea, chest tightness, LOC, cardiac arrest

Differential Diagnosis

Dialysis Complications

• Dialysis-associated hypotension
• Dialysis disequilibrium syndrome
• Air embolism
• Missed dialysis (pulmonary edema)

Management

• Prevent any further air entry
• Immediately cover puncture site with saline soaked gauze
• Hemodynamic support with positive inotropes
• Rapid CPR in large air embolus

Disposition

• Treat w/ 100% NRB

See Also

• Dialysis complications