Saturday October 29, 2005
Venous Air Embolism - VAE - immediate maneuvers

If Venous Air Embolism is suspected during line procedure with symptoms of sudden occurrence of cardiopulmonary dysfunction like hypotension, hypoxia or churning murmur over left sternal border ( "millwheel murmur" ) - following 7 steps are essential:

1. Clamp the line (do not withdraw) - to prevent further air.

2. Rotate patient to left lateral decubitus position - to decrease air leaving through RV outflow tract.

3. Place patient in Trendelenburg position - to help air trap in the apex of the ventricle.

4. Increase oxygen to 100% - Supplemental oxygen reduces the size of embolus. (Avoid High PEEP as it may increase the risk of paradoxical emboli).

5. Advance the catheter little, unclamp the line and aspirate from the 'distal port' to attempt to remove air. (PA-catheter is not as effective as triple lumen catheter in aspirating air).

6. If hypotension occurs - start IVF wide open and add pressor if needed (catecholamines are prefered).

7. Continue supportive treatment till air is absorbed or further management for complications like paradoxical emboli or hyperbaric oxygen therapy is planned.

Refrences: Click to get abstract/article.

1. Venous Air Embolism - emedicine.com
2. Gas Embolism - NEJM, feb. 2000, Volume 342:476-482
3. Venous air embolism: a review. J Clin Anesth 1997;9:251-257
4. Venous Air embolism - Rashad Net University