Critical Care Pearls Quotes

“Venous Air Embolism is a rare but potentially fatal complication of central line insertion in the upper body area and could be prevented with trendelenburg positioning (at least 15 degrees), given no orthopnea. In case, Venous Air Embolism is suspected during line procedure with symptoms of sudden occurrence of cardiopulmonary dysfunction like hypotension, hypoxia or churning murmur over the left sternal border (“millwheel murmur”) - following 7 immediate maneuvers 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. Enhance (or do if not done yet) Trendelenburg position - to help air trapped 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 (catecholamine are preferred).”
― Iqbal Ratnani, Critical Care Pearls: Basics for critical patient care and board review