Air Embolism Symptoms and Management highlights common causes, risks, identification and best practices in preventing and treating intravenous air embolisms. Air embolisms can occur in the vein as a venous air embolism, or in an artery as an arterial air embolism. Both can be a complication of a variety of procedures – including surgeries, intravenous (IV) catheters, and trauma – and quick identification and clinically appropriate treatment is critical. Read to learn more about air embolisms and strategies healthcare providers can use to prevent them.
What is an Air Embolism?
Air Embolisms are a life-threatening complication that occurs when air enters the circulatory system. A venous air embolism refers to air that has entered a vein, while an arterial air embolism refers to air that has entered an artery. The most dangerous complication associated with air embolisms is the risk of the embolism travelling to other parts of the body, specifically the lungs, brain, and heart. Due to the severity of this potential complication, healthcare providers should always suspect an air embolism when patients experience sudden respiratory distress or neurological changes in presence of a potential cause such as IV catheters or barotrauma (damage caused by sudden changes in air or water pressure in the body). To confirm a diagnosis, clinicians use a variety of tools, including transesophageal echocardiograms (TEE), ultrasonography, electrocardiography (ECG/EKG), arterial blood gases, laboratory tests, end-tidal carbon dioxide, pulmonary artery catheterization, and imaging.
What Causes Air Embolisms?
There are many Causes of Air Embolisms, and they may vary depending on whether the air embolism is in a vein or artery. These include surgery, trauma, and IV catheters.
While most surgical procedures can present a risk of an air embolism, brain surgeries are the most common. If an air embolism occurs during surgery, trained clinicians can typically treat it before it becomes an issue. Trauma is another major cause of air embolisms, and typically occurs because of penetrating or blunt injuries. This includes barotrauma, a subset of trauma that is caused by pressure change injuries, usually mechanical ventilation and diving accidents. Finally, IV catheters pose a large risk of air embolism. This can be caused by damaged tubing or detachment of tubing, improper flushing (failure to remove the air in a saline flush), and incorrect priming (failing to push the air out of the tubing before attaching it to the IV infusion set).
What are the Signs and Symptoms of Air Embolisms?
The Signs and Symptoms of an Air Embolism can range from minor to life-threatening, depending on the type of air embolism, where it travels within the body, and the patient’s condition.
Venous Air Embolisms are more common and usually resolve on their own. However, if the effects are serious, symptoms usually present as dyspnea (shortness of breath), hypotension (low blood pressure), dizziness, crackles or wheezing sounds in the lungs, and/or hypoxemic respiratory failure (respiratory failure attributed to a lack of oxygen). These manifestations relate to pulmonary issues, as the embolism will usually travel through the veins to the heart, and out through the pulmonary artery. In rare cases, the embolism may pass through the lungs and into systemic circulation, where it can have broader and more severe effects.
In the event of an Arterial Air Embolism, symptoms will vary based on where in the body the embolism travels. It is important to note that there may be some overlap due to the interdependence of the vital organs, so clinicians should utilize the diagnostic tools highlighted in the previous section if they suspect this complication. Arterial air embolisms that travel to the nervous, circulatory, and pulmonary systems are the most dangerous types, and the signs and symptoms for these are highlighted below.
Impact on the Nervous System
If the arterial air embolism travels to and Impacts the Nervous System, it can block circulation and cause ischemia (an inadequate oxygen supply to the brain). If undetected and/or untreated, ischemia can progress to a stroke, which may cause permanent deficits in motor and sensory function for patients. Only 2-3 ml of air injected into cerebral circulation can be deadly, and as a result, air embolisms in the central nervous system are treated as an emergency. Other manifestations of an air embolism travelling to the nervous system are mental status changes (confusion and loss of consciousness) or seizures. If the patient is suffering a stroke, the “FAST” acronym (face, arms, speech, time) can also be used to identify symptoms.
Impact on the Circulatory System
Arterial air embolisms may also Impact the Circulatory System, and could present as hypotension, arrhythmias (irregular heart rhythms), chest pain, and more. Because this decreases heart function, other parts of the body may also have ischemia, which can lead to muscle and joint pains. The embolism may also cause inadequate perfusion to the heart (reduced flow of oxygen-rich blood to the tissues), leading to a myocardial infarction (heart attack). Heart attacks normally present as chest pain radiating to the left arm, shortness of breath, sweating, and an impending sense of doom. For women, these symptoms may differ and present as overwhelming fatigue, shortness of breath, and pain between the shoulder blades.
Impact on the Pulmonary System
Finally, arterial air embolisms may also Impact the Pulmonary System. Symptoms of this include shortness of breath, difficulty breathing, muscle and joint pains, fatigue, and, in late stages, cyanosis (blue tint to skin). This may progress to respiratory failure or damage to other organs and must also be treated as an emergency.
Can Air Embolisms be Prevented?
Education regarding preventative measures is vital to reducing the prevalence of air embolisms. To prevent barotrauma, air pressure for patients on mechanical ventilation should be minimized. In addition, rapid ascent during scuba diving without appropriate breathing techniques can pose a high risk due to the pressure changes. For neurosurgical or otolaryngologic surgeries where the patient is at high risk, healthcare providers should monitor for venous air embolisms with transesophageal or transthoracic echocardiograms (TEE/TTE). Finally, in the case of IV catheters, there are many precautions healthcare providers can take to reduce the incidence. Central line tubing should be bent and clamped anytime the system is opened, patients should be instructed to hold their breath during tubing changes (deep inspiration may force air in), and only high-quality catheters should be used to prevent the fracture and/or detachment of connections.
Treatment of Air Embolisms
If an air embolism is suspected, healthcare providers must act immediately. A code should be called, and the patient should be assessed using the “ABCs” method (airway, breathing, and circulation). If the patient requires any support (i.e. additional oxygen, ventilation, vasopressors, etc.), these must be given quickly. To prevent further embolization, healthcare providers should also reposition the patient. The left Trendelenburg or left lateral decubitus positions (lying on the left side with or without the feet elevated above the head) are used for a venous air embolism, and the supine position (lying flat on the back) is used for an arterial air embolism.
Air Embolism Causes, Prevention and Management; How Vascular Wellness Reduces the Risk of Air Embolisms
Vascular Wellness reduces the risk of air embolisms in a variety of ways. Our expert nurse clinicians are Vascular Access Board Certified (VA-BC), highly trained and specialized in the use and care of central venous catheters, and they undergo semiannual skill checks to ensure quality and consistency. Our 98%+ success rate and 0% insertion-related infection rate demonstrates our commitment to providing the highest quality, dependable vascular access and allows for peace of mind during insertion. Our clinicians’ expertise has also led to faster IV therapy, reduced hospital stays, and decreased readmissions. This supports patients by lessening the time they need to spend with a venous or arterial line, which removes one of the major causes of air embolism – IV catheters. Finally, we only use top-rated, hospital preferred supplies from Becton Dickinson (BD), formerly Bard. Both superior supplies and the education we provide to patients and their healthcare teams on proper care/maintenance of vascular access devices mitigates the risk of damaged tubing or tubing detachment, and thus, the possibility of developing an air embolism.
Vascular Wellness reduces the risk of air embolisms in a variety of ways. Our expert nurse clinicians are Vascular Access Board Certified (VA-BC), highly trained and specialized in the use and care of central venous catheters, and they undergo semiannual skill checks to ensure quality and consistency. Our 98%+ success rate and 0% insertion-related infection rate demonstrates our commitment to providing the highest quality, dependable vascular access and allows for peace of mind during insertion. Our clinicians’ expertise has also led to faster IV therapy, reduced hospital stays, and decreased readmissions. This supports patients by lessening the time they need to spend with a venous or arterial line, which removes one of the major causes of air embolism – IV catheters. Finally, we only use top-rated, hospital preferred supplies from Becton Dickinson (BD), formerly Bard. Both superior supplies and the education we provide to patients and their healthcare teams on proper care/maintenance of vascular access devices mitigates the risk of damaged tubing or tubing detachment, and thus, the possibility of developing an air embolism.
Curious about other IV Complications?
Click below to read about other potential complications of central lines:
What are the potential complications of a Central Line?
Like any medical procedure, the insertion of a Central Venous Catheter (CVC) can have potential complications. Such complications are severely mitigated when an experienced and trained clinician uses best practices like the clinicians at Vascular Wellness. While potential complications exist, there are tremendous benefits… READ MORE
Want to learn more about our extensive training?
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Vascular Access Services Training at Vascular Wellness
Vascular Wellness Vascular Access training is actual training, meaing in addition to classroom education, we offer simulation and hands-on training as part of our classes. Furthermore, our classes are taught by Vascular Access Board Certified (VA-BC) nurse clinician specialists and experts (not just educators)… READ MORE
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