When air enters the circulation it can cause an air embolism,
which can result in air bubbles that travel to the brain, heart or
lungs. The air bubbles can cause a heart attack, stroke, or
respiratory failure. These can occur in your arteries and
veins.
There a number of ways in which air emboli can be caused, but in a
clinical setting they are caused by injections, surgical procedures
or by way of a catheter inserted or taken out of the vein or
artery.
I have recently settled a case where my client's partner
suffered what was likely to be an air embolus entering the blood
stream after he was disconnected from a dialysis machine. He later
collapsed and sadly suffered a stroke. An MRI taken of his brain
showed that the likely cause of the stroke was an air embolism in
the brain.
It is noted in the Oxford text book of clinical nephrology
that:
" ...air embolism is one of the most serious
complication of haemodialysis...if air embolism occurs, it is
almost always due to human error."
There should be safety precautions in place to make sure that it is
impossible for an air bubble to enter the dialysis machine. Sadly,
this did not happen in my client's case. As a result of the air
embolism entering the blood stream my client's partner
sustained cerebral damage. The NHS Trust responsible for his care
made an admission of liability and wrote a letter of apology to my
client.
Air emboli are very dangerous to patients and can occur when a
central venous catheter or line is inserted or taken out. A central
venous catheter (CVC), also called a central line, is a long, thin,
flexible tube used to give medicines, fluids, nutrients, or blood
products over a long period of time, usually several weeks or more.
A catheter is often inserted in the arm or chest through the skin
into a large vein.
Later this week on 17 August an inquest will be heard into the
death of Mr Neil Shestopal whose CVC was removed whilst he
was sitting in an armchair in the London Clinic. After removal it
is claimed that he immediately suffered a cardiac arrest as a
result of an air embolism entering his circulation.
There are basic guidelines to comply with when removing CVC lines
to avoid an air embolism these are:
- Inform the patient
- Place the patient flat on their back, not sitting or upright.
- Instruct the patient to hold their breath and do a Valsalva manoeuvre , which means to blow air into your closed mouth on breathing out while the catheter is being taken out
- If the patient is not conscious or able to understand the instructions make sure you remove the catheter following inspiration
- Cover the insertion site straight away with a sterile dressing, keep firm manual pressure until haemostasis is achieved. The insertion site must be covered with an air-occlusive dressing, and should stay on the site for about 24-72 hours.
Patient safety is absolutely paramount and staff should, and must be, properly trained before they remove or insert CVC lines; without proper training, there is a real risk of stroke and death for the patient. These cases demonstrate how devastating this can be.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.