A M P Death by “air”ror RESENTATION AIR EMBOLISM · cerebral air embolism is 23%Heckmann 35% survived with severe neurologic deficits 38% with good or complete recovery True incidence

522015

1

1

Death by ldquoairrdquoror

How much is too much

Daphne Broadhurst RN BScN

President-Elect Canadian Vascular Access Association

Clinical Specialist Medical Pharmacies Ottawa

3

A MEDICAL PHARMACIES PRESENTATION

AIR EMBOLISM

Daphne Broadhurst RN BScN CVAA(c)

LONG TERM CARE PHARMACY SERVICES

1 Case Reports

2 How lethal is air When air turns bad

3 Itrsquos invisible- how do you know

4 Howrsquos the air getting in

5 Stop the air flow

6 No air allowed

LINE UP

5


522015

2



Air embolism is a rare potentially catastrophic and often underappreciated complication of vascular access devices

Entry of air into the venous or arterial vasculatureGorski Odowd

What is an AIR EMBOLISM

I

Case Reports

10


8 mth old jugular IV started for hydration

Family reported to nurse air bubbles seen in the line after nurse squeezed IV bag

Baby then screamed turned blue arrested and died

Cause of death cerebral air embolism

Kendyll Bliss

httpwwwsptimescom20030209ColumnsA_

couple_s_loss_may_oshtml

522015

3


4 wk old infant peripheral IV infusion via pump started

1 minute later IV set seen to be 23 empty

Levy

Cyanotic with grunting mottled skin and unmeasurable BP

Full recovery

Causation inadequate priming of administration set


14 yo boy received 2 infusions of pantolac in 100mL NS amp lactated ringers via peripheral IV

Autopsy revealed copious fine frothy red blood found in svc ivc neck veins heart sc emphysema over upper parts of body

Cause of death venous air embolism following iv infusionAgarwal


62 yo female with long-term PN via tunnelled silicone catheter

Turned in bed and ldquosuddenly felt generally uncomfortable with severe air hungerrdquo and became cyanotic but no other signssymptoms

Recovered rapidly with O2 8Lm and placement in left lateral decubitus position

Catheter was torn in 2 at a point between the sutures and the catheter hubHaavik


72 year-old patient unintentionally disconnected the cvad

Found unresponsive with severe tetraparesis and akinetic mutism with stable cardiopulmonary status

No neurologic improvement 3 months later Heckmann

522015

4


65 yo male 20 min after IJ CVAD removed up to bathroom to defecate

Found on floor unconscious uarrHRuarrPuarrBP diffuse wheezes amp crackles

Intubated Hyperbaric oxygen (Patent foramen ovale)

Hours later uarrcardiac outputuarrR uarrTdeg gthematemesis IJ site bleedinggt DIC

Several days later patient discharged home Kapoor T Gutierrez G Critical Care 20037(5)98-100 Retrieved from httpebookbrowsecom4-air-embolism-pdf-d218188205


James Tyree

53yo male treated for

stomach cancer

Dialysis catheter removed

Patient died from air

embolism during CVAD

removal


httpwwwromeomediacomcategoryLegal20

Marketingpage=5

httpwwwinsiderexclusivecomshow-

content289-medical-malpractice--the-narin-bun-

storyhtml

Nurse prepared to remove CVAD used to deliver antibiotics

Nurse inadvertently pulled catheter out causing air embolism

Narin Bun

Patient resuscitated catastrophic brain damage

HOW LETHAL IS AIR

Air Embolism

522015

5


DEATH BY AIR

httpdigitallibraryadelaideeduaudspacebitstr

eam244041890102wholepdf


Is it common Mortality rates due to catheters range

from 5-30Natal Bessereau

Mortality associated with CVAD-related cerebral air embolism is 23Heckmann

35 survived with severe neurologic deficits

38 with good or complete recovery

True incidence unknown Crude prevalence 265 cases per 100000 admissionsBessereau

Prognostic factors of mortality cardiac arrest ICU admissionBessereau


Incidence LONG TERM CARE PHARMACY SERVICES

httpswwwyoutubecomwatchv=oZ1_TA

wCUWw

522015

6


Right Heart Outflow Obstruction

bull cardiac output

bull Cardiovascular collapse MI


Pathophysiologyhellip

Air in R ventricle Turbulence

Inflammatory response

RBC platelets fibrin amp

fat globules

Endothelial damage

Ischemia

Pulmonary edema

httpebookbrowsecom2

001-11-28-code-blue-in-

the-ct-suite-air-embolism-

pdf-d159139478


It dependshellip

Location bull Point of entry bull Embolus lodges

Volume amp Rate

bull High volume bull High rate

Patient Variables

bull Position bull Cardiac amp lung fx bull + pressure gradient

How Much is Too Much LONG TERM CARE PHARMACY SERVICES

Size (amp rate) matters

522015

7


48 PIVs flushed with saline demonstrated small air emboli on CT in right heart pulmonary trunk and L brachiocephalic vein

Source air in syringe or cannulaGroell

Peripheral IV

Portal of

entry


How Much is Too Muchhellip

Atmospheric

pressure

Intrathoracic

pressure

darr Intrathoracic

pressure

bull Upright position

bull Dyspnea

bull Deep inspiration

bull Hypovolemia

+ Pressure

Gradient

Air entry is more likely if pressure in veins is below atmospheric pressure

Upright position particularly favours the rapid entry of air bubblesOdowd Andrews


The minimum volume of air lethal to humans is not yet knownToung Pant Agarwal

2 fatal cases of 100-200 mL air with 1 author stating lethal volume may be greater if normal cardiac functionToung

Infusion of 50 mL in healthy patients has been reported to cause hypotension dysrhythmias and sometimes deathTorres

Volume


Rate


Volume How Much is Too Muchhellip

It has been estimated from studies with dogs that as little as 20 mLsec of air will be associated with symptoms of air embolism and 70 to 150 mLsec or 3-5 mlkg of air can be fatalECRI Mirski Natal Wilkins Pant

It has been suggested that the heart may be able to withstand large quantities of air if injected slowly as dogs have been able to withstand up to 1400 mL of air over a several-hour period

MirskI Groell

Exposing an opened IV line for only a second (ie when disconnecting tubing or changing the needleless connector) can let in 100mL of airMasoorli

The closer the entry into the venous system to the right heart is and the faster the air entry the smaller the amount of air is needed to cause a fatal outcomeMirskI Natal von Jurgenson

Rate

522015

8



Infusion-related Air Embolism

Little available data in relation to how much air is tolerated through an infusion system The passage of a few air bubbles into the patient is a common occurrence with no substantial evidence of adverse consequences

Pump air detector standard = 05mL71mm

Suggested lethal volume of ~225 mL in healthy adult is equivalent to gt1 m air bubble in standard IV tubingWilkins

Rate


A 2 or 3 mL bolus of air in the cerebral circulation can be fatal

As little as 05 mL of air in a coronary artery can cause ventricular fibrillation NataL von Jurgenson Levy

Tiny but lethal

A small air embolus can be fatal

Volume


Patent Foramen Ovale (PFO)

10-35 of patients have a subclinical PFO


Arterial Air Embolism

The lungs are able to filter air to prevent the air from travelling from the venous to arterial circulation up to a threshold of about 035 mLkgmin

after which air cannot be filtered and may enter arterial system with arterial bubbles detected in 50 of patients where air entry exceeds this threshold Wilkins

522015

9


Arterial Air Embolism LONG TERM CARE PHARMACY SERVICES

PFO Increasing the risk of air embolism

40 of 26 cases of cerebral air embolism patients had a patent foramen ovale

1531 patients with neurological symptoms following air embolism had right-to-left shunting via intrapulmonary shunt or patent foramen ovaleWilkins Besserau

05 mL has been reported as lethal in the left-side arterial circulationPant



ITrsquoS INVISIBLE- HOW DO YOU KNOW

Air Embolism

522015

10


Respiratory

Dyspnea

Tachypnea

Cough

Hypoxia

Wheezing

Signs amp Symptoms

Cardiac

Chest pain

Hypotension

Cyanosis

Tachycardia

Tachyarrhythmia bradyarrhthymia

PAH

Ward Armstrong Haavik Natal Ruskin Pant Andrews Odowd

Subclinical to mild to catastrophic SS


Respiratory

Cardiac

Signs amp Symptomshellip

CNS (cerebral arterial embolism) Heckmann

Sense of impending doom

Focal Lesions

Hemiparesis

Loss of vision

Mortality rate 8

Encephalopathic

Acute confusional state

Decreased consciousness

Coma

Seizures

Akinetic mutism

High mortality rate - 36 Ward Haavik Heckmann Odowd Natal Odowd Feil


CNS


Likely to suffer long-term neurological deficits if present on ICU admission with

focal motor deficits

Babinski sign

On mechanical ventilation of 5 days or more

(OR = 1278 398ndash4109 OR = 676 224ndash 2033 OR = 1514 292ndash7852 respectively) Bessereau

Ward Haavik Heckmann Odowd Natal Odowd Feil


Financial Consequences

httpwwwsafeinfusiontherapycomcpsrdex

chghc-safeinfusion-en-inthsxsl7241html

522015

11


Air Embolism Liability

Bhananker


Anesthesiology legal claimsBhananker

Peripheral vascular catheters =2 of claims

Air embolism one of the most common complications ndash 8

Air embolism claims had highest median payment and a rate of 100 payment-per-claim

($325000 2007 with a range of $25800ndash $4120200)

Financial Consequenceshellip


httpwwwmlivecomnewsgrand-

rapidsindexssf201208parents_sue_devos_childrens_hohtml

HOWrsquoS THE AIR GETTING IN

Air Embolism

522015

12


Type of VADs

CVAD PIV

55


feil


VADs accounted for 14 gas embolism (n=29125 at Hyperbaric oxygen center)Besserreau

Removal (n=9)

Accidental removal (n=8)

Manipulation and usual care (n=7)

Insertion (n=5)

Peripheral venous catheterization (n=2)

Causes of Air Embolism

522015

13


ACCIDENTAL DISCONNECTION

Cause of almost half of cerebral air embolism cases in a review of 1426 published case reports (1975-1998)Heckmann

Air embolism due to catheter disconnection has a mortality rate between 29 and 43


Air embolism caused by a laceration to

central venous catheter during shaving Pearson

Causes of Air Embolismhellip


Ward


Ward


httpwwwfdagovMedicalDevicesSafetyAlertsandNoticesTubingandLuerM

isconnectionsucm313275htm


522015

14


CASE STUDY

An ER patient had an IV heparin lock but no IV fluids had been started The

patient also had a noninvasive automatic BP cuff placed for continuous

monitoring

The BP cuff tubing was disconnected when the patient went to the bathroom

When she returned her spouse mistakenly connected the BP cuff tubing to the

IV catheter and approximately 15 mL of air was delivered to the IV catheter

The patient died from a fatal air embolus despite resuscitation efforts

Causeshellip LONG TERM CARE PHARMACY SERVICES

Causes


Improper priming of administration set (4 fatal cases in literature)

Air vented bottles

Fluid infusions that are finished

Fluid infusions with rapid infusion through an air-filled drip chamber and the administration set remains open pose threats for air entrySingh Gardner von Jurgenson

(A one-litre sized crystalloid IV infusion bag can contain up to 60 mL of air)Schnoor

Rate

STOP THE FLOW

Air Embolism


Early detection and treatment are critical to prevent or minimize cardiovascular pulmonary and neurologic damageAndrew

Stop air entryWilkins Garg Heckman

Notify MD Call 911 if in alternate care setting stay with patient and provide reassurance von

Jurgenson Natal

Left lateral decubitus and trendelenburg position

Treatment

522015

15


100 O2 artificial ventilation with airbagendotracheal intubation

CPR closed cardiac massage

Fluid resuscitation (to increase intravascular volume venous pressure and venous return)Levy Clark Natal

Inotropic support (eg dobutamine) if cardiovascular collapse to increase CVPMirski Feil

Aspiration of air through distal lumen of CVP line or pulmonary artery catheter if catheter already in placePant Garg Odowd

Treatmenthellip LONG TERM CARE PHARMACY SERVICES

Hyperbaric oxygen therapy which is the main therapy for massive arterial air embolism preferably initiated within 3-5 hours of the event (reduces size of air bubbles accelerates nitrogen resorption and increases oxygen content of arterial blood) AndrewsTorres Heckman Mirski

Diagnostic measures include ABGs CXREKG pulse oximetry ventilation-perfusion scan CT of chest and head echocardiography pulmonary artery catheter Andrews Heckman Natal

Treatmenthellip

NO AIR ALLOWED

Air Embolism

AIR


Insertion of VADS

Hydrate patient prior to insertion to correct hypovolemia whenever possible Feil

Occlude needle hub and catheter during insertion removalMirskiNatal

PREVENTION

Education practice guidelines amp protocols

522015

16


During CVAD insertion stop ventilation during insertion of needle increase right atrial pressure during tunnelling of catheterMirski

During peripheral cannulation and removal place the arm below the level of the heartBBraun

PREVENTION LONG TERM CARE PHARMACY SERVICES

Care amp Maintenance of VADS

Minimize IV manipulationsGroel

Supine or Trendelenburg position during daily management of scalp vein infusionFortrat

Remove air from add-on devices (syringes tubings needleless connectors stopcocks and all other devices added to the catheter)INS Wilkins Ensure stopcocks that are not in use are switched off and covered with a Luer-Lok capneedleless devicevon Jurgenson

Always use luer-lock connections to avoid accidental disconnectionsPant von Jorgenson INS

PREVENTIONhellip


Care amp Maintenance of VADs Air detectorsfilters

Air sensors in infusion pumps Wilklins Pant ECRI Feil Adult infusion systems should be designed to prevent infusion of volumes of air gt50 μL in normal use and to prevent infusion of volumes of air gt1 mL in failure mode The smallest volume of air possible for neonates with a maximum air infusion volumes of 10 μL in failure modeWilkins

Air elimination filter on administration setsWilkins

Gardner Feil

PREVENTIONhellip LONG TERM CARE PHARMACY SERVICES

Care amp Maintenance of VADS Priming

Careful filling and handling of administration sets and thorough priming of filters (with filter in proper position) as per manufacturerrsquos guidelinesGardner Wilkins von Jurgenson

Check for air bubbles prior to starting the infusion

Close clamps of the administration set prior to priming then spike the fluid container and gently squeeze the drip chamber until it is half-filledvon Jurgenosn

If a burette is used ensure the tubing btw containerbag and burette is clamped offvon Jurgenson

Remove air from infusion bags when infusing fluids using inflatable pressure infusors Feil

PREVENTIONhellip

522015

17


Care amp Maintenance Priminghellip

If the set has a roller clamp move

it up to the drip chamber

close the clamp

spike the bag

half-fill the drip chamber

open the clamp and prime the lineDick

Preventionhellip

httpwwwjemscomarticlepatient-

carebubbles-air-proofing-your-iv-l


Care amp Maintenance Infusion

Inspect all parts of the infusion system for defects damage or leakagevon Jurgenson

Ensure administration set junctions are secure especially before patients get out of bedGorski

Check the infusion system regularly for air bubbles empty solution container (containers should not run dry) iv tubing that runs dry leakage or disconnectionon

Jurgenson

Close tubing clamps prior to changing fluid containersvon

Jurgenson

Clamp off air-vented containers before they are completely empty von Jurgenson

PREVENTIONhellip


Care amp Maintenance of VADS Air in line

Remove any air bubbles in an infusion system detected during infusion using a syringe at a downstream injection site (or alternatively by disconnecting the infusion set an allowing free flow to clear the air bubble although this may increase the infection risk due to the disconnection) On occasion it may be preferable to discard the entire system and start again In rare circumstances it may be necessary to use a new set to re-spike the infusion bag but this should be avoided ldquoInfrequent tiny pin head bubbles even though not desirable can be left without action but should be monitoredrdquo von Jorgenson



Never using scissors near the venous access device as this could result in accidental severing of the catheterGorski

Avoid the use of hemostats which can crack the catheter hubAndrews

Careful observation during shaving if a cvad is in the neckSchimp

PREVENTIONhellip

522015

18


Care amp Maintenance of VADS Patient Education

catheter displacement and disconnection

to properly prime tubing

to check connections frequently

to clamp the CVAD at appropriate times

to avoid the use of sharp objects (such as scissors) near the catheter

to avoid pulling on the line

how to manage air embolism

AndrewsINS Gorski


Removal of VADS

Place the patient in the Trendelenburg position when possible (although this is somehat controversial in the literature) If not possible the supine position is sufficientFeil

Position the catheter exit site (eg neck arm) at a height lower than the height of the patientrsquos heartFeil

PREVENTIONhellip


Removal of VADS

Instruct the patient to hold his or her breath and perform a Valsalva maneuver as the last portion of the catheter is removed

If Valsalva contraindicated with aortic stenosis recent myocardial infarction glaucoma and retinopathy ensure that a catheter clamp is present before changing administration sets or needleless connectors and time the removal during patient expirationINS Feil


Removal of VADs

Place digital pressure on the site until hemostasis is achieved One to five minutes is suggestedFeil

Apply a sterile occlusive dressing upon CVAD or scalp vein removal such as gauze impregnated with petroleum jelly or an antiseptic ointment and cover with a transparent film dressing (a dressing alone or gauze and a dressing is not occlusive)

Leave dressing in place for at least 24 hours Change the dressing every 24 hours until the exit site has healed ( a scab has formed)

Instruct the patient to remain lying flat for 30 minutes after removal of the catheter Feil

Schlimp Natal Mirski INS Feil Masoorli Fortrat Clark

PREVENTIONhellip

522015

19


lsquolsquoNo medical tragedy is greater than the

avoidable iatrogenic death

Perhaps saddest of all is the occurrence

of venous air embolism which is almost

always the result of a therapeutic error or

carelessness

There is no instance in which a needle is placed

in the venous system when the hazard of air

embolism does not existrsquorsquo Sowell et al

SUMMARY

Incidence of air embolism may be low and likely most cases

may be subclinical

Potential for severe neurologic respiratory and cardiovascular

morbidity and mortality with high mortality rates attributed to

CVAD-related air embolism ranging from 23-50Feil Natal The

clinical relevance of a small air embolism is uncertain as is the

amount of air required to cause harm

Any patient with a vascular access may be at a higher risk than

expected due to the incidence of silent patent foramen ovale

increasing the risk of even a small amount of air entry

Healthcare professionals and carers manipulating vascular

access devices must be aware of the danger of air embolism

and adopt good practice to identify and manage air embolism

and keep air out of our patientsrsquo lines

AIR


References

Sowell MW Lovelady CL Brogdon BG Wecht CH Infant death due to air embolism

from peripheral venous infusion J Forensic Sci 200752(1)183-8

Levy I Mosseri R Garty B Peripheral intravenous infusionmdashanother cause of air

embolism Acta Paediatr 200685(3)385ndash6

Fortrat JO Saumet M Savagner C Leblanc M Bouderlique C Bubbles in the brain

veins as a complication of daily management of a scalp vein catheter Am J

Perinatol 200522(7)361-3

Torres Martiacutenez FJ Kuffler DP Hyperbaric oxygen treatment to eliminate a large

venous air embolism a case study Undersea Hyperb Med 201138(4)297-304

Haavik PE Steen PA Air embolism caused by rupture of a silicone-central venous

catheter Journal of Parenteral and Enteral Nutrition19848(5)579-580

Agarwal SS Lavlesh Kumar Krishnadutt Harishankar Chavali Shashidhar

Chennamallapa Mestri Fatal venous air embolism following intravenous infusion

Journal of Forensic Sciences 200954(3)682-4

Insider Exclusive Medical Malpractice ndash The Narin Bun Story 2011 Retrieved from

httpwwwinsiderexclusivecomshow-content289-medical-malpractice--the-narin-bun-

storyhtml

Heckmann JG Lang CJG Kindler KHuk W Erbguth FJ Neundoumlrfer B Neurologic

manifestations of cerebral air embolism as a complication of central venous

catheterization Critical Care Medicine 200028(5)1621-1625

Unsure which is first and last name therefore not abbreviated

522015

20


Feil M Reducing risk of air embolism associated with central venous access devices PA

Safety Advisory 2012 Jun9(2)58-64 Retrieved from

httppatientsafetyauthorityorgADVISORIESAdvisoryLibrary2012Jun9(2)Pages58asp

x

Clark DK Plaizier E Devastating cerebral air embolism after central line removal J

Neurosci Nurs 201143(4)193-6 quiz 197-8

Gorski L Reducing the Risk of Air Embolism Journal of Infusion Nursing 2009 32(2)71-

72

Odowd LC Kelley MA Air Embolism Retrieved from

httpcmbibjmueducnuptodatecritical20careembolic20diseaseair20embolismhtm

or 2009 Accessed at httpwwwuptodatecomcontentsair-

embolismsource=search_resultampselectedTitle=1257E71

Canadian Agency for Drugs and Technologies in Health Risk of Air Embolus for Air in

Intravenous Tubing Clinical Evidence and Guidelines 13 October 2010 Retrieved from

httpwwwcadthcamediapdfJ0481_Risk_Embolus_with_IV_Tubing_HTIS-1pdf

Bessereau J Genotelle N Chabbaut C Huon A Tabah A Aboab J Chevret S Annane D

Long-term outcome of iatrogenic gas embolism Intensive Care Med 201036(7)1180-7

Vesely TM Air embolism during insertion of central venous catheters J Vasc Interv Radiol

2001 121291ndash5

Groell R Schaffler GJ Rienmueller R The peripheral intravenous cannulamdash a cause of

venous air embolism Am J Med Sci1997314(5)300ndash2 Retrieved from

httpjournalslwwcomamjmedsciAbstract199711000The_Peripheral_Intravenous_Can

nula__A_Cause_of6aspx


Garg N Moorthy N Goel PK Intracardiac aspiration for life-threatening air embolism

during cardiac catheterization in tetralogy of fallot an aborted sudden death Journal of

Invasive Cardiology 201224(11)E294-E296 Retrieved from

httpwwwinvasivecardiologycomarticlesintracardiac-aspiration-life-threatening-air-

embolism-during-cardiac-catheterization-tetral

Natal BL Venous Air Embolism [online] Medscape April 16 2012 Retrieved from

httpemedicinemedscapecomarticle761367-overview

Andrews C Preventing air embolism emergency management related to central venous

catheterization American Journal of Nursing 2002102(1)34-36

Armstrong RF Peters JL Cohen SL Air embolism caused by fractured central-venous

catheter Lancet 1977 April 30954 Letter to the editor

Infusion Nurses Society (INS) Infusion nursing standards of practice 2011 Hagerstown

(MD) INS

Mirski MA Lele AV Fitzsimmons L et al Diagnosis and treatment of vascular air

embolism Anesthesiology 2007106(1)164-77

Pant D Kumar Narani K amp Sood J Significant air embolism a possibility even with

collapsible intravenous fluid containers when used with rapid infuser system Indian J

Anaesth 201054(1) 49ndash51 Retrieved from

httpwwwncbinlmnihgovpmcarticlesPMC2876914

Ward MK Shadforth M Hill AV Kerr DN Air embolism during haemodialysis Br Med J

1971 3(5766)74-8


Ruskin KJ Venous Air Embolism[online] 30 July 1996 Retrieved from

httpanestitunipaitgtavaehtml

Madden B Paruchuru P Kunst H Sucking noise and collapse after central venous

catheter removal J R Soc Med 200093(11)592-3 Retrieved from


Schlimp CJ Loimer T Schmidts MB Rieger M Lederer W Venous air embolism through

central venous access BMJ Case Rep 2009 Jun 26 Retrieved from

httppubmedcentralcanadacaarticlerendercgiaccid=PMC3029402

Willis J Duncan C Gottschalk S Paraplegia due to peripheral venous air embolus in a

neonate a case report Pediatrics 198167(4)472-3

Novack V Shefer A Almog Y Images in cardiology Coronary air embolism after removal

of central venous catheter Heart 200692(1)39

von Juumlrgensonn S Prevention and management of air in an IV infusion system Br J

Nurs 2010 2719(10)S28-S30

ECRI Institute Air embolism through central venous catheters Hazard [Health Devices

Dec 198514(14)436-7] Retrieved from

httpwwwmdsrecriorgsummarydetailaspxdoc_id=8149

Alexander M Corrigan A GorskiL et al editors Infusion Nursing An Evidence-Based

Approach 3rd edn St LouisMO ElsevierSaunders 2010

Singh H Tewari A Kaur B Garg S U turn to venous air embolism Indian J Crit Care

Med 200913(2)92-3

Bajanowski T Kohler H DuChense A Koops E Brinkmann B Proof of air embolism

after exhumation Int J Legal 19981122-7

Wilkins R Unverdorben M Accidental intravenous infusion of air a concise review

Journal of Infusion Nursing 201235(6)404-408


Bhananker SM Liau DW Kooner PK Posner KL Caplan RA Domino KB Liability

related to peripheral venous and arterial catheterization a closed claims analysis

Anesth Analg 2009109(1)124-9

Gardner RM Bond EL Clark JS Safety and efficacy of continuous flush systems for

arterial and pulrnonary artery catheters The Annals of Thoracic Surgery 1977 23 (6)

534-538 Retrieved from httpatsctsnetjournalsorgcgireprint236534

Schnoor J Macko S Weber I Rossaint R The air elimination capabilities of pressure

infusion devices and fluid-warmers Anaesthesia 200459(8)817ndash821 Retrieved from

httponlinelibrarywileycomdoi101111j1365-2044200403841xfull

Yeakel AE Lethal air embolism from plastic blood-storage container

JAMA 1968204(3)267-9

Perivascular Nurse Consultants Air Embolism A Silent Killer Presented at the 22nd

Annual Scientific Meeting of the Association for Vascular Access Sept 2008 Savannah

Georgia Retrieved from httpwwwavainfoorgwebsitedownloadaspid=205574

Masoorli S Air embolism RN Magazine 199962(11)32-34

Toung TK Rossber MI Hutchins GM Volume of air in a lethal venous air embolism

Anesthesiology 200194(2)360-361 Retrieved from

httpjournalslwwcomanesthesiologypagesarticlevieweraspxyear=2001ampissue=020

00amparticle=00031amptype=fulltext

BBraun Air Embolism Risk Prevention in Infusion Therapy [online] B Braun

Melsungen AG 032011 Retrieved from

httpfrancaisbbraunchdocumentsKnowledgeContent_Wissen_Risikopraevention_Inf

usionstheraphie_Air_Embolismpdf

Dick T Bubbles air-proofing your IV lines-pronto JEMS 200934(2)32

Infusion Nurses Society Policies and Procedures for Infusion Nursing 4th edition2011

522015

2



Air embolism is a rare potentially catastrophic and often underappreciated complication of vascular access devices

Entry of air into the venous or arterial vasculatureGorski Odowd

What is an AIR EMBOLISM

I

Case Reports

10


8 mth old jugular IV started for hydration

Family reported to nurse air bubbles seen in the line after nurse squeezed IV bag

Baby then screamed turned blue arrested and died

Cause of death cerebral air embolism

Kendyll Bliss

httpwwwsptimescom20030209ColumnsA_

couple_s_loss_may_oshtml

522015

3




Levy


Full recovery















522015

4








James Tyree


stomach cancer




removal



Marketingpage=5



storyhtml



Narin Bun


HOW LETHAL IS AIR

Air Embolism

522015

5


DEATH BY AIR














wCUWw

522015

6



bull cardiac output







fat globules

Endothelial damage

Ischemia

Pulmonary edema

httpebookbrowsecom2



pdf-d159139478


It dependshellip


Volume amp Rate


Patient Variables




522015

7




Peripheral IV

Portal of

entry



Atmospheric

pressure

Intrathoracic

pressure

darr Intrathoracic

pressure


bull Dyspnea


bull Hypovolemia

+ Pressure

Gradient







Volume


Rate





MirskI Groell



Rate

522015

8







Rate




Tiny but lethal


Volume








522015

9










Air Embolism

522015

10


Respiratory

Dyspnea

Tachypnea

Cough

Hypoxia

Wheezing

Signs amp Symptoms

Cardiac

Chest pain

Hypotension

Cyanosis

Tachycardia


PAH




Respiratory

Cardiac




Focal Lesions

Hemiparesis

Loss of vision

Mortality rate 8

Encephalopathic



Coma

Seizures

Akinetic mutism



CNS




Babinski sign








522015

11



Bhananker












Air Embolism

522015

12


Type of VADs

CVAD PIV

55


feil



Removal (n=9)



Insertion (n=5)



522015

13










Ward


Ward





522015

14


CASE STUDY



monitoring






Causes



Air vented bottles




Rate

STOP THE FLOW

Air Embolism





Jurgenson Natal


Treatment

522015

15










Treatmenthellip

NO AIR ALLOWED

Air Embolism

AIR


Insertion of VADS



PREVENTION


522015

16










PREVENTIONhellip





Gardner Feil








PREVENTIONhellip

522015

17





close the clamp

spike the bag



Preventionhellip








Jurgenson


Jurgenson


PREVENTIONhellip









PREVENTIONhellip

522015

18










AndrewsINS Gorski


Removal of VADS



PREVENTIONhellip


Removal of VADS




Removal of VADs






PREVENTIONhellip

522015

19







carelessness




SUMMARY


may be subclinical













AIR


References







Perinatol 200522(7)361-3










storyhtml





522015

20





x




72











2001 121291ndash5


















(MD) INS








1971 3(5766)74-8















Nurs 2010 2719(10)S28-S30







Med 200913(2)92-3








Anesth Analg 2009109(1)124-9








JAMA 1968204(3)267-9















522015

3




Levy


Full recovery















522015

4








James Tyree


stomach cancer




removal



Marketingpage=5



storyhtml



Narin Bun


HOW LETHAL IS AIR

Air Embolism

522015

5


DEATH BY AIR














wCUWw

522015

6



bull cardiac output







fat globules

Endothelial damage

Ischemia

Pulmonary edema

httpebookbrowsecom2



pdf-d159139478


It dependshellip


Volume amp Rate


Patient Variables




522015

7




Peripheral IV

Portal of

entry



Atmospheric

pressure

Intrathoracic

pressure

darr Intrathoracic

pressure


bull Dyspnea


bull Hypovolemia

+ Pressure

Gradient







Volume


Rate





MirskI Groell



Rate

522015

8







Rate




Tiny but lethal


Volume








522015

9










Air Embolism

522015

10


Respiratory

Dyspnea

Tachypnea

Cough

Hypoxia

Wheezing

Signs amp Symptoms

Cardiac

Chest pain

Hypotension

Cyanosis

Tachycardia


PAH




Respiratory

Cardiac




Focal Lesions

Hemiparesis

Loss of vision

Mortality rate 8

Encephalopathic



Coma

Seizures

Akinetic mutism



CNS




Babinski sign








522015

11



Bhananker












Air Embolism

522015

12


Type of VADs

CVAD PIV

55


feil



Removal (n=9)



Insertion (n=5)



522015

13










Ward


Ward





522015

14


CASE STUDY



monitoring






Causes



Air vented bottles




Rate

STOP THE FLOW

Air Embolism





Jurgenson Natal


Treatment

522015

15










Treatmenthellip

NO AIR ALLOWED

Air Embolism

AIR


Insertion of VADS



PREVENTION


522015

16










PREVENTIONhellip





Gardner Feil








PREVENTIONhellip

522015

17





close the clamp

spike the bag



Preventionhellip








Jurgenson


Jurgenson


PREVENTIONhellip









PREVENTIONhellip

522015

18










AndrewsINS Gorski


Removal of VADS



PREVENTIONhellip


Removal of VADS




Removal of VADs






PREVENTIONhellip

522015

19







carelessness




SUMMARY


may be subclinical













AIR


References







Perinatol 200522(7)361-3










storyhtml





522015

20





x




72











2001 121291ndash5


















(MD) INS








1971 3(5766)74-8















Nurs 2010 2719(10)S28-S30







Med 200913(2)92-3








Anesth Analg 2009109(1)124-9








JAMA 1968204(3)267-9















522015

4








James Tyree


stomach cancer




removal



Marketingpage=5



storyhtml



Narin Bun


HOW LETHAL IS AIR

Air Embolism

522015

5


DEATH BY AIR














wCUWw

522015

6



bull cardiac output







fat globules

Endothelial damage

Ischemia

Pulmonary edema

httpebookbrowsecom2



pdf-d159139478


It dependshellip


Volume amp Rate


Patient Variables




522015

7




Peripheral IV

Portal of

entry



Atmospheric

pressure

Intrathoracic

pressure

darr Intrathoracic

pressure


bull Dyspnea


bull Hypovolemia

+ Pressure

Gradient







Volume


Rate





MirskI Groell



Rate

522015

8







Rate




Tiny but lethal


Volume








522015

9










Air Embolism

522015

10


Respiratory

Dyspnea

Tachypnea

Cough

Hypoxia

Wheezing

Signs amp Symptoms

Cardiac

Chest pain

Hypotension

Cyanosis

Tachycardia


PAH




Respiratory

Cardiac




Focal Lesions

Hemiparesis

Loss of vision

Mortality rate 8

Encephalopathic



Coma

Seizures

Akinetic mutism



CNS




Babinski sign








522015

11



Bhananker












Air Embolism

522015

12


Type of VADs

CVAD PIV

55


feil



Removal (n=9)



Insertion (n=5)



522015

13










Ward


Ward





522015

14


CASE STUDY



monitoring






Causes



Air vented bottles




Rate

STOP THE FLOW

Air Embolism





Jurgenson Natal


Treatment

522015

15










Treatmenthellip

NO AIR ALLOWED

Air Embolism

AIR


Insertion of VADS



PREVENTION


522015

16










PREVENTIONhellip





Gardner Feil








PREVENTIONhellip

522015

17





close the clamp

spike the bag



Preventionhellip








Jurgenson


Jurgenson


PREVENTIONhellip









PREVENTIONhellip

522015

18










AndrewsINS Gorski


Removal of VADS



PREVENTIONhellip


Removal of VADS




Removal of VADs






PREVENTIONhellip

522015

19







carelessness




SUMMARY


may be subclinical













AIR


References







Perinatol 200522(7)361-3










storyhtml





522015

20





x




72











2001 121291ndash5


















(MD) INS








1971 3(5766)74-8















Nurs 2010 2719(10)S28-S30







Med 200913(2)92-3








Anesth Analg 2009109(1)124-9








JAMA 1968204(3)267-9















522015

5


DEATH BY AIR














wCUWw

522015

6



bull cardiac output







fat globules

Endothelial damage

Ischemia

Pulmonary edema

httpebookbrowsecom2



pdf-d159139478


It dependshellip


Volume amp Rate


Patient Variables




522015

7




Peripheral IV

Portal of

entry



Atmospheric

pressure

Intrathoracic

pressure

darr Intrathoracic

pressure


bull Dyspnea


bull Hypovolemia

+ Pressure

Gradient







Volume


Rate





MirskI Groell



Rate

522015

8







Rate




Tiny but lethal


Volume








522015

9










Air Embolism

522015

10


Respiratory

Dyspnea

Tachypnea

Cough

Hypoxia

Wheezing

Signs amp Symptoms

Cardiac

Chest pain

Hypotension

Cyanosis

Tachycardia


PAH




Respiratory

Cardiac




Focal Lesions

Hemiparesis

Loss of vision

Mortality rate 8

Encephalopathic



Coma

Seizures

Akinetic mutism



CNS




Babinski sign








522015

11



Bhananker












Air Embolism

522015

12


Type of VADs

CVAD PIV

55


feil



Removal (n=9)



Insertion (n=5)



522015

13










Ward


Ward





522015

14


CASE STUDY



monitoring






Causes



Air vented bottles




Rate

STOP THE FLOW

Air Embolism





Jurgenson Natal


Treatment

522015

15










Treatmenthellip

NO AIR ALLOWED

Air Embolism

AIR


Insertion of VADS



PREVENTION


522015

16










PREVENTIONhellip





Gardner Feil








PREVENTIONhellip

522015

17





close the clamp

spike the bag



Preventionhellip








Jurgenson


Jurgenson


PREVENTIONhellip









PREVENTIONhellip

522015

18










AndrewsINS Gorski


Removal of VADS



PREVENTIONhellip


Removal of VADS




Removal of VADs






PREVENTIONhellip

522015

19







carelessness




SUMMARY


may be subclinical













AIR


References







Perinatol 200522(7)361-3










storyhtml





522015

20





x




72











2001 121291ndash5


















(MD) INS








1971 3(5766)74-8















Nurs 2010 2719(10)S28-S30







Med 200913(2)92-3








Anesth Analg 2009109(1)124-9








JAMA 1968204(3)267-9















522015

6



bull cardiac output







fat globules

Endothelial damage

Ischemia

Pulmonary edema

httpebookbrowsecom2



pdf-d159139478


It dependshellip


Volume amp Rate


Patient Variables




522015

7




Peripheral IV

Portal of

entry



Atmospheric

pressure

Intrathoracic

pressure

darr Intrathoracic

pressure


bull Dyspnea


bull Hypovolemia

+ Pressure

Gradient







Volume


Rate





MirskI Groell



Rate

522015

8







Rate




Tiny but lethal


Volume








522015

9










Air Embolism

522015

10


Respiratory

Dyspnea

Tachypnea

Cough

Hypoxia

Wheezing

Signs amp Symptoms

Cardiac

Chest pain

Hypotension

Cyanosis

Tachycardia


PAH




Respiratory

Cardiac




Focal Lesions

Hemiparesis

Loss of vision

Mortality rate 8

Encephalopathic



Coma

Seizures

Akinetic mutism



CNS




Babinski sign








522015

11



Bhananker












Air Embolism

522015

12


Type of VADs

CVAD PIV

55


feil



Removal (n=9)



Insertion (n=5)



522015

13










Ward


Ward





522015

14


CASE STUDY



monitoring






Causes



Air vented bottles




Rate

STOP THE FLOW

Air Embolism





Jurgenson Natal


Treatment

522015

15










Treatmenthellip

NO AIR ALLOWED

Air Embolism

AIR


Insertion of VADS



PREVENTION


522015

16










PREVENTIONhellip





Gardner Feil








PREVENTIONhellip

522015

17





close the clamp

spike the bag



Preventionhellip








Jurgenson


Jurgenson


PREVENTIONhellip









PREVENTIONhellip

522015

18










AndrewsINS Gorski


Removal of VADS



PREVENTIONhellip


Removal of VADS




Removal of VADs






PREVENTIONhellip

522015

19







carelessness




SUMMARY


may be subclinical













AIR


References







Perinatol 200522(7)361-3










storyhtml





522015

20





x




72











2001 121291ndash5


















(MD) INS








1971 3(5766)74-8















Nurs 2010 2719(10)S28-S30







Med 200913(2)92-3








Anesth Analg 2009109(1)124-9








JAMA 1968204(3)267-9















522015

7




Peripheral IV

Portal of

entry



Atmospheric

pressure

Intrathoracic

pressure

darr Intrathoracic

pressure


bull Dyspnea


bull Hypovolemia

+ Pressure

Gradient







Volume


Rate





MirskI Groell



Rate

522015

8







Rate




Tiny but lethal


Volume








522015

9










Air Embolism

522015

10


Respiratory

Dyspnea

Tachypnea

Cough

Hypoxia

Wheezing

Signs amp Symptoms

Cardiac

Chest pain

Hypotension

Cyanosis

Tachycardia


PAH




Respiratory

Cardiac




Focal Lesions

Hemiparesis

Loss of vision

Mortality rate 8

Encephalopathic



Coma

Seizures

Akinetic mutism



CNS




Babinski sign








522015

11



Bhananker












Air Embolism

522015

12


Type of VADs

CVAD PIV

55


feil



Removal (n=9)



Insertion (n=5)



522015

13










Ward


Ward





522015

14


CASE STUDY



monitoring






Causes



Air vented bottles




Rate

STOP THE FLOW

Air Embolism





Jurgenson Natal


Treatment

522015

15










Treatmenthellip

NO AIR ALLOWED

Air Embolism

AIR


Insertion of VADS



PREVENTION


522015

16










PREVENTIONhellip





Gardner Feil








PREVENTIONhellip

522015

17





close the clamp

spike the bag



Preventionhellip








Jurgenson


Jurgenson


PREVENTIONhellip









PREVENTIONhellip

522015

18










AndrewsINS Gorski


Removal of VADS



PREVENTIONhellip


Removal of VADS




Removal of VADs






PREVENTIONhellip

522015

19







carelessness




SUMMARY


may be subclinical













AIR


References







Perinatol 200522(7)361-3










storyhtml





522015

20





x




72











2001 121291ndash5


















(MD) INS








1971 3(5766)74-8















Nurs 2010 2719(10)S28-S30







Med 200913(2)92-3








Anesth Analg 2009109(1)124-9








JAMA 1968204(3)267-9















522015

8







Rate




Tiny but lethal


Volume








522015

9










Air Embolism

522015

10


Respiratory

Dyspnea

Tachypnea

Cough

Hypoxia

Wheezing

Signs amp Symptoms

Cardiac

Chest pain

Hypotension

Cyanosis

Tachycardia


PAH




Respiratory

Cardiac




Focal Lesions

Hemiparesis

Loss of vision

Mortality rate 8

Encephalopathic



Coma

Seizures

Akinetic mutism



CNS




Babinski sign








522015

11



Bhananker












Air Embolism

522015

12


Type of VADs

CVAD PIV

55


feil



Removal (n=9)



Insertion (n=5)



522015

13










Ward


Ward





522015

14


CASE STUDY



monitoring






Causes



Air vented bottles




Rate

STOP THE FLOW

Air Embolism





Jurgenson Natal


Treatment

522015

15










Treatmenthellip

NO AIR ALLOWED

Air Embolism

AIR


Insertion of VADS



PREVENTION


522015

16










PREVENTIONhellip





Gardner Feil








PREVENTIONhellip

522015

17





close the clamp

spike the bag



Preventionhellip








Jurgenson


Jurgenson


PREVENTIONhellip









PREVENTIONhellip

522015

18










AndrewsINS Gorski


Removal of VADS



PREVENTIONhellip


Removal of VADS




Removal of VADs






PREVENTIONhellip

522015

19







carelessness




SUMMARY


may be subclinical













AIR


References







Perinatol 200522(7)361-3










storyhtml





522015

20





x




72











2001 121291ndash5


















(MD) INS








1971 3(5766)74-8















Nurs 2010 2719(10)S28-S30







Med 200913(2)92-3








Anesth Analg 2009109(1)124-9








JAMA 1968204(3)267-9















522015

9










Air Embolism

522015

10


Respiratory

Dyspnea

Tachypnea

Cough

Hypoxia

Wheezing

Signs amp Symptoms

Cardiac

Chest pain

Hypotension

Cyanosis

Tachycardia


PAH




Respiratory

Cardiac




Focal Lesions

Hemiparesis

Loss of vision

Mortality rate 8

Encephalopathic



Coma

Seizures

Akinetic mutism



CNS




Babinski sign








522015

11



Bhananker












Air Embolism

522015

12


Type of VADs

CVAD PIV

55


feil



Removal (n=9)



Insertion (n=5)



522015

13










Ward


Ward





522015

14


CASE STUDY



monitoring






Causes



Air vented bottles




Rate

STOP THE FLOW

Air Embolism





Jurgenson Natal


Treatment

522015

15










Treatmenthellip

NO AIR ALLOWED

Air Embolism

AIR


Insertion of VADS



PREVENTION


522015

16










PREVENTIONhellip





Gardner Feil








PREVENTIONhellip

522015

17





close the clamp

spike the bag



Preventionhellip








Jurgenson


Jurgenson


PREVENTIONhellip









PREVENTIONhellip

522015

18










AndrewsINS Gorski


Removal of VADS



PREVENTIONhellip


Removal of VADS




Removal of VADs






PREVENTIONhellip

522015

19







carelessness




SUMMARY


may be subclinical













AIR


References







Perinatol 200522(7)361-3










storyhtml





522015

20





x




72











2001 121291ndash5


















(MD) INS








1971 3(5766)74-8















Nurs 2010 2719(10)S28-S30







Med 200913(2)92-3








Anesth Analg 2009109(1)124-9








JAMA 1968204(3)267-9















522015

10


Respiratory

Dyspnea

Tachypnea

Cough

Hypoxia

Wheezing

Signs amp Symptoms

Cardiac

Chest pain

Hypotension

Cyanosis

Tachycardia


PAH




Respiratory

Cardiac




Focal Lesions

Hemiparesis

Loss of vision

Mortality rate 8

Encephalopathic



Coma

Seizures

Akinetic mutism



CNS




Babinski sign








522015

11



Bhananker












Air Embolism

522015

12


Type of VADs

CVAD PIV

55


feil



Removal (n=9)



Insertion (n=5)



522015

13










Ward


Ward





522015

14


CASE STUDY



monitoring






Causes



Air vented bottles




Rate

STOP THE FLOW

Air Embolism





Jurgenson Natal


Treatment

522015

15










Treatmenthellip

NO AIR ALLOWED

Air Embolism

AIR


Insertion of VADS



PREVENTION


522015

16










PREVENTIONhellip





Gardner Feil








PREVENTIONhellip

522015

17





close the clamp

spike the bag



Preventionhellip








Jurgenson


Jurgenson


PREVENTIONhellip









PREVENTIONhellip

522015

18










AndrewsINS Gorski


Removal of VADS



PREVENTIONhellip


Removal of VADS




Removal of VADs






PREVENTIONhellip

522015

19







carelessness




SUMMARY


may be subclinical













AIR


References







Perinatol 200522(7)361-3










storyhtml





522015

20





x




72











2001 121291ndash5


















(MD) INS








1971 3(5766)74-8















Nurs 2010 2719(10)S28-S30







Med 200913(2)92-3








Anesth Analg 2009109(1)124-9








JAMA 1968204(3)267-9















522015

11



Bhananker












Air Embolism

522015

12


Type of VADs

CVAD PIV

55


feil



Removal (n=9)



Insertion (n=5)



522015

13










Ward


Ward





522015

14


CASE STUDY



monitoring






Causes



Air vented bottles




Rate

STOP THE FLOW

Air Embolism





Jurgenson Natal


Treatment

522015

15










Treatmenthellip

NO AIR ALLOWED

Air Embolism

AIR


Insertion of VADS



PREVENTION


522015

16










PREVENTIONhellip





Gardner Feil








PREVENTIONhellip

522015

17





close the clamp

spike the bag



Preventionhellip








Jurgenson


Jurgenson


PREVENTIONhellip









PREVENTIONhellip

522015

18










AndrewsINS Gorski


Removal of VADS



PREVENTIONhellip


Removal of VADS




Removal of VADs






PREVENTIONhellip

522015

19







carelessness




SUMMARY


may be subclinical













AIR


References







Perinatol 200522(7)361-3










storyhtml





522015

20





x




72











2001 121291ndash5


















(MD) INS








1971 3(5766)74-8















Nurs 2010 2719(10)S28-S30







Med 200913(2)92-3








Anesth Analg 2009109(1)124-9








JAMA 1968204(3)267-9















522015

12


Type of VADs

CVAD PIV

55


feil



Removal (n=9)



Insertion (n=5)



522015

13










Ward


Ward





522015

14


CASE STUDY



monitoring






Causes



Air vented bottles




Rate

STOP THE FLOW

Air Embolism





Jurgenson Natal


Treatment

522015

15










Treatmenthellip

NO AIR ALLOWED

Air Embolism

AIR


Insertion of VADS



PREVENTION


522015

16










PREVENTIONhellip





Gardner Feil








PREVENTIONhellip

522015

17





close the clamp

spike the bag



Preventionhellip








Jurgenson


Jurgenson


PREVENTIONhellip









PREVENTIONhellip

522015

18










AndrewsINS Gorski


Removal of VADS



PREVENTIONhellip


Removal of VADS




Removal of VADs






PREVENTIONhellip

522015

19







carelessness




SUMMARY


may be subclinical













AIR


References







Perinatol 200522(7)361-3










storyhtml





522015

20





x




72











2001 121291ndash5


















(MD) INS








1971 3(5766)74-8















Nurs 2010 2719(10)S28-S30







Med 200913(2)92-3








Anesth Analg 2009109(1)124-9








JAMA 1968204(3)267-9















522015

13










Ward


Ward





522015

14


CASE STUDY



monitoring






Causes



Air vented bottles




Rate

STOP THE FLOW

Air Embolism





Jurgenson Natal


Treatment

522015

15










Treatmenthellip

NO AIR ALLOWED

Air Embolism

AIR


Insertion of VADS



PREVENTION


522015

16










PREVENTIONhellip





Gardner Feil








PREVENTIONhellip

522015

17





close the clamp

spike the bag



Preventionhellip








Jurgenson


Jurgenson


PREVENTIONhellip









PREVENTIONhellip

522015

18










AndrewsINS Gorski


Removal of VADS



PREVENTIONhellip


Removal of VADS




Removal of VADs






PREVENTIONhellip

522015

19







carelessness




SUMMARY


may be subclinical













AIR


References







Perinatol 200522(7)361-3










storyhtml





522015

20





x




72











2001 121291ndash5


















(MD) INS








1971 3(5766)74-8















Nurs 2010 2719(10)S28-S30







Med 200913(2)92-3








Anesth Analg 2009109(1)124-9








JAMA 1968204(3)267-9















522015

14


CASE STUDY



monitoring






Causes



Air vented bottles




Rate

STOP THE FLOW

Air Embolism





Jurgenson Natal


Treatment

522015

15










Treatmenthellip

NO AIR ALLOWED

Air Embolism

AIR


Insertion of VADS



PREVENTION


522015

16










PREVENTIONhellip





Gardner Feil








PREVENTIONhellip

522015

17





close the clamp

spike the bag



Preventionhellip








Jurgenson


Jurgenson


PREVENTIONhellip









PREVENTIONhellip

522015

18










AndrewsINS Gorski


Removal of VADS



PREVENTIONhellip


Removal of VADS




Removal of VADs






PREVENTIONhellip

522015

19







carelessness




SUMMARY


may be subclinical













AIR


References







Perinatol 200522(7)361-3










storyhtml





522015

20





x




72











2001 121291ndash5


















(MD) INS








1971 3(5766)74-8















Nurs 2010 2719(10)S28-S30







Med 200913(2)92-3








Anesth Analg 2009109(1)124-9








JAMA 1968204(3)267-9















522015

15










Treatmenthellip

NO AIR ALLOWED

Air Embolism

AIR


Insertion of VADS



PREVENTION


522015

16










PREVENTIONhellip





Gardner Feil








PREVENTIONhellip

522015

17





close the clamp

spike the bag



Preventionhellip








Jurgenson


Jurgenson


PREVENTIONhellip









PREVENTIONhellip

522015

18










AndrewsINS Gorski


Removal of VADS



PREVENTIONhellip


Removal of VADS




Removal of VADs






PREVENTIONhellip

522015

19







carelessness




SUMMARY


may be subclinical













AIR


References







Perinatol 200522(7)361-3










storyhtml





522015

20





x




72











2001 121291ndash5


















(MD) INS








1971 3(5766)74-8















Nurs 2010 2719(10)S28-S30







Med 200913(2)92-3








Anesth Analg 2009109(1)124-9








JAMA 1968204(3)267-9















522015

16










PREVENTIONhellip





Gardner Feil








PREVENTIONhellip

522015

17





close the clamp

spike the bag



Preventionhellip








Jurgenson


Jurgenson


PREVENTIONhellip









PREVENTIONhellip

522015

18










AndrewsINS Gorski


Removal of VADS



PREVENTIONhellip


Removal of VADS




Removal of VADs






PREVENTIONhellip

522015

19







carelessness




SUMMARY


may be subclinical













AIR


References







Perinatol 200522(7)361-3










storyhtml





522015

20





x




72











2001 121291ndash5


















(MD) INS








1971 3(5766)74-8















Nurs 2010 2719(10)S28-S30







Med 200913(2)92-3








Anesth Analg 2009109(1)124-9








JAMA 1968204(3)267-9















522015

17





close the clamp

spike the bag



Preventionhellip








Jurgenson


Jurgenson


PREVENTIONhellip









PREVENTIONhellip

522015

18










AndrewsINS Gorski


Removal of VADS



PREVENTIONhellip


Removal of VADS




Removal of VADs






PREVENTIONhellip

522015

19







carelessness




SUMMARY


may be subclinical













AIR


References







Perinatol 200522(7)361-3










storyhtml





522015

20





x




72











2001 121291ndash5


















(MD) INS








1971 3(5766)74-8















Nurs 2010 2719(10)S28-S30







Med 200913(2)92-3








Anesth Analg 2009109(1)124-9








JAMA 1968204(3)267-9















522015

18










AndrewsINS Gorski


Removal of VADS



PREVENTIONhellip


Removal of VADS




Removal of VADs






PREVENTIONhellip

522015

19







carelessness




SUMMARY


may be subclinical













AIR


References







Perinatol 200522(7)361-3










storyhtml





522015

20





x




72











2001 121291ndash5


















(MD) INS








1971 3(5766)74-8















Nurs 2010 2719(10)S28-S30







Med 200913(2)92-3








Anesth Analg 2009109(1)124-9








JAMA 1968204(3)267-9















522015

19







carelessness




SUMMARY


may be subclinical













AIR


References







Perinatol 200522(7)361-3










storyhtml





522015

20





x




72











2001 121291ndash5


















(MD) INS








1971 3(5766)74-8















Nurs 2010 2719(10)S28-S30







Med 200913(2)92-3








Anesth Analg 2009109(1)124-9








JAMA 1968204(3)267-9















522015

20





x




72











2001 121291ndash5


















(MD) INS








1971 3(5766)74-8















Nurs 2010 2719(10)S28-S30







Med 200913(2)92-3








Anesth Analg 2009109(1)124-9








JAMA 1968204(3)267-9















Documents

A M P Death by “air”ror RESENTATION AIR EMBOLISM · cerebral air embolism is 23%Heckmann 35% survived with severe neurologic deficits 38% with good or complete recovery True incidence