A Rare Iatrogenic Complication Associated With Iv Lines
Özet
Cerebral venous air embolism (CVAE) is a rare, iatrogenic, and potentially fatal complication associated with intravascular catheters (IVCs), primarily occurring during the manipulation of central venous lines, though occasionally linked to peripheral IV lines. Pathophysiologically, CVAE occurs when air bubbles overcome the atmospheric-to-intravenous pressure gradient, leading to retrograde entry into the cerebral venous system, dural sinuses, and associated venous plexuses against blood flow. While many cases remain asymptomatic, patients can present with non-specific symptoms like headache, nausea, and confusion, or severe neurological deficits including seizures, ischemic stroke due to end-artery occlusion, and cerebral edema. Non-contrast conventional computed tomography (CT) serves as the gold standard for early diagnosis in the acute phase, identifying intracranial air bubbles with characteristic low Hounsfield units. Treatment focus centers on Trendelenburg positioning to guide air bubbles back to the central circulation, administration of 100% high-concentration oxygen to reduce embolic volume, and avoiding Valsalva maneuvers. Prevention remains paramount, requiring proper patient positioning and ensuring catheter lumens are thoroughly flushed with saline before any clinical manipulations.
Referanslar
1.Savey A, Machut A (eds) (2012) Institut national de veille sanitaire (INVS) Surveillance des infections nosocomiales en réanimation adulte. Résul tats REA-Raisin, France, résultats 2011. INVS, Lyon.
2.Maki DG, Kluger DM, Crnich CJ (2006) The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 81:1159–1171.
Bothma PA, Schlimp CJ. Retrograde cerebral venous gas embolism: are we missing too many cases? Br J Anaesth 2014;112:401–4.
Klein J, Juratli TA, Weise M, Schackert G. A systematic review of the semi-sitting position in neurosurgical patients with patent foramen ovale: how frequent is paradoxical embolism? World Neurosurg 2018;115:196–200.
Muth CM, Shank ES. Gas embolism. N Engl J Med 2000;342:476– 82.
Chuang DY, Sundararajan S, Sundararajan VA, Feldman DI, Xiong W. Accidental air embolism. Stroke 2019;50:e183– e186.
Allioui S, Zaimi S, Sninate S, Abdellaoui M. Air bubbles in the brain: retrograde venous gas embolism in the cavernous sinus. Radiol Case Rep 2020;15:1011–3.
Ploner F, Saltuari L, Marosi MJ, Dolif R, Salsa A. Cerebral air emboli with use of central venous catheter in mobile patient. Lancet 1991;338:1331.
9.Caulfield A, Lansberg M, Marks M, Albers G, Wijman C. MRI Characteristics of Cerebral Air Embolism from a Venous Source. Neurology. 2006;66(6):945-6.
McMinn RMH (editor). Last’s anatomy. Revised 9th ed. Chatswood: Elsevier Australia; 2019. p. 741–75.
Standring S (editor). Gray’s anatomy: the anatomical basis of clinical practice. 40th ed. London: Churchill Livingstone Elsevier; 2008. p. 584.
Souza MP, Magalhães E, Cascudo Ede F, Jogaib MA, Silva MC. Accidental catheterization of epidural venous plexus: tomographic analysis. Rev Bras Anestesiol 2016;66:208–11.
Lanzieri CF. The significance of asymmetry of the foramen of Vesalius. AJNR Am J Neuroradiol 1998;9:1201–4
