Central Line Air Embolism

[Amistad, RN]

Hi there! I was recently reading about central lines and how the patient should be lying down while we remove them to prevent air embolism. Most of my patients have Hickmans and ports, but we do remove PICCs every once and a while. I'm just curious... How does sitting upright cause an air embolism versus lying down? Do pts with midlines need to be lying down also?

-Amistad

[core0]

Hi there! I was recently reading about central lines and how the patient should be lying down while we remove them to prevent air embolism. Most of my patients have Hickmans and ports, but we do remove PICCs every once and a while. I'm just curious... How does sitting upright cause an air embolism versus lying down? Do pts with midlines need to be lying down also?

-Amistad

.

Two different theories.

1. Most guidelines recommend tredenelberg when placing or removing a CVL. Mostly this has to do with increased right sided pressures making embolism less likely.

2. If there is an embolism, the air will go to the highest point (heart lungs) instead of the brain.

There is precious little science on either but most studies seem to think that occluding the catheter/entry site is more important that whether the patient is sitting up or not. Trendelenberg is most likely important in large bore IJ CVLs. Less important in PICC and probably not important in a midline.

[Amistad, RN]

Thanks for your response core0!! Those theories make sense to me. I actually had a patient today who suffered a stroke a few months ago after a central line was pulled because he threw a clot. Reminds me that central lines are serious business!