what are nursing considerations for an air embolus

RedCell · Jan 28, 2008

Left lateral decubitus position to reduce air lock

Central venous catheter to right atrium, start sucking

PEEP on ventilator to limit entrainment of air (Kind of blows though becuase by increasing central venous pressure, you lose preload)

Inotropic support when indicated.

If it is a big enough embolus call priest and make sure there is a spare bedroom in the ice box.

I saw this one time during a craniotomy. Picked it up on precordial first. Did all of the above plus had the surgeon flood the field and slap on some bone wax. Didn't work out so well for the old guy.

Daytonite, BSN, RN · Jan 28, 2008

an air embolism is room air that enters the circulation through iv lines or sometimes from chest trauma due to gunshot wounds or puncture wounds. the air is then propelled into the heart creating an intracardiac air lock at the pulmonic valve and preventing blood from leaving the right side of the heart. the nitrogen in the air can dissolve quickly in the blood, but ischemia and necrosis can occur if the remaining gasses in the air embolus are totally blocking the blood vessel it is lodged in. the signs of air embolism are:

chest pain
shoulder and low back pain depending on the location of the embolus
sudden onset of pallor
cyanosis
dyspnea
coughing
tachycardia
hypotension
weak rapid pulse
churning sound auscultated over the precordium in some cases
patient may faint or lose consciousness
progression to syncope, shock and cardiac arrest

treatment is supportive and includes placing the patient on his left side in trendelenburg position and notifying the physician. the patient needs to remain on bed rest and be given supplemental oxygen until the air in the vascular system has been eliminated.

(page 434, intravenous therapy: clinical principles and practice, by judy terry, leslie baranowski, rose anne lonsway and carolyn hedrick, published by the intravenous nurses society) "nursing interventions. . .if an air embolism is suspected, the patient should be placed immediately on the left side in trendelenburg's position; this measure keeps the air in the pulmonary outflow tract to a minimum by trapping it in the right heart chambers and great veins proximal to the pulmonic valve. if the air embolism results from an open or leaking infusion line, the line should be changed immediately and replaced with new tubing that is filled with solution. the source of air intake must be corrected immediately, or air will continue to be drawn into the system. the physician should be notified, and the patient's vital signs should be monitored. oxygen is usually administered in these cases."