air bolus in swan gantz

[jkej]

Our anesthetist gently pointed out one of our nurses had been injecting air into the wrong lumen during the PAC insertion, which prevented the different waveforms from showing up. No harm occurred; however, could the insertion of air in the wrong port caused an embolism?

[meandragonbrett]

What part was air being injected into?

[3ccBolus]

Whoa, that's pretty bad. Yes- If you introduce air into a line that is inside the patient, an air embolus can occur. I think the balloon (I assume that's what they were trying to inflate) generally holds about 1.5ml of air, depending on manufacturer. Hopefully 1.5 wouldn't cause an embolus, but it wouldn't do them any favors. The possibility exists though, especially if he/she kept refilling the syringe with air to try again. That person really needs some more education before working with swans.

[jkej]

The doc never mentioned which port was actually used.

[aCRNAhopeful]

It wouldn't be any worse than injecting air into a central line right? Certainly not good practice but unlikely to cause harm.

[chare]

the following was copied from venous air embolism: emedicine emergency medicine.

generally, small amounts of air are broken up in the capillary bed and absorbed from the circulation without producing symptoms. traditionally, it has been estimated that more than 5 ml/kg of air displaced into the intravenous space is required for significant injury (shock or cardiac arrest) to occur. however, complications have been reported with as little as 20 ml of air (the length of an unprimed iv infusion tubing) that was injected intravenously. the injection of 2 or 3 ml of air into the cerebral circulation can be fatal. furthermore, as little as 0.5 ml of air in the left anterior descending coronary artery has been shown to cause ventricular fibrillation. basically, the closer the vein of entrainment is to the right heart, the smaller the lethal volume is.

[stram87]

Our swan gantz caths have a syringe attached that cannot be removed and only allow you to inflate the ballon with 1.5ml of air. While it doesnt seem likely that 1.5ml of air could cause major problems it is certainly possible.