Gorovitz & Borten, P.C.
Attorneys at Law

550 Cochituate Road, Suite 25
Framingham, Massachusetts
01701
Tel: (781) 890-9095
Air Embolism
Venous or arterial air embolism may be a life threatening event. The condition is
seen in many fields of medicine, including intensive care and operating room. The
circumstances under which physicians and nurses may encounter air embolism
are no longer limited to neurosurgical procedures conducted in the “sitting
position” and occur in such diverse areas as the interventional radiology suite or
laparoscopic surgical center.
Radiological procedures such as angiography and during the injection of air as a
contrast agent have also been implicated in venous and arterial air embolism, as
have cardiac catheterizations and cardiac ablation procedures.
The causes of air embolism include entry of air through intravascular catheters
such as peripheral and central venous cannula, pulmonary artery catheters,
hemodialysis catheters, pressurized infusion systems and long term central
catheters such as Hickman catheters.
Vascular air embolism is the entrainment (appearance) of air (or exogenously
delivered gas) from the operative field or other communication with the
environment into the
venous or arterial vasculature, producing systemic effects. Most episodes of VAE
(Vascular Air Embolism) are likely preventable.
Venous or arterial emboli may produce sudden cardiovascular decompensation
with rapidly developing falls in end tidal carbon dioxide, haemoglobin saturation,
and blood pressure associated with heart rate and rhythm changes. This is a life
threatening situation in which prompt diagnosis and immediate intervention is
critical.
The two fundamental factors determining the morbidity and mortality of VAE are
directly related to the amount of air entering the blood-stream, the speed with
which it enters and the body position at the time of embolism.  Rapid entry of air
into the circulation may cause severe hemodynamic instability. A fatal dose is
considered to be 300 - 500 mL of air at a rate of 100 mL/sec; a rate which is  
possible with a 14 gauge needle and a pressure gradient of only 5 cm H2O
between air and venous blood. In the critically ill, unstable patient, smaller
volumes of air may also be fatal.
When a large bolus of air rapidly enters into the venous system, it causes an air
lock in the right atrium and ventricle causing right ventricular outflow obstruction
and death. With slow entry of air into the right ventricle, obstruction occurs at the
level of the pulmonary vasculature, causing vasoconstriction and pulmonary
hypertension.
This may cause severe morbidity and mortality, and can be due to direct entry of
air into the arterial circulation or paradoxical venous embolism. The term
“paradoxical embolism” is used to describe situations in which gas crosses into
the left atrium through a patent foramen ovale or atrial septal defect, thus causing
air embolism within the systemic circulation. This may cause cardiac and
neurological manifestations, although neurological deficits may develop as a
result of prolonged hypoxemia and shock as well as direct air embolism
While a large share of VAE occurs at the commencement of surgery - 78.7%, still
18% of embolic phenomena are reported at the end of surgery, probably
associated with
reopening of injured vein when retractors are removed.

Surgical Procedures at Risk for Air Embolism
•        Neurosurgical  sitting position craniotomies. Posterior fossa procedures
•        Cervical laminectomy
•        Spinal fusion
•        Radical neck dissection
•        Thyroidectomy
•        Ophthalmologic procedures
•        Cardiac surgery, Coronary air embolism
•        Orthopedic procedures such as total hip arthroplasty, arthroscopy,
•        Thoracic procedures such as thoracocentesis
•        Obstetric–gynecologic procedures such as cesarean delivery
•        Laparoscopic procedures, Rubin insufflation procedures, vacuum abortion
•        Urology–prostatectomy
•        Gastrointestinal surgery such as laparoscopic cholecystectomy,
gastrointestinal endoscopy and liver transplantation

Risk of Air Embolism in Direct Vascular Access Procedures
•        Central venous access related
•        Radial artery catheterization
•        Parenteral nutrition therapy
•        Interventional radiology
•        Pain management procedures
•        Epidural catheter placement (loss of resistance to air technique)
•        Diagnostic procedures
•        Contrast-enhanced CT
•        Contrast-enhanced CT chest
•        Lumbar puncture
•        Thoracentesis
•        Hemoperfusion
•        Intraaortic balloon rupture
•        Rapid blood cell infusion systems
•        Blood storage container

Air embolism that cause injury may give rise to a medical malpractice cause of
action. If as a result of a physician's or nurse's error your condition worsened or
you have been unexpectedly injured, you deserve legal representation. If you are
suffering from complications due to an air embolism, let
Dr. Borten and the Boston
area medical malpractice attorneys at Gorovitz & Borten review the specifics of
your case. We can help you assert your rights and get the compensation you
deserve.
Contact Information
For a free confidential consultation and receive a response within 24 hours (when
possible), please contact us by phone, fax or e-mail with your question or concern.

Telephone:  781-890-9095     -     Fax:   781-890-9098
                                                                                       
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