A compilation of journals, case studies and articles about Air Embolism.
Sowell MW, Lovelady CL, Brogdon BG, Wecht CH. Infant death due to air embolism from peripheral venous infusion. J Forensic Sci. 2007 Jan;52(1):183-8.
Swartz N, Eisenkraft JB. Probable venous air embolism during epidural placement in an infant. Anesth Analg 1993;76:1136–8.
Chang AC, Wells W. Shunt lesions. In: Chung AC, Hanley FL, Wernovsky G, Wassell DL, editors. Pediatric cardiac intensive care. Philadelphia: Saunders, 2005:207–8.
Diagnosis & Treatment
Mirski MA, Lele AV, Fitzsimmons L, Toung TJ. Diagnosis and treatment of vascular air embolism. Anesthesiology. 2007 Jan;106(1):164-77. Review.
Shaikh N, Ummunisa F. Acute management of vascular air embolism. Journal of Emergencies, Trauma and Shock. 2009;2(3):180-185.doi:10.4103/0974-2700.55330.
General Review Articles
Muth CM, Shank ES. Gas embolism. N Engl J Med. 2000 Feb 17;342(7):476-82. Review.
von Jürgensonn S. Prevention and management of air in an IV infusion system. Br J Nurs. 2010 May 27-Jun 9;19(10):S28-30.
O'Quin RJ, Lakshminarayan S. Venous air embolism. Arch Intern Med. 1982 Nov;142(12):2173-6.
Laskey AL, Dyer C, Tobias JD. Venous air embolism during home infusion therapy. Pediatrics. 2002 Jan;109(1):E15.
Orebaugh SL. Venous air embolism: clinical and experimental considerations. Crit Care Med. 1992 Aug;20(8):1169-77. Review.
Hartveit F, Lystad H, Minken A. The pathology of venous air embolism. Br J Exp Pathol. 1968 Feb;49(1):81-6.
Oyama Y, Spencer MP. Cardiopulmonary effects of intravenous gas embolism; with special reference to fate of intravascular gas bubbles. Jpn Circ J. 1971 Dec;35(12):1541-9.
Wong B, Zimmerman D, Reintjes F, Courtney M, Klarenbach S, Dowling G, Pauly RP. Procedure-related serious adverse events among home hemodialysis patients: a quality assurance perspective. Am J Kidney Dis. 2014 Feb;63(2):251-8. doi: 10.1053/j.ajkd.2013.07.009. Epub 2013 Aug 30. Review.
Bessereau J, Genotelle N, Chabbaut C, Huon A, Tabah A, Aboab J, Chevret S, Annane D. Long-term outcome of iatrogenic gas embolism. Intensive Care Med. 2010 Jul;36(7):1180-7. doi: 10.1007/s00134-010-1821-9. Epub 2010 Mar 11
Marchand P, Van Hasselt, Luntz CH. Massive venous air embolism. S Afr Med J. 1964 Mar 28;38:202-8.
Durant TM, Long J, Oppenheimer MJ. Pulmonary (venous) air embolism. Am Heart J. 1947 Mar;33(3):269-81
Palmon SC, Moore LE, Lundberg J, Toung T. Venous air embolism: a review. J Clin Anesth. 1997 May;9(3):251-7. Review.
Laidlow, Kate. Air Embolism ? : Don’t worry it was just a bubble…. IVNNZ Newsletter. 2011.
Bhananker SM, Liau DW, Kooner PK, Posner KL, Caplan RA, Domino KB. Liability related to peripheral venous and arterial catheterization: a closed claims analysis. Anesth Analg. 2009 Jul;109(1):124-9. doi: 10.1213/ane.0b013e31818f87c8.
Domino KB, Bowdle TA, Posner KL, Spitellie PH, Lee LA, Cheney FW. Injuries and liability related to central vascular catheters: a closed claims analysis. Anesthesiology. 2004 Jun;100(6):1411-8. Review.
Barak, Michal, and Yeshayahu Katz. "Microbubbles: pathophysiology and clinical implications." CHEST Journal 128.4 (2005): 2918-2932.
Barak M, Nakhoul F, Katz Y. Pathophysiology and clinical implications of microbubbles during hemodialysis. Semin Dial. 2008 May-Jun; 21(3):232-8. doi: 10.1111/j.1525-139X.2008.00424.x. Review.
Warmers, Pumps & Filters
Woon S, Talke P. Amount of air infused to patient increases as fluid flow rates decrease when using the Hotline HL-90 fluid warmer. J Clin Monit Comput. 1999 May;15(3-4):149-52.
Stevenson GW, Tobin M, Hall SC. Fluid warmer as a potential source of air bubble emboli. Anesth Analg. 1995 May; 80(5):1061.
Destiny Chau, D, Gish,B, Tzanetos, D, Zhang, C. A dangerous side of In-Line IV filters when used for vasoactive infusions in infants. J Anesth Safety Patient Foundation. 2013; 28(2).
Wolin, J, Vasdev, G. Potential for air embolism using Hotline™ model HL90 fluid warmer. J Clin. Anesth. 1996; 8(1):81-82.
Breen, P, Hong, A. Beware of Air in the Blood Pump. Anesth Analg. 2000; 91(4):1038.
Varga C, Luria I, Gravenstein N. Intravenous Air: The Partially Invisible Phenomenon. Anesth Analg. 2016 Nov;123(5):1149-1155. PubMed PMID: 27749346.
Haddad, I., Doucet, P., Lobozzo, J., Vadhera, A. Volume of Air Generated from HotlineⓇ Warmer – Plenty to Cause Serious Injury/Morbidity in Pediatrics. ClearLine MD. 2016.
Sviri S, Woods WP, van Heerden PV. Air embolism--a case series and review. Crit Care Resusc. 2004 Dec;6(4):271-6.
Williamson JA, Webb RK, Russell WJ, Runciman WB. The Australian Incident Monitoring Study. Air embolism--an analysis of 2000 incident reports. Anaesth Intensive Care. 1993 Oct;21(5):638-41.
Cereda C, Staedler C, Moschovitis G, Caronni F, Bassetti CL, Azzola A. 'Bubbles in the brain': systemic air embolism syndrome from an atrial-oesophageal fistula. Emerg Med J. 2011 May;28(5):455. doi: 10.1136/emj.2010.093195.
Tommasino C, Rizzardi R, Beretta L, Venturino M, Piccoli S. Cerebral ischemia after venous air embolism in the absence of intracardiac defects. J Neurosurg Anesthesiol. 1996 Jan;8(1):30-4.
Fibel KH, Barnes RP, Kinderknecht JJ. Pressurized Intravenous Fluid Administration in the Professional Football Player: A Unique Setting for Venous Air Embolism. Clin J Sport Med. 2015 Jul;25(4):e67-9. Doi: 10.1097/JSM.0000000000000150.
15 March 2017
March 12 - 18 is Patient Safety Awareness Week, an initiative of the National Patient Safety Foundation that encourages everyone to Stand United for Patient Safety to reduce harm in patient care. #WEAREALLPATIENTS
The danger of air masses in IV lines is an important patient safety issue - and one that can be avoided. Air masses in IV lines can be fatal and may cause serious clinical complications, extended hospital stays, and additional costs. ClearLine IV is the only FDA-cleared, CE-certified product that detects and removes air in IV fluid lines continuously and automatically. Help spread awareness about the issue of air in IV lines and the importance of protecting patients against the dangerous infusion of air.
© 2017 ClearLine MD
08 March 2017
Pumps are well known to have issues dealing with air in IV lines. Within the past 10 years, 2,549,871 pumps were included in recalls due to air-related accidents or incidents according to the FDA’s Maude database for adverse events.
The 2.5 million pumps were recalled due to air-related issues including faulty air-in-line sensors, failure to detect air in lines while using specific medications, false air-in-line alarms, wrong air sensor calibrations, failure to meet air-in-line specifications, defects in tubing, and failure to maintain pump accuracy for detecting air bolus. All of these could potentially lead to dangerous levels of air being delivered to patients.
In addition to potentially entraining air, the FDA warns that “the interruption of therapy can lead to serious adverse health consequences or death.” Health professionals must be vigilant in ensuring the lines are clear of air to avoid the risk of air entering the patient line.
Recalled models include the Alaris Pump Module, Model No. 8100 and AIL sensor kits, Hospira brand Symbiq Two-Channel Infuser, Triton Infusion Pump, Sigma Spectrum Infusion Pump, Baxter Colleague CX Infusion Pump, Baxter Flo-Gard 6301 Dual Channel Volumetric Infusion Pump, Baxter Colleague 3 and 3 CX Infusion Pumps, Curlin Ambulatory Infusion Pump System and Administration set, and Infinity Enteralite Ambulatory Feeding Pumps.
The Maude database houses medical device reports submitted to the FDA by mandatory reporters when marketed devices may have caused or contributed to a death or serious injury or has malfunctioned in a way that would likely cause or contribute to a death or serious injury. The FDA encourages health professionals to report adverse hospital events online at: www.fda.gov/MedWatch/report.
Note: graph only includes hardware
13 February 2017
The FDA just announced a recall of nearly 350,000 Alaris Syringe Pumps for faulty air detection sensors. Of great concern, the faulty sensors may cause the pump to stop therapy infusion to the patient. Healthcare professionals may have to clear the alarm and restart the infusion. The FDA recall warns that “interruption of infusion could lead to serious adverse health consequences or death.”
This recall yet again underscores the challenges pumps have detecting air masses in IV lines and reliance on clinicians to intercept and manually remove air from IV lines.
The FDA encourages health professionals to report adverse hospital events online at: www.fda.gov/MedWatch/report. Additional information and a copy of the recall is available here.
CareFusion recall included Alaris Syringe Pump model no. 8100 and air-In-line sensor kits (P/N 147083-102 and 49000221) manufactured and distributed between 2011 and 2015.
© 2017 ClearLine MD