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• W2942146608 abstract "In the Journal of Neuro-Ophthalmology, Rossiter-Thornton et al (1) illustrate air from a peripheral intravenous line lodged in the superior ophthalmic vein of an 83-year-old woman. We reported a similar case 25 years ago; our case differed in that air was trapped in the cavernous sinus (2). Numerous case reports have documented this phenomenon, with air bubbles visible on head computerized tomography imaging in 27/12,880 (0.2%) of patients after intravenous line placement (3). Rossiter-Thornton et al state that “an air bubble can ascend through the superior vena cava into the dense venous networks of the head and neck if the thorax and head are erect at the time of injection.” They also suggest that atrial fibrillation might have contributed to air embolism by causing venous stasis in the atria. In fact, once an air bubble reaches the heart, it cannot enter the cerebral venous circulation. It passes through the pulmonary artery into the lungs where it is absorbed. However, if a cardiac wall defect, such as a patent foramen ovale, is present, air can pass from the right heart to the left heart, sometimes causing stroke from arterial air embolism. In our case, and that described by Rossiter-Thornton, air most likely traveled up the arm, traversed the right subclavian vein, and entered the internal jugular vein. There is no reason to postulate that the air ever entered either the right brachiocephalic vein or the superior vena cava. Once in the internal jugular vein, air ascends through the inferior petrosal sinus to reach the cavernous sinus. It remained there in our case, but in Rossiter-Thornton's case, it continued to rise, entering the superior ophthalmic vein. Note that it was arrested at the highest point, just where the superior ophthalmic vein must duck under the superior orbital rim to join the supraorbital vein. Many clinicians are careless about purging air from syringes and intravenous tubing. Air bubbles can also originate from the dead space in the hub of needles and catheters, as well as the Luer tip of syringes. During surgery, when I point out air bubbles traveling through the intravenous line toward a patient's arm, I am usually met with a shrug from the anesthetist. Although introduction of small amounts of air rarely causes harm, it is a potential hazard that should be avoided (4). Perhaps, a more clever design of the connections between syringes, needles, intravenous tubing, and catheters could alleviate this problem." @default.
• W2942146608 created "2019-05-03" @default.
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• W2942146608 date "2019-09-01" @default.
• W2942146608 modified "2023-09-23" @default.
• W2942146608 title "Air Bubbles Introduced From Peripheral Intravenous Lines Into the Cerebral Venous System" @default.
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• W2942146608 doi "https://doi.org/10.1097/wno.0000000000000784" @default.
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