Cerebral Air Embolism after Central Venous Catheter Removal: A Case Report and Literature Review

Abstract

Objective: To explore the clinical manifestations, managements and prognosis of cerebral air embolism after central venous catheter removal. Methods: A 51-year-old female had thoracic sympathecotomy for her Raynaud’s disease under video assisted thoracoscopic surgery. She was confirmed having congenital atrial septal malformation. The surgical procedures were uneventfully. She was suddenly onset of shortness of breathing, consciousness loss and convulsion after the right internal jugular venous catheter removal. The CT scan showed the air embolism on the right frontal lobes of the brain. Her left extremities were paralysis. She walked on hers own with her left hand weakness by multidiscipline therapy including hyperbaric oxygen therapy after five weeks. Five relevant case reports (from Jan 2000 to Jun 2013) were found in PubMed, EMBASE and Google Scholar. Results: All of six cases had CT or MRI signs of cerebral air embolism. The air emboli entered into artery system from venous system through potential right to left shunt in four cases after the central venous catheters pulled out. Those patients who were diagnosed as paradoxical cerebral air embolism manifested hemiplegic. Two cases showed the air emboli in sinus cavernosus and the cortical veins which resulted in cerebral venous air embolism and cerebral edema, in which the symptoms disappeared within few hours. Conclusion: It is important to prevent cerebral air embolism when removing the central venous catheter. The approaches are as follows: asking patient in supine position, instructing patient breath holding, applying Vaseline gauzes or antibiotic ointments and covering the exit site with airtight tapes.