Venous air embolism from central venous catheterization: A need for increased physician awareness

Objectives: To report a series of patients with clinically diagnosed venous air embolism (VAE) and major sequelae as a complication of the use of cent ral venous catheters (CVCs), to survey health care professionals' practices regarding CVCs, and to implement an educational intervention for optimizin g approaches to CVC insertion and removal. Setting: Tertiary care, university-based 806-bed medical center. Interventions: We surveyed 140 physicians and 53 critical care nurses to ap praise their awareness of the proper management and complications of CVCs. We then designed, delivered, and measured the effects of a multidisciplinar y educational intervention given to 106 incoming house officers. Measurements and Main Results: Although most physicians (127, 91%) chose th e Trendelenburg position for CVC insertion, only 42 physicians (30%) report ed concern for VAE. On CVC removal, only 36 physicians (26%) cited concern for VAE. Some physicians (13, 9%) reported elevating the head of the bed du ring CVC removal, possibly increasing the risk of VAE. Awareness of VAE or its prevention did not correlate with the level of physician training, expe rience, or specialty. After the educational intervention, concern for and a wareness of proper methods of prevention of VAE improved (p < .001). At 6-m onth follow-up, reported use of the Trendelenburg position continued, but c oncern cited for VAE had returned to baseline. Conclusions: There is inadequate awareness of VAE as a complication of CVC use. Focused instruction can improve appreciation of this potentially fatal complication and knowledge of its prevention, but the effect declines rapi dly. To achieve a more sustained improvement, a more intensive, hands-on, p eriodic educational program will likely be necessary, as well as reinforcem ent through enhanced supervision of CVC insertion and removal practices.