• Fatma Yildirim 1 University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Chest Diseases and Intensive Care, General Surgery Intensive Care Unit, Ankara, Turkey
  • Irem Karaman Bahcesehir University Faculty of Medicine
  • Meltem Şimşek University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Internal Diseases and Intensive Care, Internal Diseases Intensive Care Unit, Ankara, Turkey
  • Emir Yetkin University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, General Surgery Clinic, Ankara,
  • Umur Poyraz University of Health Sciences,Dışkapı Yıldırım Beyazıt Training and Research Hospital, Clinic of Neurology, Ankara, Turkey



Central catheterization, nutrition, central air embolism


Central catheterization can be placed in critically ill patients in the intensive care unit (ICU) for some purposes such as dialysis, nutrition, and hemodynamic monitoring. Air embolism is a very rare complication of central catheterization. A 46-year-old male patient with no known comorbidities underwent laparoscopic total colectomy and protective loop ileostomy for colon cancer. He was taken to the general surgery ICU for close hemodynamic follow-up in the postoperative period. Since he was cachectic and could not reach the target of oral nutrition within 1 week, a central catheter was inserted in the right internal jugular vein with ultrasonographic imaging, and total parenteral nutrition (TPN) was started. The patient, who had no additional problems in the follow-up, was transferred to the general surgery ward. Three and half hours after the transfer, the patient became unconscious and had extensor posture. Therefore, emergency cranial computed tomography (CT) was performed and he was taken back to the ICU. There was no finding in favour of bleeding in cranial CT. The patient was intubated to protect the airway, as he had a generalized tonic-clonic seizure during his follow-up. Air bubbles were seen in the main pulmonary artery and right ventricle in the multidetector thorax CT. Cranial CT angiography was taken at the 24th hour, and diffusion cranial MRI was performed for diagnosis of central air embolism. No air was detected to be aspirated in the cerebral arteries in cranial CT angiography. On the 6th day, the patient regained consciousness, extubated, and physical therapy was started. On the 12th day of hospitalization, the patient was discharged with 2/5 loss of motor power in the left upper extremity. When the patient's wife's anamnesis was detailed, it was learned that in order to mobilize the patient, she separated the TPN from the catheter and left the catheter tip open.


Gordy S, Rowell S. Vascular air embolism. Int J Crit Illn Inj Sci 2013;3(1):73–6.

McCarthy CJ, Behravesh S, Naidu SG, Oklu R. Air Embolism: Practical Tips for Prevention and Treatment. J Clin Med 2016;5(11):93.

Ely EW, Hite RD, Baker AM, Johnson MM, Bowton DL, Haponik EF. Venous air embolism from central venous catheterization: a need for increased physician awareness. Crit Care Med 1999;27(10):2113–7.

Brull SJ, Prielipp RC. Vascular air embolism: a silent hazard to patient safety. J Crit Care 2017;42:255–63.

Yesilaras M, Atilla OD, Aksay E, Kilic TY. Retrograde cerebral air embolism. Am J Emerg Med 2014;32(12):1562.e1–2.

Pinho J, Amorim JM, Araújo JM, Vilaça H, Ribeiro M, Pereira J, et al. Cerebral gas embolism associated with central venous catheter: Systematic review. J Neurol Sci 2016;362:160–4.

Feil M. Preventing central line air embolism. Am J Nurs 2015;115(6):64–9.

Malinoski D, Ewing T, Bhakta A, Schutz R, Imayanagita B, Casas T, et al. Which central venous catheters have the highest rate of catheter-associated deep venous thrombosis: a prospective analysis of 2,128 catheter days in the surgical intensive care unit. J Trauma Acute Care Surg 2013;74(2):454–62.

Bell J, Goyal M, Long S, Kumar A, Friedrich J, Garfinkel J, et al. Anatomic site- specific complication rates for central venous catheter insertions. J İntensive Care Med 2020;35(9):869–74.

Guo JL, Wang HB, Wang H, Le Y, He J, Zheng XQ, et al. Transesophageal echocardiography detection of air embolism during endoscopic surgery and validity of hyperbaric oxygen therapy: Case report. Medicine (Baltimore) 2021;100(23):e26304.

Heming N, Melone MA, Annane D. Update on the Management of Iatrogenic Gas Embolism. In: Vincent JL, editor. Annual Update in Intensive Care and Emergency Medicine 2020. Cham: Springer International Publishing, 2020; p.559–68.

Brockmeyer J, Simon T, Seery J, Johnson E, Armstrong P. Cerebral air embolism following removal of central venous catheter. Mil Med 2009;174(8):878–81.

Bravo-Cuellar A, Ramos-Damian M, Puebla-Pérez A, Gomez-Estrada H, Orbach-Arbouys S. Pulmonary toxicity of oxygen. Biomed Pharmacother 1990;44(8):435–7.




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