Sahutoglu Tuncay, Sakaci Tamer, Hasbal Nuri Baris, Kara Ekrem, Ahbap Elbis, Sevinc Mustafa, Koc Yener, Basturk Taner, Sahutoglu Elif, Unsal Abdulkadir
Department of Nephrology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey.
Division of Nephrology, Department of Internal Medicine, Recep Tayyip Erdogan University, Rize, Turkey.
Hemodial Int. 2017 Jan;21(1):29-34. doi: 10.1111/hdi.12456. Epub 2016 Jul 25.
Air embolism (AE) is a rare, but serious complication that can occur in the practice of hemodialysis. In contrast to careful techniques and meticulous care during insertions and manipulations of the central catheters, awareness of the risk of AE following catheter removal is less. We aimed to analyze the clinical characteristics of the all case reports with AE after catheter removal and summarize the mechanisms, clinical consequences, treatment and prevention of AE.
In addition to our case, MEDLINE database was searched for all case reports with AE following catheter removal, and the clinical, diagnostic and outcome data were analyzed.
A total of 10 patients (including our case) (M/F 6/4; median age 50.5 years) were found for the analysis. Procedures for prevention of AE were reported in a few patients (Trendelenburg position 2, airtight dressing 1). The time that elapsed between catheter removals and onset of AEs was ranged from seconds to 6 hours. The most common findings were dyspnea (90%), hypoxemia (70%), and cerebral dysfunction (70%). The most common sites where air could be detected were the left ventricle (40%), pulmonary artery (30%) and right ventricle (30%). Mortality was reported in 4 (40%) cases and the remaining 6 patients had complete recovery. Blocking of air portal was not reported in any of the fatal cases.
AE following catheter removal carries a major risk of mortality. Great awareness and attention to preventive procedures and appropriate care after development of AE seem mandatory.
空气栓塞（AE）是血液透析操作中一种罕见但严重的并发症。与中心静脉导管置入和操作过程中的精细技术及精心护理形成对比的是，对导管拔除后发生AE风险的认识较少。我们旨在分析导管拔除后发生AE的所有病例报告的临床特征，并总结AE的机制、临床后果、治疗及预防措施。
除了我们的病例外，检索MEDLINE数据库中所有导管拔除后发生AE的病例报告，并分析其临床、诊断及结局数据。
共纳入10例患者（包括我们的病例）（男/女6/4；中位年龄50.5岁）进行分析。少数患者报告了预防AE的措施（头低脚高位2例，密闭敷料1例）。导管拔除至AE发作的时间间隔从数秒至6小时不等。最常见的表现为呼吸困难（90%）、低氧血症（70%）和脑功能障碍（70%）。空气最常被检测到的部位是左心室（40%）、肺动脉（30%）和右心室（30%）。4例（40%）报告死亡，其余6例患者完全康复。所有死亡病例均未报告空气入口阻塞情况。
导管拔除后发生的AE具有较高的死亡风险。对预防措施要有高度的认识和关注，AE发生后进行适当护理似乎是必要的。
