DEFINITION
Air embolism is the entry of air bubbles into the central venous system (rarely arterial system) by direct or indirect access into the blood stream through a central or peripheral route. The symptoms reflect the end organ affected.
Entry of air in the heart.
In seated patients, infused air will tend to migrate into the cerebral venous system without entering the heart, causing obstruction to cerebral venous return with loss of consciousness, convulsions, and even death. In recumbent patients, the air tends to enter the heart, generate foam in the right ventricle, and pass on into the lungs. At this point, dyspnea, cough, and chest tightness can be expected. Further passage of air across the capillary bed into the left ventricle can result in air embolization to the arteries of the brain and heart, with acute neurologic and cardiac dysfunction.
Prevention
Ensure all lines are secured
Ensure all alarm systems are fully functioning
Continual observation of all dialysis circuit
Remove all empty containers attached to the dialysis circuit
PURPOSE
1. To ensure that a safe and hazard free dialysis treatment is delivered
2. To identify any issues that require further action and follow up to ensure that the patient receives safe individualized therapy and thus maintain optimum quality of care.
CONDITIONS
1. Applies to all Registered Nursing Personnel working in dialysis centres in Oman.
2. This procedure can be performed by a nurse undertaking nephrology / dialysis training program, provided he/she is closely supervised by an experienced dialysis nurse at all times.
PROCEDURE
| SN | Nursing Action | Rationale |
| 01 | If haemodialysisis ON, clamp the venous line and stop the pump. If open access to central venous catheter (CVC), immediately clamp ports of CVC. | To prevent further air entry into the circulation |
| 02 | Place the patient in a recumbent position on the left side with the head and chest tilted downward until the embolism is ruled out. | To prevent the entry of air into the circulation and thereby into the cerebral blood vessels, with the right ventricle acting as a bubble trap |
| 03 | Administer 100% oxygen | To reduce cerebral hypoxia |
| 04 | Seek medical assistance | This is a medical emergency that requires further emergency management |
| 05 | Give prescribed intravenous therapy. Intravenous infusion of low molecular weight dextran or dextrose through peripheral line. | To improve capillary perfusion of brain tissues |
| 06 | Maintain observation and document events as they happen with administered medications. Note effects of medications and condition of patient and response to management. | Documentation of such events is essential for monitoring and follow-up the patient’s conditions. |
| 07 | Keep the patient for a minimum of 4-6 hours for close observation. Transfer to Intensive Care Unit for further management if necessary. | To insure patient condition is improved and safe to discharge . |