Pressure monitoring can accurately position catheters for air embolism aspiration

Venous air embolism is a potentially catastrophic surgical complication. While prevention and early diagnosis represent the cornerstones of management, definitive therapy of a massive air embolus relies on aspiration of the air through an appropriately located multiorifice catheter. Currently, the most common method for accurately positioning a multiorifice catheter in the high right atrium is an intravenous electrocardiogram (IVECG). Because that method is not always technically feasible, we evaluated a right ventricular waveform as a marker for accurate and reliable catheter localization. Twenty patients were prospectively evaluated. After successful insertion of an antecubital introducer sheath, a multiorifice catheter was advanced into the central circulation (5 orifices, one at the distal tip and four 1.0 x 1.5 mm side orifices spaced 0.5 cm apart beginning 1.2 cm from the distal tip). Simultaneous IVECG and pressure waveforms were monitored. After the catheter was advanced into the right ventricle, it was withdrawn until an IVECG P-wave characteristic of the superior vena cava-right atrial junction was observed. The time from cannulation of the basilic vein until obtaining a characteristic IVECG of the superior vena cava-right atrial junction was 6.6 +/- 4.2 minutes (mean +/- SD). The distance between loss of the right ventricular waveform to the appearance of the desired IVECG P-wave configuration was 3.6 +/- 0.35 cm (mean +/- SD). Because the origin of the observed IVECG complex (1.7 cm proximal to the distal orifice) and of the right ventricular waveform are located in two different places, the tip of the catheter was not considered to be in an optimal position for air aspiration.(ABSTRACT TRUNCATED AT 250 WORDS)