Simple Mistakes Causing Catastrophic Complications: Central Venous Catheter Removal Leading to Cerebral Air Embolism

Central venous catheters (CVCs) are commonly placed in patients in critical care units (CCUs) for a variety of reasons. Indications for CVC placement include rapid volume resuscitation, central venous pressure monitoring, venous access in patients with severe vascular disease, hemodialysis, and the need for the administration of vasoactive/bioactive medications. The placement of a CVC, however, does not come without risks to the patient, and one must keep these complications in mind. A 66-year-old male with Stage IV chronic kidney disease was admitted for dehydration secondary to diarrhea and was started on intravenous fluid resuscitation. During his eventful hospital course, the patient was transferred to the CCU, where a right internal jugular CVC was placed with eventual removal. A few minutes after removal, the patient was found to be poorly responsive, diaphoretic, and noted to have neurologic findings. A computed tomography scan of the head and a computed tomography angiogram of the head and neck revealed air within the subarachnoid space, subtle parenchymal hypodensity along the right cerebral cortex, and air inside the jugular and vertebral venous system. Magnetic resonance imaging of the brain revealed air within the cavernous sinuses, cortical veins, and dural sinuses. The patient was treated with aspirin and statin therapy given stroke-like symptoms, with eventual improvement and discharge. Air embolism (AE) is an uncommon and dangerous complication that can result from various reasons, such as trauma, surgery, septal defects, or barotrauma. In this case, the AE was a devastating complication of a CVC. They can occur at various portions of the insertion and removal process. AE may cause cardiopulmonary distress and/or neurologic symptoms. Given the clinical context, a high level of suspicion is required to diagnose cerebral AE. This unfortunate event highlights the dangerous complications of a routine procedure. Early diagnosis and clinical suspicion of AE decrease morbidity and mortality.