Gas embolism associated with a midline catheter in ICU patient: A case report

Midline peripheral intravenous catheters are widely used for long-term peripheral venous access due to ease of placement and a lower complication profile than central lines. To date, gas embolism has not been reported in association with midline catheters. We report the case of a 59-year-old man with COVID-19-related acute respiratory distress syndrome, who developed sudden coma and acute hypoxemia. Bedsides, echography revealed gas embolism in all cardiac chambers, and body-CT scan showed cerebral air emboli and hepatic portal venous gas. The event followed disconnection of a midline catheter infusion set while the patient was spontaneously breathing, hypovolemic and seated. Neurological sequelae persisted despite prompt hyperbaric oxygen therapy and supportive care. This is the first reported case of cerebral gas embolism related to a midline catheter. The case highlights the importance of individualized catheter length, secure line fixation, and risk factor awareness to prevent air embolism, even with peripheral lines.