Air embolism in the agitated traumatic brain injury patient: an unusual complication

Central venous catheters are often utilized in the acute care management of the traumatic brain injury (TBI) patient. While in the agitated phase of recovery, TBI patients often focus on removing indwelling tubes or venous access lines. Air embolism is among the most serious complications reported in the use of central venous catheters. We present a case of air embolism in an agitated patient, and discuss prevention methodologies. A 38-year-old male was involved in a fall, with an initial Glasgow Coma Scale of 12. CAT scan imaging revealed a left frontal intracerebral haematoma. He required central venous catheter placement for management of associated chest and abdominal injuries. Agitated from early in his stay, the patient was able to twist off several hubs from the central venous catheter with his teeth, resulting in an air embolus. The patient experienced sudden clinical deterioration with oxygen saturation decling to 70%. The patient's course improved after several days of ventilatory support. He eventually successfully completed inpatient rehabilitation, achieving independence in activities of daily living and ambulation. This case illustrates a serious potential complication in the agitated patient. Physicians and rehabilitation specialists should advocate for secured taping of central venous catheter hubs and adequate padding of catheter dressings in agitated patients.