Abstract

Venous air embolism (VAE) occurs when air or gas enters the venous circulation. It is an uncommon but potentially fatal iatrogenic complication of surgical procedures and is often a diagnosis of exclusion. A 40-year-old female presented for laparoscopic peritoneal dialysis catheter revision. Following surgical trocar placement, insufflation, and Trendelenburg positioning there was an immediate drop in EtCO2 from the low 30’s to 15 mm Hg. When the surgical team was alerted it was discussed that the liver was nicked, causing concern for venous air embolism. Insufflation was stopped, patient was placed in the left lateral Trendelenburg position, and was manually ventilated. The patient exhibited rhythm changes including 1st-degree heart block and 2nd-degree Mobitz type 1 heart block with ST depression. The patient was relatively stable and the decision was made to continue the procedure. Within a few minutes, the patient then spontaneously converted back to sinus rhythm with resolved ST changes, increasing EtCO2 to 50’s mm Hg and SpO2 to 98%. Quick diagnosis and management of this complication is vital to preventing morbidity and mortality. Intraoperative echocardiography may be a useful tool to aid in definitive diagnosis and management of these patients. When TEE is utilized in non-cardiac surgery it commonly leads to improved changes in medical management in 40% of patients. Focused or rescue echocardiography could be an option to make echocardiography more broadly available to all anesthesia providers.

Author Details

Alyson L. Mason, DNP(c), BSN

Sigma Membership

Non-member

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Venous Air Embolus, Echocardiography, End-Tidal Carbon Dioxide

Advisor

Terri Cahoon

Degree

DNP

Degree Grantor

Samford University

Degree Year

2025

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

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Abstract.pdf (85 kB)

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