A-line air embolism

Q: Air embolism via arterial line (A-line) is more likely to occur? (select one)

A) Supine position

B) Upright position

Answer: B

Air embolism via arterial lines can be more devastating than central venous lines and may cause severe consequences such as stroke.  Air embolism via A-line usually occurs due to bubbles in the flush solution of an arterial catheter. They can travel in either direction (antegrade or retrograde) and can cause embolic damage to the brain, spinal cord, heart, or even skin. Studies have demonstrated that even 2 mL of air from radial artery can cause a clinically significant cerebral air embolism. This is due to the fact that arterial air emboli does not have a luxury to get filtered out through pulmonary capillaries. Interestingly, this risk is higher when patient is in an upright position, or of a short stature.

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References:

1. McCarthy CJ, Behravesh S, Naidu SG, Oklu R. Air Embolism: Practical Tips for Prevention and Treatment. J Clin Med. 2016;5(11):93. Published 2016 Oct 31. doi:10.3390/jcm5110093

2. Chang C, Dughi J, Shitabata P, et al. Air embolism and the radial arterial line. Crit Care Med 1988; 16:141.

3. Glenn S. Murphy, Joseph W. Szokol, Jesse H. Marymont, Michael J. Avram, Jeffery S. Vender; Retrograde Air Embolization during Routine Radial Artery Catheter Flushing in Adult Cardiac Surgical Patients: An Ultrasound Study. Anesthesiology 2004;101(3):614-619. doi: https://doi.org/

4. 2.Klein J, Juratli TA, Weise M, Schackert G. A systematic review of the semi-sitting position in neurosurgical patients with patent Foramen Ovale: how frequent is paradoxical embolism?World Neurosurg. 2018; 115:196–200. doi: 10.1016/j.wneu.2018.04.114

5. Arthur C Theodore, Gilles Clermont, Allison Dalton, MD: Indications, interpretation, and techniques for arterial catheterization for invasive monitoring. Uptodate: last updated: Jul 24, 2019.