Venous air embolism during gastrointestinal endoscopic procedures: Rapid overview

Risk factors

Previous surgery, intervention, or injury of the bile duct system (eg, TIPS, blunt or penetrating liver trauma, percutaneous transhepatic biliary drain, postsurgical gastrointestinal fistula)
Inflammatory conditions (eg, cholangitis, hepatic abscess, inflammatory bowel disease, necrotizing enterocolitis)
Procedural issues (eg, sphincterotomy, metal stent, cholangioscopy, biliary sphincterotomy, high pressure or rate of gas insufflation)

Clinical signs*

Decreased ETCO₂
Decreased SPO₂
Hypotension, cardiovascular compromise
Neurologic deterioration (sedated patients)

Management

Call for help
Notify proceduralist
- Stop gas insufflation
- Remove endoscope
- Terminate procedure
Discontinue N₂O and administer 100% O₂
Discontinue PEEP
Turn patient to left lateral decubitus position, head down
Airway management as needed
Cardiovascular support
- IV fluids
- Vasopressors as needed
- ACLS as necessary
Urgent bedside echocardiography
Monitor for signs of bleeding, perforation, sepsis

TIPS: transjugular intrahepatic portosystemic shunts; ETCO₂: end-tidal carbon dioxide; SPO₂: peripheral arterial oxygen saturation; N₂O: nitrous oxide; O₂: oxygen; PEEP: positive end-expiratory pressure; IV: intravenous; ACLS: advanced cardiac life support.
* Clinical signs depend on severity of venous air embolism.

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خرید پکیج

Venous air embolism during gastrointestinal endoscopic procedures: Rapid overview