Many are afraid that after the dropper for intravenous infusion is over, the air from it can enter the circulatory system and provoke deadly air embolism. We decided to check if such a fear is reasonable.
Probable getting into a vein air from ended The droppers are worried many Internet users. Questionswhat will happen with patient And How much This dangerous, set on forums, V Blogs and communities about Medicine V social networks. Popularizes this fear and mass culture - for example, the character of Ian McCellen in the film "Capable student"Comes suicide, blowing a catheter inserted into Vienna. In the series "Dr. House"Dybala dictator is trying to provoke Dr. Ellison Cameron to introduce him a bubble of air with injection. The mortal danger of air in a dropper or simply in a syringe is also played out in the series "Orange - Hit of the season" And "Monsters", And in the final"Eternity"The protagonist in this way straightens out with his sworn enemy (though air embolism does not kill him, but causes the syndrome locked person).
Airy embolism is hit In the bloodstream of air bubbles. Its prevalence is difficult to determine, since light cases are asymptomatic and patients do not seek medical help. Depending on where the air bubble turned out to be, venous, arterial and cerebral embolism is distinguished (it is also the embolism of the brain arteries). Venous is not as serious as arterial, which, in turn, is less dangerous cerebral. For each of these varieties, dangerous volumes of air are also distinguished. So, even 2-3 ml of air entering the brain arteries, Deadly Dangerous, while for death with venous embolism Required not less than 100-200 ml. Symptoms also differ: when blocking the brain arteries, the formation of pathology occurs according to the type of ischemic stroke, with damage to the pulmonary artery, respiratory failure and lung infarction develops, and when blocking the artery that feeds the organ, the lesion and possible necrosis of its tissues.
Often Airy embolism occurs due to the breakthrough of the walls of the alveoli with the capillaries. In particular, this is a common complication among divers who do not observe safety precautions. She can also arise As a complication of chest injuries, with the rupture of placental veins in childbirth, during surgical interventions. Described Even cases of air embolism in women during cunnilingus in the presence of damage and ruptures in the tissues of the vagina or uterus. Also, air can enter the blood supply system due to the incorrectly selected regime of the artificial ventilation apparatus of the lungs (IVL).
Normally, the pressure in the peripheral veins (it is in them that droppers are installed) does not allow The air from the outside get inside. This is easy to make sure if you recall the process of taking blood from the vein - when the needle is introduced, the blood begins to flow out, and not the air is absorbed into the circulatory system. Therefore, even if the dropper ends, the air from it will not fall into the body, on the contrary, a small amount of blood can rise along the catheter.
However, in a jugular or subclavian vein, pressure can catastrophically fall due to dehydration and even become negative. However, in such conditions, peripheral veins are “blown away” and it is impossible to put a dropper. Moreover, in order to help the patient with severe dehydration, it is necessary to introduce so much fluid into the body that doing this through a dropper is ineffective. In such cases, a central venous catheter is usually installed. During the procedure, doctors and their assistants carefully monitor the prevention of air entering Vienna-according to the “gold standard”, they are recommended to carry out catheterization under the ultrasound control. To prevent the patient’s air embolism, Place In the position of Trendelenburg (in which the pelvis is located above the head) - thus, the installation site of the catheter is lower than the heart and thereby the risk of penetration of air bubbles into the bloodstream is minimized. Also Recommended Do not carry out the installation of CVC on the inhalation of the patient so that the pressure in the central veins is maximum, and it should be removed, on the contrary, it follows exhaust or during the Valsalva maneuver*.
However, it is impossible to completely exclude the probability that during this procedure it will enter the circulatory system. For example, the cardiologist of the St. Petersburg Research Institute of Ambulance named after Gianelidze Konstantin Krilev Describes Such a case:
Many years ago, a patient with a diagnosis of a stroke was brought to my intensive care. He was dehydrated - more than a day has passed since the stroke, and he could not drink all this time, since he was unconscious. To put him a central venous catheter, I entered the needle into a subclavian vein and disconnected a syringe to introduce a conductor into the needle. At this time, a whistling sound was heard - air began to flow through the needle through the needle. Of course, I quickly clamped the lumen with my finger, but a certain amount of air still fell into the circulatory system. Although I knew that it was relatively safe, it felt uneasy. True, in the end, it all ended safely - against the backdrop of replenishing the volume of fluid, the patient became much better, and he even came into consciousness.
Despite all precautions, air embolism is a common complication in surgery. With neurosurgical interventions, for example, she is happening in almost 80% of cases, and with orthopedic - 57%. Even cases of air embolism are described during ophthalmological operations - removing a foreign body and correcting retinal detachment.
Specialists from the University of Jones Hopkins (USA) Analyzed More than 4,000 reports on the occurrence of air embolism during surgical procedures and divided the interventions into groups: high risk, moderate and low. There were seven operations in the first group: cranitomy in a sitting position (type of operation on the brain, which includes the removal of part of the cranial box to obtain access to the brain), surgery on the posterior cranial fossa or in the neck, laparoscopic procedures, replacing the hip joint, cesarean section, and removal of CVK, as well as correcting craniosynostosis - craniosynostosis - craniosynostosis. early fusion of skull seams. Neither the moderate group nor the low -risk group includes procedures associated with the installation of droppers in peripheral veins.
Thus, usually the pressure in the peripheral veins, where the dropper is installed, does not allow air to enter the circulatory system. When dehydration, venous pressure can be critically decreased - however, the patient in this condition put an ordinary dropper is almost impossible and ineffective. Instead, the patient is installed by the central venous catheter, with this procedure, the risk of air embolism is much higher. However, it can be significantly reduced due to the correct implementation technique and additional precautions like ultrasound control.
*Exercise, which consists in an attempt to make a strong exhalation when clamped with the mouth and nose and closed vocal cords. It is used, for example, by air passengers to get rid of the sensation of ears congestion during a set or drop in height, as well as turbulence.
Image on the cover: University of Providence
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