Abstract: TH-PO268
Unveiling a Rare Complication: Arterial Air Embolism during Hemodialysis without Intracardiac Shunt
Session Information
- Hemodialysis and Frequent Dialysis - 1
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Gross, Matthew William, Johns Hopkins University, Baltimore, Maryland, United States
- Cervantes, C. Elena, Johns Hopkins University, Baltimore, Maryland, United States
- Hanouneh, Mohamad A., Johns Hopkins University, Baltimore, Maryland, United States
Introduction
Air embolism is a rare complication during hemodialysis, due to safety measures like venous air traps and alarms. It's typically linked to the use of central venous catheters or the administration of anticoagulation or saline during dialysis. We report a case of arterial air embolization during dialysis in a patient without intracardiac shunt.
Case Description
A 56-year-old woman with ESRD on intermittent hemodialysis via a central venous catheter experienced facial droop and left-sided weakness during hemodialysis soon after receiving a heparin bolus with saline flushes. Her vitals remained stable. The venous line clamped, treatment was terminated, and the patient was positioned in trendelenburg. A CT scan showed an acute right frontal lobe infarct due to an air embolism (Figure 1A and 1B) and bubbles in the pulmonary artery (Figure 1C). Patient underwent three sessions of hyperbaric oxygen therapy. Her neurologic exam returned to baseline, and imaging confirmed resolution of air in the sulci of the right lateral superior frontal region (Fig 1D). Transthoracic echocardiography with agitated saline was done twice and did not demonstrate any intracardiac shunt.
Discussion
The usual manifestation of air embolism during hemodialysis is related to the air entering the cardiopulmonary circulation and includes chest pain, dyspnea and hypotension. Arterial air embolization, while less prevalent, presents a heightened risk, potentially leading to seizures or strokes. Such occurrences may arise in the presence of a right-to-left shunt or, as in our case, if pulmonary capillaries fail to adequately purge a significant volume of air, thereby overburdening the filtration capacity of the pulmonary vasculature. Quick identification is crucial, and treatment involves administering 100% oxygen, placing the patient in the trendelenburg position to contain the air in the right ventricle apex, clamping the venous line, stopping the blood pump, addressing any catheter disruptions, and providing intubation and cardiopulmonary support if needed.