Catheter exchange and air embolism

August 23, 2008

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Kolbeck et al (2008) examine the issue of wire catheter exchange and the potential for air embolism, part of the process included clamping the catheter with the wire in place. We emphasize that clamping the catheter when a wire is inside the central venous access device may result in a wire embolism. However, the article adds to the body of literature that concerns the risk of air embolism.

Kolbeck, K.J., Stavropoulos, S.W. and Trerotola, S.O. (2008) Over-the-Wire Catheter Exchanges: Reduction of the Risk of Air Emboli. Journal of Vascular and Interventional Radiology. 19(8), p.1222-1226.

Abstract:

Purpose: This study evaluated the aerostatic properties of the catheter clamp during over-the-wire catheter exchanges and determined if protective devices reduce volumes of air emboli (AE).

Materials and Methods: A cuffed catheter was placed in an AE model in physiologic conditions and the volume of AE was recorded during 60 seconds (n = 10). Similarly, the volume of AE entering the model during 30 seconds was recorded with the catheter clamp open (n = 10) or closed over the wire (n = 10), and with the sliding clamp in the open position (n = 10). The volume of AE during 60 seconds was recorded with the sliding clamp closed over the wire (n = 10) and with the aerostatic valve with (n = 10) and without (n = 10) a wire in place.

Results: Without a wire, no AE occurred with the catheter clamp closed (60 seconds, n = 10). There was no statistically significant difference between the volumes of AE with the catheter clamp open or closed over the wire during 30 seconds (43 mL ± 4 and 32 mL ± 11, respectively). With the protective devices in place and the wire unchanged in position, no AE occurred during 60 seconds. A positive control (sliding clamp and catheter clamp open, n = 10) yielded AE volumes of 44 mL ± 5 in 30 seconds.

Conclusions: AE can occur with the catheter clamp closed over a wire. Protective devices reduce the volume of AE under simulated physiologic conditions and are recommended with over-the-wire catheter exchanges.