Management of Venous Air Embolism During Tunneled Hemodialysis Catheter Placement: Role of Targeted Aspiration and Patient Positioning.

OBJECTIVE

The traditional treatment for venous air embolism has been mainly conservative, with very few reports advocating the use of manual aspiration. The objective of this report is to describe a novel procedure that employed a practical combination of positional maneuvers and direct catheter-based aspiration for air embolism encountered during tunneled hemodialysis catheter insertion.

METHODS

A retrospective review of three cases of venous air embolism encountered during a 3-year period (September 2022-July 2025) was conducted, in which the patient repositioning combined with manual aspiration of intravascular air was employed.

RESULTS

Venous air embolism characteristically occurred during removal of the dilator-guidewire assembly from the vascular sheath during the procedure, especially in long-term tunneled catheters, owing to the larger caliber of the peel-apart sheath. The embolized air has the potential to lodge in the right ventricular outflow tract, thereby reducing pulmonary venous return and cardiac output. Immediate patient repositioning combined with rapid central venous catheter insertion and targeted manual aspiration of intravascular air achieved prompt clinical stabilization in all three cases.

CONCLUSION

Venous air embolism is a rare but life-threatening complication of image-guided central venous catheter insertions. For symptomatic air embolism involving the right ventricular outflow tract, prompt catheter insertion, proper positioning, and manual aspiration of air through the inserted catheter, in conjunction with oxygen supplementation, may assist in managing this acute condition promptly.