Central line to remove air

[caligas]

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I know the board answer for massive embolism includes “multi orificed catheter” to remove air.

Has anyone ever actually successfully done this? What kind of catheter?

 

[ToKingdomCome]

I know the board answer for massive embolism includes “multi orificed catheter” to remove air.

Has anyone ever actually successfully done this? What kind of catheter?

The CPR will probably compress the air at that point . Putting a neck line in while cpr ongoing prob isn’t worth it

 

[ambiturner]

We occasionally put them in in residency for high risk neuro cases, personally never needed to use one but had a colleague that used a MAC line to pull (a portion of) a massive embolus out one time. Agree that if the line isn’t in before the air embolus it won’t be any help by the time you put one in.

 

[sevoflurane]

I know the board answer for massive embolism includes “multi orificed catheter” to remove air.

Has anyone ever actually successfully done this? What kind of catheter?

Yes- Have done it.
Definitely works. Not sure if you can save anyone with massive embolus. N of 2.

Once for renal cell ca with extension into the vena cava. The other time during a lap chole with a verees needle into the liver.

Renal cell patient had a cordis in already and I was able to suck out some air. Patient still died from cardiopulmonary collapse. Didn’t make it out of the room.

Lap Chole ended up on crash bypass and was able to pull out some CO2. Even then it was remarkable how much CO2 was in the right atrium once we progressed through sternotomy- visually see Co2 bubbles theough the thin right atrium. This one may have lived, but had a large pfo with resultant massive stroke. Died in the ICU.

N=2. Both patients I was able to extract 15-30 ccs of air/co2. Both patients died.

 

[sevoflurane]

Renal Cell had a cordis, lap chole had a MAC catheter.

 

[Gator7]

Had a suspected VAE during a crani in residency. CV attending came in and saw air in the RV and put in central line and tried to aspirate. Unfortunately it didn’t help and the patient died in the OR.

Obviously no way to know for certain if it was truly a VAE, but it unfolded pretty textbook.

As a side note, most shocking part was the neuro and ENT surgeon refusing to assist with the code. They wanted to stay sterile so they could continue the operation. Truly just scum.

 

[cchoukal]

Renal Cell had a cordis, lap chole had a MAC catheter.

Uh, lap chole had a MAC? Before the air?

 

[sevoflurane]

Uh, lap chole had a MAC? Before the air?

No silly….. 😂😂

 

[cchoukal]

No silly….. 😂😂

Thought maybe you were clairvoyant.

 

[sevoflurane]

One of those cases that stuck w me.

April Fools about 12 years ago.
65 y/o sweet amish lady with a h/o IBD. Had multiple surgeries in the past and current ileostomy.
New surgeon few months out. CT of the abdomen on the left was full of adhesions. Ileostomy was center left.

Varees goes in, etco2 goes down, dysrrhythmogenic, hypoxic and bps coming down fast.

Responsive to pressors (likely the pfo)…. so i dropped a probe, placed a MAC and called my CT surgeon lickidy split.

He just laughed at me because it was april fools. Eventually he understood I wasn’t kidding. Moved one room over where we had CPB machine primed and ready to go. Crashed on. Opened up the right atrium and evacuated the Co2. Felt good about the “save” despite being worried about the pfo.
CT that night was terrible- massive bilateral strokes. PFO saved her from immediate death, but also caused her ultimate demise.

 

[PpfSuxTube]

I know the board answer for massive embolism includes “multi orificed catheter” to remove air.

Has anyone ever actually successfully done this? What kind of catheter?

Not precisely what you're asking but during 2 mitral clips this year, air entrained into the system and went down the RCC and hovered over the RCC sinus.
Rapid st elevation, Brady, hypotension, RV akinetic.

We saw it quick and the cardiologist put in some catheter and sucked it out....
Gave some mil and finished both cases...
Idk what catheter they used tbh.

 

[BlueRug]

to answer the OP: yes during training

Two with lines already in place.

Three with emergent blind lines (and 60cc syringe that sucked about 20-30cc co2 out). Seasoned CV staff each time.

 

[Beeftenderloin]

Yes- Have done it.
Definitely works. Not sure if you can save anyone with massive embolus. N of 2.

Once for renal cell ca with extension into the vena cava. The other time during a lap chole with a verees needle into the liver.

Renal cell patient had a cordis in already and I was able to suck out some air. Patient still died from cardiopulmonary collapse. Didn’t make it out of the room.

Lap Chole ended up on crash bypass and was able to pull out some CO2. Even then it was remarkable how much CO2 was in the right atrium once we progressed through sternotomy- visually see Co2 bubbles theough the thin right atrium. This one may have lived, but had a large pfo with resultant massive stroke. Died in the ICU.

N=2. Both patients I was able to extract 15-30 ccs of air/co2. Both patients died.

If you did it twice and they died both times, sorry to burst your bubble, but it sounds like it didn’t work.

This more or less confirms my suspicion that if there is enough air entrained that you’re pulling large volumes out of the cava with an intro or a triple lumen, it’s already game over.

I’ve had 2 massive air emboli with hemodynamic collapse as well. Both misadventure with the Veress. Both rapidly recognized when CO2 dropped to nothing and sat probe started making the brown noise. Rapidly placed TEE both times and visualized air in RA, RV, and PAs, but none in the cava. Both patients got large doses of epinephrine and lived, neuro intact.

 

[Maverikk]

@Beeftenderloin how large we talking?

 

[sevoflurane]

If you did it twice and they died both times, sorry to burst your bubble, but it sounds like it didn’t work.

This more or less confirms my suspicion that if there is enough air entrained that you’re pulling large volumes out of the cava with an intro or a triple lumen, it’s already game over.

I’ve had 2 massive air emboli with hemodynamic collapse as well. Both misadventure with the Veress. Both rapidly recognized when CO2 dropped to nothing and sat probe started making the brown noise. Rapidly placed TEE both times and visualized air in RA, RV, and PAs, but none in the cava. Both patients got large doses of epinephrine and lived, neuro intact.

Definitely works in the sense that YES, you can get air/co2 out.

Survival of any embolus is dependent on and how big the embolus is (immediate CP collapse) and how quickly it is recognized/dealt with.

Renal cell case was immediate CP collapse. Zero chance of survival.
Lap chole case was a smaller embolus as we actually had time to get onto bypass.

But yeah, both cases I was able to get 15-30ccs of air/co2 out. So it worked in that sense.

 

[turnupthegas]

Once. The surgeon stuck the Varess needle in the liver and ran it at high flow during a lap ventral hernia. Textbook hemodynamics followed Patient coded. I stuck a central line in and aspirated a decent amount of air. Was able to get ROSC and the patient survived.

 

[Beeftenderloin]

Definitely works in the sense that YES, you can get air/co2 out.

Survival of any embolus is dependent on and how big the embolus is (immediate CP collapse) and how quickly it is recognized/dealt with.

Renal cell case was immediate CP collapse. Zero chance of survival.
Lap chole case was a smaller embolus as we actually had time to get onto bypass.

But yeah, both cases I was able to get 15-30ccs of air/co2 out. So it worked in that sense.

Fair.

 

[PpfSuxTube]

Our triple lumens are only 15cm long and that's just barely long enough to reach RA in a 5'5 male so what length catheter you all using?

We have 3 lengths vasc Cath available upto 24cm but theyre not as quickly available.

 

[Arch Guillotti]

Our triple lumens are only 15cm long and that's just barely long enough to reach RA in a 5'5 male so what length catheter you all using?

Why are they so short? I think every one I have ever seen is 20+ cm.

 

[deleted641888]

Why are they so short? I think every one I have ever seen is 20+ cm.

We also have the 16 cm ones, usually for right-sided lines, and 20 cm ones for left-sided or femoral access. That being said, I've put every variation in different spots depending on availability and urgency.