Air Embolism during Insertion and Replacement of Tunneled Dialysis Catheters: A Retrospective Investigation of the Effect of Aerostatic Sheaths and Over-the-Wire Exchange

作者：Hsu Michael; Trerotola Scott O^*

来源：Journal of Vascular and Interventional Radiology, 2015, 26(3): 366-371.

DOI：10.1016/j.jvir.2014.11.035

Purpose: To determine the impact of the introduction of aerostatic sheaths on air embolism (AE) events, during tunneled dialysis catheter (TDC) insertion and to characterize such events occurring during over-the-wire exchange (OTWE).
Materials and Metheds: Between July 2001 and April 2013, 5,789 TDCs were placed, including 3,963 de novo placements, 1,811 OTWEs, and 15 tract recanalizations. There were 15 AE events repotted, and the medical records of these patients were reviewed. the effect of aerostatic sheaths, introduced in July 2005, was compared with the period before their introduction; the same TDC design was used throughout.
Results: Of the 15 AE events, 1.0 occurred during de novo placement (10 of 3,963 placement; 0.25%), 4 occurred during OTWE (4 of 1,811 placements; 0.22%), and 1 occurred during tract recanalization. With regard to aerostatic sheaths in de novo TDC placement 4 of 1,174 (0.34%) AE events occurred before aerostatic sheath introduction, and 6 of 2,789 (0.22%) AE events occurred after aerostatic sheath introduction. These rates did not differ statistically (P = .5).
Conclusions: Use of aerostatic sheaths trended toward reducing AE events during de novo TDC placement, This trend was not statistically significant, probably owing to the rarity of AE despite the large sample size. Air embolism occurs during OTWE at a rate similar to de novo placement with aerostatic sheaths as well as during tract recanalization:

• 出版日期2015-3