Air embolism during central venous catheter placement

"Acute venous air embolism is an uncommon but feared complication of central venous catheter procedures. Large volumes of intravascular air (generally estimated at approximately 50–100 mL) may obstruct right ventricular outflow and provoke circulatory collapse" Birgün et al (2026).

"Acute venous air embolism is an uncommon but feared complication of central venous catheter procedures. Large volumes of intravascular air (generally estimated at approximately 50–100 mL) may obstruct right ventricular outflow and provoke circulatory collapse" Birgün et al (2026).

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Air embolism during central venous catheter placement

Abstract:

Acute venous air embolism is an uncommon but feared complication of central venous catheter procedures. Large volumes of intravascular air (generally estimated at approximately 50–100 mL) may obstruct right ventricular outflow and provoke circulatory collapse, whereas smaller volumes may still cause clinically significant arterial embolization in the presence of a right-to-left shunt such as a patent foramen ovale. Mortality in procedural air embolism is driven less by the absolute amount of air introduced and more by the velocity of entrainment, the patient’s intrathoracic pressure status, and whether a right to left shunt is present (e.g., a patent foramen ovale). Therefore, the clinical expression of this complication may vary from transient dyspnea to immediate cardiovascular arrest.

Reference:

Birgün A, Sarıhan A, Çelik MC, Kalçık M, Bekar L. Acute Venous Air Embolism During Central Venous Catheter Placement: Rapid Deterioration and Imaging-Confirmed Diagnosis. J Emerg Med. 2026 Jul 12;88:232-234. doi: 10.1016/j.jemermed.2026.07.012. Epub ahead of print. PMID: 42585862.