Prevention

These ideas are not scientifically proven, but makes sense, based on analysis of real cases as well as near missed cases. Above all, they do not cost a lot of money, and can prevent morbidity and mortality for patients and save healthcare individuals and organisations a large amount of distress, embarrassment, and even money.

1. Avoid 'excessive' pressures when inflating any body cavity with gas, e.g. laparoscopies, thoracoscopies, gastrointestinal endoscopies.

2. Consider using carbon dioxide for insufflation inĀ  gastrointestinal endoscopies.

3. Adding colour to contrast material. Working in dimmed light, make it difficult to ensure all air is expelled from contrast injecting systems.

4. Use of tissue glue and/ or a purse string suture to close the orifice left when a big line e.g. dialysis line is removed. This applies particularly in older or malnourished patients where the elasticity of the tissue does not allowed for closure of the tract in the expected 30 to 60 minutes, or in the presence of scarring area of line insertion.

5. Continuous vigilance, careful monitoring and care by an experienced neuro anaesthetist in cases where neurosurgery in the sitting position has to be done

6. Before any intravenous injection or infusion is started, the syringe or infusion set should be flushed by the person administering it, not assuming that the person setting it up has primed it or drawn up the drug even if the syringe is labelled.

7. When setting up invasive pressure measurement transducer systems, 2 people should check that the system is primed, and free of air bubbles. Gas bubbles flushed into the arterial system under pressure is extremely dangerous. Two nurses checking drugs and doing the same for arterial lines will add to safety without significant additional work. Adding a colouring agent may enhance safety.

8. Cardiac surgery is associated with an important risk of central or peripheral organ damage, attributed in part to air embolism from incompletely deaired cardiac chambers. Insufflation of carbon dioxide into the thoracic cavity is used in some centres for organ protection in cardiac surgery.

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