Abstract Details

Title Air in the Brain: An Unexpected Complication of a Misplaced Peripheral Intravenous Line

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P04 - (-)

Poster/Presentation
Number 073

Objective

Background BACKGROUND: With the advent of safer technologies, VADs are becoming increasingly common treatments for patients with heart failure. Patients with VADs have altered vascular physiology and are at risk of neurological diseases not commonly seen otherwise.

Design/Methods DESIGN/METHODS: We present a patient seen in our hospital. The clinical history, laboratory, and imaging studies are reviewed.

Results RESULTS: A 35 year old man with dilated cardiomyopathy requiring VAD was admitted for worsened heart failure. For fluid and medication administration, a peripherally inserted central catheter (PICC) was placed. Two days later, he developed sudden onset left field cut, neglect and left hemiplegia with an NIHSS of 16. Stat non-contrast head CT showed infarct of the right parietal lobe and intravascular air in the right middle cerebral artery. Contrast was administered through his PICC line however, only his right craniocervical circulation was visualized. Further imaging demonstrated that the PICC line had been mistakenly placed in an artery instead of vein and tunneled to the right innominate artery. It was determined that the PICC line had been misplaced due to the absence of arterial pulsations as a result of his VAD, and that it was the likely source of his cerebral arterial air embolism. He was placed on 100% oxygen, and his symptoms improved within an hour and by day three had made an almost complete recovery.

Conclusions CONCLUSIONS: To our knowledge, this is the first reported case of a cerebral air embolism and stroke as the result of an arterially placed PICC line. Due to their altered vascular physiology, patients with VADs are at risk for this rare disorder, and this report highlights the importance of vigilance for unanticipated complications in these patients.

Authors/Disclosures
Sunil Sheth, MD (University of Texas At Houston) PRESENTER	Dr. Sheth has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Penumbra. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Imperative Care.
Helen Colquhoun	Helen Colquhoun has received personal compensation for serving as an employee of Sage Therapeutics. Helen Colquhoun has stock in Sage Therapeutics. Helen Colquhoun has received intellectual property interests from a discovery or technology relating to health care.
Rachel Paul, MD	No disclosure on file
Julia Durrant, MD (OHSU)	Dr. Durrant has nothing to disclose.

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