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January 1, 1973

Prevention of Air Embolism During Subclavian Venipuncture

Author Affiliations

Charity Hospital New Orleans

JAMA. 1973;223(1):79-80. doi:10.1001/jama.1973.03220010065027

To the Editor.—  Air embolism is a serious complication of percutaneous cannulation of the branches of the superior vena cava and has caused numerous deaths.1-5 Having the patient in Trendelenburg's position, deep expiration at the time of venipuncture, and occluding the needle hub with a finger after disconnecting the syringe while preparing to insert the catheter have been suggested as preventive measures.2-4 Use of Trendelenburg's position helps filling and distension of the vein, but air embolism can still occur.4 Even a brief exposure of the catheter hub to the atmosphere may result in a significant aero-embolus. Using Poiseuille's law, Flanagan and co-workers calculated that 100 cc of air per second could easily pass through a 14-gauge needle.5 Air embolism can also occur when the intravenous tubing is disconnected from the catheter hub during irrigation or flushing of the system or while drawing a blood sample. In