Fatal Air Embolism After Central Line Removal

This case involves an 18-year-old female that was suffering from a severe asthma attack when she was taken to the ER. Upon being admitted, she was placed on a central line due to recurrent unstable blood pressure values. After a week in the hospital, the patient was discharged and upon her arrival at home she collapsed and was rushed back to the ER. At this point, it was discovered she had an air embolism that resulted in a severe stroke and has left her in a persistent vegetative state. The patient is on life support and requires the placement of an intravenous total parenteral nutrition line (TPN).

Question(s) For Expert Witness

1. Would it be reasonable to assume that a physician can determine if the central line was put in incorrectly?

2. When should the incorrect placement have been noticed?

Expert Witness Response E-001718

Physicians have to verify that the IV tubing is full of fluid without air bubbles, verify that blood returns from the central line, and that correct positioning is secured after insertion of the line. If the patient was in respiratory distress when the line was inserted, she could have sucked air into the line if it was not occluded when first inserted, as the intrathoracic pressure could be quite negative. It is highly probable that the embolism occurred on the day of discharge, most likely when the central line was taken out without following standard precautions to prevent air from entering the large bore vein. A true stroke (blocked blood vessel) would be highly unlikely unless she had a heart deformity allowing the air to cross from the right side of the heart to the left, so I would suspect that her PVS is due to hypoxia only.