- “ASA Standard Monitors” should be used and watched carefully in every procedure done under general, regional, or local anesthesia. Particular attention must be paid to end-tidal CO2, which may provide early detection.
High AE Risk Cases (e.g., sitting craniotomy): Use the following additional detection and treatment technologies when possible:
- Precordial Doppler Ultrasonography: Early detection.
- Trans-Esophageal Echocardiography (TEE): Early detection.
- Pulmonary Artery Catheter: Potential treatment by aspiration from right atrium and ventricle.
- End-tidal nitrogen (N2) monitoring: If there is no nitrogen in the inspired gas, then sudden appearance of end-tidal N2 implies AE until proven otherwise.
Use air removal from infusion precautions with all intravenous cannulas, especially central venous (CVP).
- Consider ClearLine® or equivalent technology for detecting and removing air from infusion fluids.
- Ensure that all central venous catheters (CVP, PA, “triple lumen”, etc.) use Luer-Lock or other secure locking technology to guard against inadvertent disconnection. A disconnected CVP in a sitting, spontaneously breathing patient can be rapidly fatal.
Electronic Health Record (EHR).
- Web-based/EHR predictive algorithms that elicit specific data such as but not limited to vital signs (BP, Temp, HR, RR, and SpO2), lab values, nurses notes, and event reports.
- The EHR can be a key component of an AE prevention program by enabling computerized decision support to ensure that every patient has a valid AE prevention plan at all times during their hospitalization.