Intracardiac air--the 'hospital killer' identified? Case reports and review of the literature.

Venous access is an essential part of caring for the sick neonate. The primary problem with catheters, whether peripherally or centrally placed, is the difficulty in maintaining them, the development of phlebitis and systemic infection, and fluid extravasation. A lesser known complication is the development of venous air embolism (VAE), as described in the 4 cases presented. We agree with others that VAE in newborn infants may occur more frequently than expected and emphasise the fact that it is preventable and that careful attention must be given to the techniques of preparing venous infusions. As health professionals (medical and nursing) we should take a harder line and regard these events as medically negligent until proven otherwise. We should take full responsibility for equipment, the connections, the infusate and the monitoring thereof. Unfortunately, the prognosis for this condition remains poor and it is unclear whether an increased awareness of this condition would influence outcome. Manufacturers of intravenous fluids should produce products devoid of air in order to reduce the risk of venous air embolism.