• Hisashi Nagai, Hideyuki Maeda, Ryohei Kuroda, Masatomo Komori, Makoto Nakajima, Akina Nara, Takako Ito-Tsujimura, Kaori Shintani-Ishida, Naoki Yahagi, and Ken-ichi Yoshida.
• From the Departments of *Forensic Medicine, and †Emergency and Critical Care Medicine, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.
• Am J Forensic Med Pathol. 2014 Dec 1;35(4):237-8.

AbstractPulmonary air embolisms due to the removal of a central venous catheter are rare, but catheter removal is known to be a high risk factor for air embolism. In particular, the removal of a large catheter, such as a double-lumen hemodialysis catheter, can allow a large amount of air to enter into the bloodstream, which often results in sudden death. So, during catheter removal, special care should be taken to prevent air from entering blood vessels, for example, to ensure that the patient's head is tilted downward, that they have inhaled and are holding their breath, and that a covering gauze and inert ointment have been applied to the exit site. We report a lethal case of pulmonary air embolism caused by the removal of a double-lumen catheter from the right internal jugular vein of a patient who was sitting up and had not been instructed to hold their breath.

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