On the proximate cause of death after the spontaneous introduction of air into the veins. With some remarks on the treatment of that accident / [John Eric Erichsen].

  • Erichsen, John Eric, 1818-1896
Date:
[1844]
Catalogue details

Licence: Public Domain Mark

Credit: On the proximate cause of death after the spontaneous introduction of air into the veins. With some remarks on the treatment of that accident / [John Eric Erichsen]. Source: Wellcome Collection.

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    And first of all, as most important, let us take into considera¬ tion the best way of preventing the occurrence of the accident m question. Before doing so, however, it may be better, m order to understand the principles on which we should act, to give a brief summarv of those circumstances that are peculiarly apt to oc¬ casion the introduction of air into the circulating system during operations. Now it is well known that what is called by the French writers the 44 canalization1’ of a vein, or its conversion in¬ to a rigid uncollapsing tube, is the condition of all others which is most favourable to the introduction of the air into it. Indeed, except in those situations in which there is a natural movement of flux and reflux of the blood in the veins, this accident cannot oc¬ cur unless these vessels be canalized, or, in other words, prevented from collapsing. This canalization of the vessel may be occasion¬ ed in a variety of ways. Either the cut vein may be surrounded by indurated cellular tissue, which will not allow it to retract upon itself, but keeps it open like the hepatic veins ; or the coats of the vessel may have acquired, as a consequence of inflammation or hypertrophy, such a degree of thickness as to prevent their falling together when divided. Again, the principal veins at the root of the neck have, as Berard has pointed out, such intimate connections with the neighbouring aponeurotic structures that they are con¬ stantly kept in a state of tension, so that their sides are held apart when they are cut across. The contractions of the platysma and other muscles of the neck may likewise, as Mr Shaw has shown, have a similar effect. In removing a tumour also that is situated about the neck, the traction exerted upon its pedicle may, if this contain a vein, cause it to become temporarily canalized ; and the incomplete section of the vessel, especially in a transverse direc¬ tion, must necessarily prevent the approximation of the sides of the incision in it, which will be rendered open and gaping by the retraction of the surrounding tissues. This patency in the inci¬ sion in the vein is apt to be increased by the position that is neces¬ sarily given to the head and arm in all operations of any magni¬ tude about the shoulders and neck. Lastly, the introduction of air into a vein will be favoured by the vessel being divided in the angle of a wound, the vein being, when the flaps that form that angle are lifted up, rendered open-mouthed and gaping. On looking over the reports of cases in which air gained admit¬ tance into the veins during operations, it will be found that these vessels were always in one or other of the above-mentioned con¬ ditions. Thus in Beauchesne’s* case, air was introduced in con¬ sequence of incomplete division of the external jugular immediately above the right subclavian, whilst in a state of tension during the removal of a portion of the clavicle. In a case that occurred to