MEDICINE Cerebral Air Embolism: an Extremely Rare Complication of Tunneled Central Venous Catheter. Case Report Mahmut Yeral 1,2 & Pelin Aytan 1 & Cigdem Yalcin 3 & Cigdem Gereklioglu 4 Accepted: 27 October 2020 # Springer Nature Switzerland AG 2020 Abstract Central venous catheters are commonly used in bone marrow transplantation units and useful for drug administration, supportive treatments, and nutrition. They are used for stem cell infusion and also hemodialysis, hemapheresis, and photopheresis proce- dures when required during posttransplant period; however, they can sometimes cause severe morbidity and mortality during insertion or removal. While air embolism which may lead to severe neurologic problems is among the rare but severe compli- cations, a meticulous and experienced approach during insertion and removal could significantly decrease this risk. In this case report, we wanted to pull attention to cerebral air embolism which is a rare mechanic complication of central venous catheters. Keywords Central venous catheter . Catheter removal . Mechanic complication . Cerebral air embolism Introduction Central venous catheters (CVCs) are frequently used in bone marrow transplantation units for various purposes including drug administration, fluid infusion, apheresis procedures, par- enteral treatment, and cell infusion. However insertion and removal of these catheters may be harmful for the patient and also lead to challenging and costly problems. Access to an unwanted artery, hematoma, and pneumothorax are the most common mechanic complications occurring with the incidence of 5–19% during catheter insertion and thereafter [1–4]. Embolism of the air into the lungs or brain is among the rare but potentially fatal complications of CVCs [5]. We wanted to pull attention to this issue through reporting two patients who experienced CVC-related cerebral air embolism. Case 1 A 36-year- old male patient with Hodgkin’s lymphoma devel- oped relapse following 6 cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) chemotherapy and com- plete remission could be achieved with 2 cycles of ICE (ifosfamide, carboplatin, etoposide) chemotherapy. Autologous peripheral stem cell transplantation was planned with mitoxantrone + melphalan conditioning regimen. A 12F, 16-cm tunneled CVC was inserted into the right internal jug- ular vein under local anesthesia and ultrasonography guidance for stem cell infusion, parenteral fluid administration, and nu- tritional support. Neutrophil engraftment was achieved on day 12 posttransplant and platelet engraftment was achieved on day 15 posttransplant. Catheter removal was planned before discharge as his clinical condition was stable, and platelet count reached 80,000/mm 3 . Renal function tests, liver func- tion tests, and plasma electrolyte values were within normal ranges. A sudden generalized convulsion and loss of con- scious developed during catheter removal at interventional radiology department although the patient was put in This article is part of the Topical Collection on Medicine * Mahmut Yeral drmyeral@gmail.com Pelin Aytan drpelinaytan@gmail.com Cigdem Yalcin drcigdemylcn@gmail.com Cigdem Gereklioglu gereklioglucigdem@hotmail.com 1 Department of Hematology, Baskent University, Adana, Turkey 2 Adana Adult Bone Marrow Transplantation Center, Baskent University, Yuregir, 01250 Adana, Turkey 3 Department of Radiology, Baskent University, Adana, Turkey 4 Department of Family Medicine, Cukurova University, Adana, Turkey SN Comprehensive Clinical Medicine https://doi.org/10.1007/s42399-020-00621-5