From the Research
Dizziness during a mediport flush can most likely be attributed to vasovagal reactions, air embolism, or catheter-related complications, and immediate action should be taken to assess and manage the patient's condition. The etiologies of dizziness during a mediport flush are multifactorial and can include:
- Vasovagal reactions, which can trigger dizziness through a sudden drop in heart rate and blood pressure in response to the procedure 1
- Air embolism, which is a rare but potentially fatal complication of medical procedures, including vascular access-related procedures like mediport flushing 2, 3
- Catheter-related complications, such as catheter-related right atrial thrombosis (CRAT) or a partial occlusion that dislodges during flushing, potentially causing a small pulmonary embolism
- Psychological responses to the flush, with anxiety triggering hyperventilation and subsequent dizziness
- The flush solution itself, particularly if it contains heparin, which can cause hypersensitivity reactions in some individuals
- Positional factors, if the patient is sitting upright during the procedure, as blood pressure regulation may be compromised
- Pre-existing cardiovascular conditions, which may make patients more susceptible to hemodynamic changes during the procedure
According to the most recent and highest quality study, the assessment and treatment of dizziness should focus on the timing of the events and triggers of dizziness to develop a differential diagnosis 4. The physical examination may include orthostatic blood pressure measurement, a full cardiac and neurologic examination, assessment for nystagmus, the Dix-Hallpike maneuver, and the HINTS examination when indicated. Laboratory testing and imaging are usually not required but can be helpful. If dizziness occurs during mediport flushing, the procedure should be paused, vital signs assessed, and the patient placed in a reclined position, and persistent or severe symptoms warrant immediate medical evaluation to rule out serious complications.