[Nellie Nurse]

It was announced in a staff meeting that it was determined that the cause of death for a patient who had died on our unit was air embolism caused by the IV. No further details were given as to the amount of air found, etc. I had always been told that small amounts of air in the tubing are inconsequential. I would like to know how much is too much air. When should I be concerned and purge the line of air and when can I allow it to infuse?

Thankyou.

[ghostcat]

Did the patient have a peripheral IV or a central line. Patient's with CVL's and open-ended PICCs can get air emboli if the cap on the end (for example the CLC2000 that we use) gets loose and comes off. I've always understood that it's very difficult for someone to get an air embolism from a PIV. Someone would have to be pushing a syringe of air in, or so it seems.

[Nellie Nurse]

We were told that it was a peripheral IV but we were not told many details.

[SFCardiacRN]

It takes a LOT of air to cause death. 50cc or more. The only ones I have heard of involved misuse of blood salvaging equipment. I think you have a right to ask for more details. Without knowing how it was done and how to prevent it, it is only a scary story.

[Binkey]

Nellie,

Small amounts of air in IV tubing usually is inconsequential, however, there has been reports of pts dying, especially if they are elderly and infirmed, with as little as 7 cc of air.
As far as a peripheral IV is concerned, a patient can suffer from an air embolism if he or she is flailing their arms around creating negative pressure when they have an open connection, but it is more likely to occur with a centrally placed catheter. It is important to make sure all connections are leur-locked, not slip locked.
Hope that helped.

[ivnurse]

For a patient to die of an air embolism only it would have to be a bolus large enought to block the pulmonary artery. On the other hand it could cause other symptoms with a smaller bolus. Usually the smaller boluses get trapped in the lungs. It would be very rare that PIV couls cause air embolism as the flow would most likely cause the blood to exit from the catheter and not draw air in.
Randy

[gwenith]

I had a patient many many moons ago who was on home dialysis. His story was that he woke to find the venous line disconnected and the machine pumping air. (He was known to be somewhat lax in his own care). Now this guy did not come straight into hospital - he had a shower first, and had a fit while showering - did he call an ambulance then? No, he went and had a lie down, and fitted again, so he decided to DRIVE himself into hospital, got into the car and fitted again, by this time he thought he might be a little ill so he called an ambulance. Now, by this time it was 12 hours AFTER he saw the air in the dialyisis machine that he arrived in ED only to have a full on cardiac arrest!!!!!

When we saw him to do an emergency dialysis on him his shunt arm was at least twice it's normal size from fingertips to shoulder with surgical emphysema.

Lord alone knows how much air was pumped into him and all I can say is some people are just plain meant to live!!

[mach1of8]

I had a patient who developed a 150 pulse minutes after another nurse removed a RIJ catheter from her while sitting upright. Does anyone have experiences like this?

[ralphrepo]

http://everything2.com/index.pl?node_id=930159

I just found the above and thought it, well... quaint.

Anyway, as far as I know, it takes a tremendous amount of air rapidly injected via periph IV if one wanted to use that as a way of killing someone. Not a very effective means. BTW, oral-vaginal sex may give pregnant women deadly air emboli, because of the presence of the placenta.

Ralph

[greenterra]

Also take a look at the allnurses air_embolism_iv_therapy thread: http://allnurses.com/forums/f27/air-embolism-iv-therapy-96687.html, it has a references that explicitly talks about how much is too much air, and mechanisms of complications.