[WeeBabyRN]

Originally Posted by elizabells

I would like to point out that lipids are not filtered, and I've come on to find, seriously, a good half inch of air in lipid tubing before.

Once I ran my lipids and there was no air in the tubing. A few minutes after I hung them, the pump was beeping. I looked at the tubing and there was a couple of inches of air near the syringe, I was mortified. Another nurse told me there was probably an air bubble at the top of the syringe that I missed, egads!

[iluvivt]

I do not think you are too concerned considering your patient population. If you are using a .22 micron filter it is bacterial,particulate retentive and AIR eliminating. If you have placed just before the IV site or the most distal it will trap any air just before entering the pts body. Just for the record a .22 micron filter can not be used for Lipids,but you can use a !.2 micron for Lipids if you desire as well as for 3 in 1 admixtures. Lipids attract all kinds of bacteria so the filter is nice but do no use the tubing for more than 24 hours. Now to the air problem. Most air embolisms occur in relation to Central lines,either during insertion,cap changes and care,or upon discontinuation where it can lodge against the pulmonary valve and block the flow of blood from the ventricle into the pulmonary arteries. An adult with a open CVC or a needle in their subclavian vein or any opening for that matter can suck in 20 ml per second. Gravely ill individuals can die with as little as a 70 cc bolus of air (3.5 sec). Most adults however need about 250 ml of air to become symptomatic. Air embolism is rare with peripheral IVs but can occur with large volumes that stay together and do not dissipate. Also you do not have intrathoracic pressure differences to suck in the air. Now with a neonate or infant it would require a lot less air if an ill adult can die with as little as 70 ml. I can not give you an exact amount but I will research it some an let you know if I can find an estimate. It is not something anyone can actually perform clinical trials on. Are you using a final .22 micron filter on your patients. Also there is some new research about microbubbles and how they may lodge in the brain vasculature and may affect functioning. I just copied the article but have been unable to read.

[justme1972]

Originally Posted by elizabells

You know, I'm that way too. And I don't really care. You'll get faster at running your TPN even with being OCD about it. From case reports I've read, an air embolism is almost the only mistake you can make as a nurse that you absolutely can't fix. Bam, it's over. And I once very nearly embolized a child with an entire UVC worth of air, because the cardiologists were rushing me. I think it's worth an extra two minutes running my lines to be absolutely sure they're okay. Since every person seems to tell me something different about how much air it really takes to hurt a neonate (and is that neonate 5kg, or 500g?), I'm not really buying any of it.

I have, however, been told I'm too much of a perfectionist. So take all that with a grain of salt.

As a student, posts like yours are very important to me.

Maybe I'm still looking through nursing with rose colored glasses, and I know that time is of the essence with some procedures, but one of the things that I have noticed since I have been on this message board, is that some senior nurses post that they have never had such-and-such happen to them, and some of the newer ones post that they have went through 3 hospital jobs in 2 years due to errors.

There has to be a reason why some nurses constantly make errors and some don't or are so rare and minor at the end of the day, they are insignificant.

I read posts like yours and start thinking...is remembering the basics and not always looking for the short cut the key to the whole thing?

[elizabells]

Originally Posted by iluvivt

Also there is some new research about microbubbles and how they may lodge in the brain vasculature and may affect functioning. I just copied the article but have been unable to read.

The other problem with bubbles as they pertain to the NICU population is that many of the kids still have PFOs. Straight shot, basically, from the right atrium to the carotid and then the brain. Emboli of any kind, air or otherwise, are much more dangerous with a PFO or ASD. There's some interesting evidence out there right now regarding PFOs and thrombotic strokes.

[SteveRN21]

IMHO, when your patient's heart is the size of a gumball, a "couple of inches" of air is all it takes to kill them.....

With practice, you'll get faster. Being able to hang fluids quickly at the risk of putting your patients in danger is not worth it....

[lvnurs9]

One way I have found to reduce air bubbles in IVF is to prime them SLOWLY. Instead of letting the fluid run through in 5 seconds, take a full minute. I rarely get bubbles that way. Flicking the bubbles usually makes it worse

[ambraberger]

As previously said, better safe then sorry, and you'll get faster with time. Can't be TOO cautious with our tiny babies. I worry about tiny little bubbles too. I've been doing this 2 years and still feel like I'm brand new. Always learning, and loving it!!! Good luck!

[Olivereindeer]

I ALWAYS remove all the air bubbles in our neonates. If you figure that a preterm baby may have only 15-20 mls of blood as a total then a few air bubbles is significant to me.
Our neonatologists will even go as far as to add drips of fluid into the open end of a line (if they have had to open it) to ensure no air bubbles occur.

All our LIPIDS are filtered however not all our IV's are. Our pumps are also very temperamental with air so it is not worth the trouble not priming it effectively.

Sorry, but allowing 2 inches of air in a 500g neonatal line seems very careless to me.

Wow...nursing assistants doing IV's...?? We don't use assistants in our Level 3 unit.

[AirforceRN]

15-20mls of blood in a neonate? Really? That's it?

[redefinition]

Originally Posted by AirforceRN

15-20mls of blood in a neonate? Really? That's it?

Yup! Sometimes I see as small as 6mls.

I've always dripped fluid into anything open. I didn't learn it where I work now, but during school when I did clinicals in a NICU.