Air bubble in Heart chamber
- 0Jun 30, '10 by FREDhpHi all.
I'm a new nurse and am currently having my orientation in a hospital. One of our topics is IV therapy and we tackled on complications such as air embolism which resulted from air in the IV line. Our preceptor told us that once air is introduced in the circulation, we should immediately turn the patient to his left side with the head of bed elevated.
Me: What would happen next after that, doesn't the air get reabsorbed or something?
Preceptor: There is nowhere where it could be reabsorbed.
Me: What would be the management or procedure to remove the air bubble that is trapped, supposedly, in the heart?
Preceptor: It cannot be removed. What could we do, stab the heart with a syringe and aspirate the air bubble? It will forever remain in the patient's heart chamber. (She answered jokingly and condescendingly?)
Me: WHAT??? i said to myself. Does that mean the patient will remain in that position FOREVER?? I dare not ask any more questions. I get the vibe that she is annoyed and thinks that my question is stupid... which I suppose it is.
I know that you have to inform the doctor immediately after positioning the patient. But.. what would happen after that?
I still don't get it. I've searched the internet yet discussions end up to positioning only. I think that the turbulence in the heart chamber will break the bubble into tiny pieces for it to be reabsorbed in the lungs. Though I have nothing concrete for this.
Help me understand please. I know I'm missing something crucial. thanks!
- 4Jun 30, '10 by klone, BSN, RNDid you preceptor tell you it takes a ridiculously large amount of air in the IV line to cause a problem? As in, the only way it could be done is if someone did it intentionally?
The small air bubbles that are always present in IV lines just get absorbed and processed.
- 0Jun 30, '10 by wtbcrna, MSN, DNP, CRNA GuideHere is a overview from medscape on VAEs. Venous Air Embolism: Treatment & Medication - eMedicine Emergency Medicine
In general we were taught left lateral decubitus position/head down and to try to suck the air out with a central venous catheter if the patient's symptoms are severe enough.
- 4Jun 30, '10 by Scarlette WingsHi,
I am sorry that you were made to feel foolish. Please do not let that reaction ever cause you to hesitate asking questions. Asking questions is how we learn. It is better to ask a question than to think you know the answer and endanger your patient or your license. Nursing is an ever learning and ever changing process.
The dangers are usually more from central lines and lines where the "tip of the catheter lies in a great vessel" as the CDC definition goes. There is rarely going to be a great deal of air that goes into an IV peripherally at an amount and speed to endanger.
Central lines on the other hand can cause air embolism. Good luck.
- 0Jun 30, '10 by LuxCalidaNP@2ndwind-
What is your source for the trendelenberg? All of mine say left lateral decubitous position. I guess the idea to keep the blood dependent in the right ventricle so that it continues unobstructed flow to the lungs...if air gets in the way, or moves up into the pulmonary arteries, then you have problems. Also agree with the other posters...
Nice article from the ER folks...imagine getting a central line placed, to remove air. According to our surgeons, if you get an air embolism big enough (30-40 mls) large enough to obstruct flow...your chances aren't that great.