Air bubble in Heart chamber

  1. 0 Hi 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!
  2. Visit  FREDhp profile page

    About FREDhp

    Joined Jun '10; Posts: 2.

    19 Comments so far...

  3. Visit  klone profile page
    4
    Did 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.
  4. Visit  netglow profile page
    3
    The patient should be positioned in the left lateral Trendelenburg position, this, moves the air bubble away from the pulmonic valve.
    EymieICURN, Zookeeper3, and vashtee like this.
  5. Visit  klone profile page
    1
    And I believe the concern is that it can cause v-fib.
    netglow likes this.
  6. Visit  netglow profile page
    0
    I believe the danger is much more for central lines... and any direct access eg cardiac cath. Much smaller amounts of air can be problematic. Your tx as I understand would be supportive... look to your ABC...assessments. Might need O2, CPR... let your Doc know ASAP.
  7. Visit  wtbcrna profile page
    0
    Here 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.
  8. Visit  TiffyRN profile page
    0
    The previous poster had some usual treatments for air embolism, some other treatments include administering 100% oxygen and hyperbaric oxygen treatment if available.
  9. Visit  Scarlette Wings profile page
    4
    Hi,
    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.
    JenniferSews, CrabbyPatty, mauxtav8r, and 1 other like this.
  10. Visit  LuxCalidaNP profile page
    0
    @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.
  11. Visit  eaRN profile page
    0
    Sorry she made you feel that way.
  12. Visit  netglow profile page
    0
    Heart, it's been burned into my brain.
  13. Visit  netglow profile page
    0
    ... there are a lot of journal articles, neuro, cardio, hemo... you can look up on line. Thing is, most that are known reputable that I can quickly find, seem to be pay per view Pretty sure cannot post them here. But, I think either position is acceptable as some sources seem to list both as options. Best is to look for your own protocol.
  14. Visit  Zookeeper3 profile page
    1
    UMN, NO, blood returning to the heart from a peripheral IV will go from the right atrium, to the right ventricle and to the lungs to diffuse ..... any few excess bubbles are left here and adsorb.

    IN a central line infusing rapidly to the right atrium and right ventricle in a rapid flow, may be pushed past this ... having to go though all the cappillary ONE CELL diffusion of the lungs before passing upon the left atrium, now left ventricle and THEN become an air embolis to cause damage... possibilities..??/?? LOW.

    While you have an instructor who wishes to scare you about the dangers of an air bubble, and they exist, they happen and they are true complications.... re read my post. There is strength in having a respect for air embolis and the complications and there is stupid. No more to say.
    Altra likes this.


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