Air in IV lines

[zacarias]

Hey all!!

I'm a new nurse and have a couple questions about IV lines. I saw an MD say that a correctly administered IV line should not have even the tiniest airbubble in it. I wonder if he's ever set up an IV himself.

Anyway, my question is, when I hang a new bag of fluid or something, sometimes the pump says "air in line" and beeps and I have to fix it. I'm wondering if there's something that I'm doing wrong when I spike the new bag. Also, when I give IV pushes, there is sometimes air bubbles that I see. I'm wondering if this is just an occurence that can happen every time you access a port along the IV line that communicates with the outside. I was just wondering if anyone had any pointers. Thanks.

[RNmomma]

I found this on the web by a Steven Harris, MD. And of course, it's on the web, so it must be true!:

////There is really no reason at all for a correctly performed intravenous injection to contain even a tiny air bubble.

Nevertheless, a few cc's of air in your venous system (a standard IV line) would be harmless, unless you were unlucky enough to have a congenital atrial or ventricular septal defect, allowing bubbles to bypass the lungs. Lungs are a great filter, and they trap bubbles and clots before they get to the brain or other places where they do damage by interfering with blood supply.

Failing a heart defect, the amount of air necessary to kill a normal person varies a great deal depending on position, chance, rapidity of injection, etc. It's more than several hundred cc's. Generally, you need enough to create a giant bubble in the right heart, large enough to interfere with liquid pumping ("vapor lock").

A few patients have probably seen a little bubble go down their IV line and into them, and had heart attacks waiting for the heart attack!

/////

[cannoli]

I had heard the amount once, but it wasn't more than several hundred, but I've forgotten what it was.

Apparently, I was also told, the reason they knew how much it takes to kill someone is because of the experiments by the Nazis.

[oramar]

I always make sure the clamp is turned firmly off before I spike, after I spike I squeeze the chamber till it is half way full. I then turn on the clamp and run the fluid as fast as possible until bubbles are all out. It really helps if you have a high hook to hang the bag on while doing this and the tubing is straight. Once the tubing is primed and all bubbles are out make sure the clamp is turned tightly off and tubing is lower than bag when you move it. If a small bubble forms around a Y try turning that small section of the tubing upside down while running the fluid. Big problem is with mini bags, don't want to be wasting a lot of antibiotic while trying to get out airbubbles.

[louloubell1]

The IVs that give me the most trouble as far as bubbles go are propofol and TPN. I guess it's the lipid content or something, but I find that I have the best results if I prime the tubing very very very slowly. Still, those two solutions just give me trouble from time to time....the damn IVAC nearly makes me crazy some nights with that beep beep beep. Really gets on my nerves when there is no bubble, and the thing just keeps alarming that there's air in the line. I actually hear that beep in my sleep some nights.....

[Agnus]

I've been away from the hospital for a while and am starting to feel really stupid. I know air in a periferal line is pretty much harmless. So why am I told it is a real danger with central lines?

[kitty29]

I work in the NICU....a little air can and does hurt. We often filter all central lines because of this, esp. pts with cardiac problems.

Air through a UAC can blanch a baby's whole leg....so think of what it can do on just a baby.

[fab4fan]

My understanding is that a small air bubble here or there isn't going to hurt...there's no cumulative effect. It's when a large amount of air is introduced into circulation that the problem occurs. It's also of greater concern with a central line vs a peripheral line.

Otherwise, the body is able to handle small air bubbles. They don't lurk forever in the circulatory system.

[fab4fan]

As noted above, it is a horse of a different color when you're dealing with a central line or peds vs adults. A small amount of air that an adult may be able to handle could spell trouble for a critically ill infant.

[kitty29]

Originally posted by fab4fan

As noted above, it is a horse of a different color when you're dealing with a central line or peds vs adults. A small amount of air that an adult may be able to handle could spell trouble for a critically ill infant.

So glad you added that little bit Fab!

[nialloh, RN]

I always heard 10cc's was the danger point, but as others are pointing out, it probably depends on your size. As for air lasting in your system, it dissolves into the blood. I just don't know how long it takes.

[rileygrl11, BSN, RN]

Zofran IVPBs drive me crazy. They always come to our unit with bubbles in them. Sometimes, I swear I am spiking a bag of soapy water.

[Agnus]

I understand about infants and children. A little air is a lot for them. However, I am trying to understand, in an adult, how it is a lot of air when it enters a central line versus a peripheral. I guess I am being a little thick headed.