Air in IV flush syringe??

Biffbradford · Nov 4, 2011

You can't point the needle up and express the air before you use it?

CVmursenary · Nov 4, 2011

that amount of air won't do any damage unless the patient has a septal shunt; that is my understanding.

PeepnBiscuitsRN · Nov 4, 2011

I too, am paranoid about air. I don't want you to take this as gospel truth, but I have been told that in order to have a problem with a PIV, you would have to have a whole tube of air- like one huge long bubble. However, with a central line, you want to be anal as can be since it's closer to the heart. I think with those pre-filled flushes, that little bubble isn't likely to cause any problems, but certainly get in the habit of priming them. With central lines however- I would say make it a rule of thumb to look at your stuff before you flush to make DARN good and sure the bubble is out.

MikeRNWI · Nov 4, 2011

Even with central lines, a ml or two of air is not something to be concerned with. In fact, there is a study done with echocardiograms called a "Bubble Study", in which 1 mL of air is agitated within 9 mL of saline (Use a full syringe and and empty one with a stop cock, and push the saline/air back and forth until it gets frothy) than you inject that into the patient. This helps to show you the pathway that the blood is taking through the heart, and therefore any abnormalities therein, such as a R to L shunt.

However, that being said, always attempt to remove the bubble from the syringe by pointing it straight up and squirting the air until saline comes out. Then, flush away!

samiam4 · Nov 4, 2011

Thanks for the comments! I'm feeling a little less paranoid...

xtxrn, ASN, RN · Nov 4, 2011

OH, I think you would have heard if something had happened

IvnurseAmanda · Nov 4, 2011

Even with central lines, a ml or two of air is not something to be concerned with. In fact, there is a study done with echocardiograms called a "Bubble Study", in which 1 mL of air is agitated within 9 mL of saline (Use a full syringe and and empty one with a stop cock, and push the saline/air back and forth until it gets frothy) than you inject that into the patient. This helps to show you the pathway that the blood is taking through the heart, and therefore any abnormalities therein, such as a R to L shunt.
However, that being said, always attempt to remove the bubble from the syringe by pointing it straight up and squirting the air until saline comes out. Then, flush away!

Couldn't have said it better myself! I tell the same scenario (bubble study) to all my students :)

Altra, BSN, RN · Nov 4, 2011

I too use the bubble study echo example to reassure nursing students, patients & families.

One particular family member refused to be placated. She literally jumped out of her chair and grabbed my wrist because she perceived that I was about to inject an air bubble. After we dealt with the removal of her hand from my wrist (!) , I used the example of the bubble study the patient had had a few hours earlier.

She refused to believe me.

She was escorted away from the patient's bedside at least once daily for the remainder of his stay. :rolleyes:

MomRN0913 · Nov 4, 2011

I believe it takes 20ml of air to do damage.

AgentBeast, BSN, RN · Nov 4, 2011

The tiny amount of air will likely dissolve in the blood before it ever reaches the heart with a Peripheral IV. Even still one of the beauties of having a functioning respiratory system is that smaller amounts of air diffuse out through the capillary bed in the lungs. Central lines are a little bit different, but not significantly different. It just takes less air to cause a problem with central lines, but unless you are complete moron and figure it's okay to give your patient a 5cc air bolus it's usually okay. I'm not saying we shouldn't take measures to prevent injecting air however. What I do is I'll prime my syringe, alcohol the port, connect my flush syringe to the port, then holding the syringe as upright as possible give the connection there a good couple of flicks with my finger. This should dislodge any air bubbles that may have been created when connecting the syringe. Now you can see the bubbles up against the stopper and flush stopping just before the air get's into the line.

netglow, ASN, RN · Nov 4, 2011

Using needless flushes, just pop cap off and pull back the plunger and then break the airseal by shooting a little spritz into the air off to some unpopulated corner of the room or into garbage (10ml flushes). Practice to do this all with one hand. Then you'll know you've got rid of the air.