Air in the line!!! What am I doing wrong?

Nurses General Nursing

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Ok, I have a question. Probably a dumb one...but oh well. When I hang IV medication...I spike the bag, prime the line, and yet it seems that about half of the time it runs in fine, and half of the time it's only a matter of time before the stupid thing beeps because of air in the line. What the heck am I doing wrong? Does anyone have any tips? How do I keep air out of the line?

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Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

There will always be air in an IV line because even though you prime it, there is air in the bag you hang.

An older nurse showed me a brilliant trick as a student. Disconnect the line from the patient (ensuring you keep it sterile). Then you just hang the whole bag and line upside down so it runs back into the bag, and this usually eliminates the air bubbles. Then reverse the bag and re-attach to the patient. Also you can use a pump where you can attach a syringe to the line and the machine will pump the air out into the syringe. Also you can keep tapping the line with your finger so that the air travels up into the bag.

Other than that I am still learning so would love to hear other suggestions.

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You could "burp" the bag. First spike the bag, then un-spike the bag. Squeeze the bag while holding the spike port up as if forcing the fluid to squirt out the port (but don't squeeze hard enough to do it). While the air has been forced out, re-spike the bag and flip over to prime the line. You must do this of course while keeping the tubing spike from touching anything. That should take care of your free air in the bag problem. Good luck

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Specializes in Trauma Surgical ICU.

For a secondary line, after I attach it to the primary I lower the bag and allow the primary fluid to go into the secondary and prime the line that way.. For primary tubing I prime it slow.

Sometimes no matter what you do the machine will beep.. I have used the syringe trick PP stated. If all else fails, I unhook from the pt and open the pump, remove the tubing and let it run a few seconds.

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For some reason, air likes to hang out in the flow regulator (cassette). This is bad because the air sensor is right below the flow regulator. Turn the flow regulator off, hang the bag and spike it, prime the chamber, TWIST THE LINE SO THE FLOW REGULATOR ONLY IS UPSIDE DOWN AND THE LINE LOOKS LIKE A SIDEWAYS "S," turn the flow regulator on, then slap the side of the flow regulator as fluid flows through it to expunge the bubbles. I tap it against the side of the pump or slap it on my palm.

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A lot of times at a facility I did a clinical rotation at, the pump would beep but there would OBVIOUSLY be no bubble. A nurse there told me that if the tubing has any residue on it (finger residue, adhesive, anything), the machine will beep like there is a bubble. so now after priming the tube right before I put it in I do a quick wipe down the tube with an alcohol wipe and the inside where the cassette sits. It seems to help me when I have done all of the above and there is still NO BUBBLE!!

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What type of pumps do you use?

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Specializes in NeuroICU/SICU/MICU.

I've seen certain IV medications spontaneously develop bubbles, especially amiodarone. It gets "foamy" where the pump is pushing the med through the line, and when enough "foam" builds up it senses a bubble. There doesn't seem to be any way to avoid it, you just flick the tubing where the foam has built up to dissipate it.

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Specializes in ICU.
Ok, I have a question. Probably a dumb one...but oh well. When I hang IV medication...I spike the bag, prime the line, and yet it seems that about half of the time it runs in fine, and half of the time it's only a matter of time before the stupid thing beeps because of air in the line. What the heck am I doing wrong? Does anyone have any tips? How do I keep air out of the line?

This likely depends on your tubing & infusion pump. Air-in-line error messages were my biggest hassle during my new grad nurse residency program.

What works for me is:

Hang the bag.

Close the roller clamp on the IV tubing.

Spike the bag.

Open the roller clamp about 50% of the way, watching the fluid flow down to the flexible rubber pumping section of the IV tubing.

Stretch the flexible part & "tweak" it (flick it with a finger tip) a couple times so as to remove most of the bubbles.

Open the roller clamp all the way.

Re-tweak the flexible pumping section to remove the remaining bubbles.

Wait until the fluid reaches the end of the tubing, then close the roller clamp.

Attach to the pt's IV connection, and you should be good to go.

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Specializes in chemical dependency detox/psych.

I've always found that priming it slowly, while keeping the ports upside down has helped. Going quickly always seemed to introduce air.

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Specializes in Emergency, Critical Care (CEN, CCRN).

For Alaris-type pumps (Medley, Alaris PC, etc - the large square "brain" with small rectangular modular "arms"), ensure that the tubing immediately below the flow control cassette is completely pushed into the clip. Otherwise, the air sensor will read the gap behind the tubing as air in the line and throw errors all day long. Another frequently overlooked source of bubbles in Alaris-style tubing is the little conical retainer at the top of the control segment. Snap it with a finger once or twice to make sure there aren't any bubbles hiding there.

A better way of burping bags: Spike the bag, hold the entire bag and line assembly upside down (i.e. bag at bottom, drip chamber pointing up) and gently squeeze from the top (now "bottom") of the bag until the bag contains no air and the drip chamber fills 1/4 full. Rapidly invert and prime line as usual. Presto, no air in bag and no sterility hazards of un-spiking. :)

Also, as RNMeg said, some medications, such as amiodarone and plasma protein preparations, are notoriously foamy. Many of these meds also require the use of an inline filter, either because of foaming issues or the risk of crystallization/precipitation in the bag or line. Doesn't save you any hassle from beeping pumps, but at least it gives you a certain measure of safety that all that foam won't be getting into your patient's bloodstream.

Hope this helps! :D

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1. Open your bag of fluids and hang it on the pole.

2. Open your IV set and CLAMP it BEFORE spiking the bag.

3. Take the tab on the IVF off, remove the IV spike protector.

4. Spike your IVF, fill the chamber

5. UNCLAMP the IV tubing. When the fluid (it doesn't matter WHAT you're running) reaches the portion that is continually compressed by the IV pump, INVERT the tubing so the air flows in the distal direction of the IVF bag.

6. SHAKE the tubing with one hand above and one had below the inversion. This ensures all air is expelled.

I used to have this problem. After I switched to this method I've NEVER had a problem.

Don't put the secondary tubing in place until AFTER this is done. Clamp the secondary tubing before connecting to primary, connect, unclamp, and then put in a dependent position and remove spike protector. Replace protector when the chamber fills, reclamp until you're ready for its use

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