IV air bubble compensation

[JL123]

Hello, I hope someone can help me with this question. I am a nursing student and it's been bothering me for a long time. What happens to air that enters the blood stream through a peripheral IV? I understand how the air can become an embolism, but my question is related to the scientific or physiologic mechanism that happens in the body that prevents complications. I have seen many air bubbles enter through PIVs and the people are fine. I just wonder, what really happens to the bubbles once in the body?

*Does the air bubble get absorbed somehow in the body? If so, how? Or, how does the body get rid of the small bubbles?

I've read in other forums that the lungs filter the bubbles but I don't understand exactly how, since I thought the blood stays separate from actual air in the alveoli. And also, the bubble would have to pass the right heart before getting to the lungs.

I would appreciate any explanation! Thank you!

[Mulan]

Note too that the presence of nitrogen bubbles in the blood is termed DCS (decompression sickness), and most of the nitorgen will initially be found in the veins as the pressure is slightly lower than the arteries. A diver may also suffer AGE (arterial gas embolism) when holding their breath on ascent, forcing air through the membrane of the alveoli and therefore placing the embolism into the artery. AGE is usually a more immediate threat to life than DCS. We are reccomended not to use trendelenberg for either with divers.

What about clots formed around the gas bubbles, this is not addressed either by trandelenberg?

I still dont get why you do it in the hospital, but not for divers with the same type of injury.

Also did you know that the divemaster/instructor is taught to accompany the injured diver to the hospital to (attempt to) ensure such things as ; medivac maintains lowest possible altitude, administration of 100% O2, no trandelenberg, and immediate recompression therapy? This may be old fashioned, but the dive industry doesnt think that healthcare teams know how to properly treat a diving injury.

Venous Air Embolism

[MurseNeutron]

Doses of air greater than 50 ml (1 ml/kg) cause hypotension and dysrhythmias. 300 ml of air entrained rapidly can be lethal.

copied from above link. you would have to try way to hard. i would worry more about taking half a shift to get the IV pump to actually run more than 5 minutes without beeping before air injury to a patient

unless..... your a baaaaaad person.

to answer the question "why would divers be put supine instead of trandelenburg?"

Emergency treatment of arterial gas embolism includes the immediate administration of 100 percent oxygen to widen the pressure gradient for nitrogen between the bubble and the circulation and thus accelerate reabsorption of gas bubbles, and hydration to decrease vascular obstruction and augment collateral flow. The Trendelenburg position decreases the risk of additional cerebral emboli, but may increase cerebral edema; thus, the supine position is the best compromise for transportation

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boyles law might also help: that at a constant temperature, the volume of a gas varies inversely with the pressure to which it is subjected. This law helps to explain the principles behind diving-related barotrauma and air embolism. Henry's law states that at a constant temperature, the amount of a gas that is dissolved in a liquid is directly proportional to the partial pressure of that gas. This law provides the explanation for decompression sickness and nitrogen narcosis.

watch the movie Man of Honor with cuba gooding JR. entertaining way to learn about it.

[ceecel.dee, MSN, RN]

you would have to try way to hard.

Measurable?

I would just be careful to check all lines of an alarming IV pump, and not allow more than an inch or so of air into any patient.

Central line extractractions need special site care (the "sucking hole" theory).

[malamarn06]

The horrer of being told in nursing school that the slightest speck of air must be retrieved from regular IV tubing stuck with me for the first 3 years of my nursing career.

then in a recent critical care course... this question was answered.... according to a HD RN she said an arm's length of Dialysis tubing would be long enough to cause a problem.... i was skeptical so i inquired further...

I am careful enough not to let that happen...

[Hellllllo Nurse, BSN, RN]

Those bubbles that you see in the IV tubings that enter the vein make their way to the chambers of the heart (remember that the veins carry blood heading back to the heart) where the turbulence causes them to break apart into even smaller bubbles. Those miniscule bubbles of air are too small to do any occlusion or occlusive damage in the body. They eventually get absorbed into the tissues of the body.

Now, having said that doesn't give nurses free rein to permit this to happen. Efforts should be taken to prevent air from getting into the IV line and the patient's vein. You should know the immediate first aid for a large amount of air that enters the blood stream: turn the patient onto their left side with the head of the bed elevated to trap the air bubble in the upper right atrium of the heart.

Great explanation, Daytonite.

[catwoman1]

I work in a Cardiology office where we do testing. When we need to do echocardiograms specifically on patients who may have a septal defect, we inject air bubbles on purpose to better trace the blood flow. there are no adverse effects to the patient. You need to inject a large amount of air (more than 25 cc's) before you see adverse reactions.

[SOREFEETEMPTYSTOMACH]

DAYTONITE IS RIGHT ON--- EVERY EFFORT SHOULD BE MADE TO PURGE THE IV LINES BEFORE STARTING THE FLOW. IT TAKES 20cc AIR TO CAUSE DAMAGE BUT DON'T TRY IT.

[kayemom]

I too was taught that it would take a whole tubing full of air to harm a patient, Nevertheless, I try to remove anything that is more than a "tiny" air bubble - for my patient's peace of mind and mine.

[soochow]

this incident of bubbles in IV tubing reminds me of my dad's unexpected death in the ward 3yrs ago.

He was a healthy and independent 95yrs old. The night before his admission to A and E he had 2 episodes of vomiting and rigor. The next morning he felt so weak that he was unable to stand up. We sent him to A and E. Full investigations were done including ECG and cardiac enzymes. All results were negatives. The doctor decided to hospitalised him for observation. An I.V. drip was set up as he was dehydrated. He had to stay in "short stay" ward in casualty for 6 hrs until the bed was available in the medical ward in the late afternoon. He was fully orientated and his only complaint was feeling hungry as he was not allowed oral intake.

Prior to his transfer to the ward I noticed that the IV drip had ran through and half of the tubing was filled with air. I alerted the nurse and she clamped the tubing. On arrival to the ward I informed the nurse about the I.V drip. She put up a new pint hastily.The houseman who examined my dad assured us that he was alright and that we can go home. We said goodbye to my dad and promised to bring his belongings later in the evening.

While on the way home (only 10 minutes after we left ) the hospital called to say that they found my father dead. The houseman could'nt give us the answer for the cause of his death. The coroner decided not to do an autopsy in view of his old age.

I could'nt help thinking at the back of my mind-did my dad died of heart attack or air embolism ? was there a negligent--

Should the nurse disconnect and flushed the tubing thoroughly before continuing the regime since half of the tubing was filled with air. From my experience it is takes time to expel all the air from the tubing by tapping and she took less than 15 seconds. I am not blaming everyone for my dad's death but to alert all our colleagues. Please be more vigilant.

clara

[Antikigirl, ASN, RN]

HEY!!!!!!!

Okay...so I never ever go on the the internet with my hospital computers...but we had this lady that got freaked out badly with a micro bubble in her IV line and about had a heart attack from it!!!!!!!!

I said...wow...you know I just saw a forum post about this...and logged on! ALL the nurses..and I mean ALL..wanted to see this post!!!!!!!!!! It is like we were all told something different and wanted a fact or two! They were THRILLED!!!!!!!!!!

Thank you all that responded and showed your reference!!!!!!!!!! Some of the RN's I know are 'by the book' and they looked it up! Others are like me and do give credit to those that actually take the time to type it!

Guess we are going to get a few members... LOL!!!!!!!!!!!!!

This was a very good question..thanks for asking it!!!!!!!

[RNfromMN, BSN, RN]

My instructor and I recently sat down and talked about this one to one (following my dreadful "Start an IV" skills check off:)). She told me that, no, small air bubbles aren't going to kill a patient, but the more comfortable you become leaving even those small air bubbles in the tubing or syringe or whathaveyou, the more comfortable you'll get leaving bigger and bigger air bubbles in - and those are the ones that obviously can cause air emboli. Her theory was that even if you see small air bubbles, always try and get them out, otherwise you'll just get too comfortable leaving them in...hope that makes sense.

[barbnyc]

I just found this cartoon on nursing students and bubbles in the tubing line.

http://www.nurstoon.com/comic37.html