IV air bubble compensation - page 4
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... Read More
Mar 25, '07Agnus,...had a three yr old in ER a few weeks ago,..Mom is hysterical,..kid had some complications after emergency appy, was eventually sent home w/a PICC and IV antibiotics (Mom taught to administer) it's midnight,.Mom is trying to give the antibiotic in the dark, trying not to wake sleeping child,..she "gives" the antibiotic (30cc), flushes the line, takes the supplies including the bottles of antibiotic back to kitchen and notices that she took an empty bottle to childs room,.Mom is absolutely positive that she "drew up" 30cc of air from an empty bottle and didn't realize it as it was dark in the room,....she's freaking,..I'm a bit unsettled as I'm sitting at triage listening to this story,...we watched the kid for about 4 hrs and sent him home,..Dr said what you said,..air went quickly to heart where it was broken into many very small bubbles, body reabsorbed it,."no harm no foul" he said,....Mom will never again give meds in the dark!!!!!
Mar 25, '07
Mar 25, '07Quote from soochowIn the United States any death that occures within 24 hours after admission must by law be investigated. (I do not recall the exact time it is I believe more like 48 or 72 hours after admission) Yes this does make one wonder.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.
Mar 25, '07Yeah, I always am cautious of any bubbles, but as long as it's not more and about an inch, I just break it up in the tubing and let 'er rip. Anything more than that, and I use a syringe to pull it out. No need to panic over the tiny bubbles, but no need to be careless, either! This is a good topic, a lot of RNs I work with have varying opinions of this.
Mar 25, '07I have a question...
How does using a syringe work? You attach it to a port on the tubing, suction & the air just comes out? Does it matter where you connect the syringe in regards to where the air is?
Mar 25, '07When I use a syringe to get air out of a line:
1. take line out of pump.
2. probably it is in upper 1/2 of line, due to letting it run dry and need to hang another bag. If this is the case, kink or clamp it just below the air, make sure there is a y port between the clamp and the connection to the bag.
3. attach syringe to needless port. Aspirate and if you need to, open the vent cover near where the spike goes into the bag/bottle. Out should come your air, fluid from bag/bottle should go in and fill up the line.
4. take syringe off and put in trash, unkink line, put back in pump, good to go.
If the air is below the pump, don't open pump door. No need. Just clamp or kink above the air, then aspirate from lower Y port. Do NOT aspirate too much or you may get blood return, and quite a bit of it. (Hey, it means you're in a vein, but duh, you should be) If you do this just flush it (if it's not a mcg/kg/min type of drip) and it will be fine.
If the air is IN the portion of the line that sits in the pump with the bubble pillow chamber things, open door. Turn bubble thing upside down like you do when priming it. Clamp below lower Y port, then attach syringe to lower Y port with bubble thing upside down, aspirate air. That should clear it out. I do this only if I don't have time to replace the tubing because if it gets this complicated, it's easier to just redo the tubing altogether.
However, if the pump's bubble chamber has a really tiny air bubble in it, tapping it on the pump will often break it up and get you going again. As one of my patients said, "oh so you just beat the crap out of it and it works huh?"
Mar 26, '07In college, my A&P prof said it takes 10cc of air to kill a mouse (that's how he used to kill them for research) and much much more to harm a human.
I was talking to an ER doc I knew and he watched a new grad forget to prime her tubing and open a bolus IV--thus injecting a whole line of air into the pt. He said the pt had no reaction at all. This particular doc stated that you need a lot of air along with pre-existing heart problems for air in the tubing to do much damage. (I guess this is why he didn't holler and stop the grad nurse from doing it...)
I used to have a formula for harm, but lost it. There was a ratio for cc of air to kg. I didn't mind losing it because now I tell my patients that you only have to worry about air in your IV if you're on TV, but in real life it doesn't hurt you. That makes most of them feel much better. (not that I allow much air in my lines, but you get the occasional little bubble combined with paranoid pt.)
Mar 26, '07It takes about 60cc of air to do any harm unless the patient has a patent foramen ovale and then a little air could do it.
Mar 26, '07If you gave me a penny for every time I've had somebody flip out over a tee-tiny air bubble in their PIV, I'd be a rich rich lady.
Mar 26, '07Quote from DaytoniteNurse geeks are cool!I was nationally certified in IV therapy at one time. I've always been a kind of nurse geek seeking out answers to questions like this. I just happened to know the answer to this one because I had thought of it before myself. It used to bother me to watch nurses nonchalantly let all kinds of air bubbles run into people's veins without a second thought. I would hang around a room waiting for these patient's to have strokes or heart attacks. Well, it never happened and I was determined to find out why, not that I wasn't thrilled for the patients and that they survived a major cataclysm! I can't remember the total amount it takes to cause a vessel to occlude and cause infarct of the surrounding tissue. I do remember that it took more than a full 1 milliliter bolus. That's a full bubble of 1-milliliter. IV tubing holds about 3-5 milliliters, so that's a lot of air. Most pumps will detect even the tiniest amount of air. Occassionally, a miniscule and undetectable bubble of air in the plastic of the IV tubing for IV pumps will set off the air detector in an IV pump. This is due to a defect in the manufacture of that one IV tubing that you just can't see with your eye. If you have an IV pump whose air detector keeps going off and you can't find an air bubble, just change the tubing.
The easiest way to get air out of IV tubing is still to use a needle, or the equivalent needleless substitute. I used to carry a few needles in my pocket for these emergencies. Uncap the needle, swab off a Y-port between the patient and the air bubble, take the tubing out of the IV pump (if it's on a pump), insert the needle, open the clamp on the IV tubing and atmospheric air will do the rest. It will pull all the IV fluid including any air bubbles down and out through the hub of the needle, so you need to have a trash can, a towel or something to shoot the works into unless you want a mess to clean up. D5W is very sticky when it dries. When the air is out, pull out the needle, readjust the IV flow clamp and/or put the tubing back into the IV pump and the IV will resume infusing--air bubbles will be gone.
Apr 6, '07I am a nursing student and I was shadowing an RN for my first day on our surgical unit. We needed to saline lock a pt's IV so they could go for shower. I asked the nurse if I could flush it and she said yes. She was the one who drew up the saline (approx. 2.5 ccs) , so I just assumed that she had ensured all the air was out of the syringe. So I went disconnected the IV Tubing and inserted the blunted syringe into the IV site in patients arm and as I was injecting the last little bit I noticed a small air bubble in the syringe (maybe 1/5th of a CC in size) and before I realize I had injected it. I got so scared! I immediatley told the nurse and she said not to worry about it. When I left shift 8hrs later the client was alright. Vitals were all stable, a little bit of tachypnea but this seemed to have started the day before and was slowly progessing.
Should I worry??