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!

[KellNY, RN]

I had a woman call our ADN because she had a *tiny* bubble go through her PIV when I hooked a (fully primed) line up to her SLIV. Didn't want to hear one word about it not being a problem. She was near hysterics and made me do serial BPs about 10 times--asymptomatic, VSS, etc etc etc. She called the ADN and threatened to sue...she'd "own the place" by this time next year. Emotional distress and whatnot. ADN made us do q15m vitals x4hrs then hourly to shut the Pt up.

No, I'm not joking.

[NurseBean]

I remember being SO scared of this during my first clinicals in school. And patients are always watching closely and freaking out if there is the tiniest of bubbles when giving IVP meds. I think it comes from something out of the movies. Can't you just see the bad guy sneaking in and injecting a sleeping pt with air and then the monitor goes flatline? Anyway, I was told in school that the entire IV tubing would have to be filled with air for you to really worry.

So now I am confused though- which is the better position to trap the air in the R atria if something should happen, left lateral with head of bed up or tendelenburg or something else? Anyone know for sure?

[Agnus]

I have always been cautious about air bubbles but not to an extreem. We know full well small bubbles are harmless. Though in peids I am extra cautious about this.

HOWEVER, I have always had a problem with being told that a central or picc line could receive zero air as it was very very dangerous to get even a tiny amount of air in. This NEVER has made sense to me. The Central or PICC is going into the left venterical for heaven sake. To me it should be less of a risk because of this for the reasons already cited. (large chamber means nothing to block and turbulance breaks up the bubble.

Yet, everyone I meet seems to believe the tinyest bubble in this type of iv is extreemly dangerous. Now I would not introduce air deliberately nor would I uncap a line without clamping it but lets get real.

Am I somehow off base with my thinking?

[BrnEyedGirl, BSN, MSN, RN, APRN]

Agnus,...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!!!!!

[RNfromMN, BSN, RN]

Wow! Interesting - good story!

[anonymurse]

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.

http://nurstoon.com/comic37.html

[Agnus]

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

In 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.

[miko014]

Yeah, 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.

[RNfromMN, BSN, RN]

:chair: I 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?

Thanks:mad:.

[Indy, LPN, LVN]

When 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?"

[RNfromMN, BSN, RN]

Clamp it off - of course! Thank you Indy!

[JRapha'sRN]

In 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.)