IV and Med HElp

[peaceful nurse, RN]

I am a nursing instructor for an ADN program. How does one prevent the little bit of air from going through the IV line when doing an IV push drug? I know that a little air is not a huge issue but I prefer to learn ways to teach my students how to not make that happen.

[RhinoRocketRN]

make sure there is no air in the syringe when you flush the line is that what you mean?

[MomRN0913]

there may always be a teeny weeny bit of air. You need to make sure the air is out of the syringe. Not may other ways to do it.

[AgentBeast, BSN, RN]

Hold the syringe upright when doing the flush?

[TinyHineyRN]

When you prime the IV line quickly, air will collect in the syringe ports. You have to flick the air out. Otherwise you will always have tiny amounts of air with a push no matter how conscientious you are of air in your syringe.

[Jenni811, RN]

Flick it

Or, you can aspirate it out of the air bubble is too big.

Make sure there is no air bubble in the syringe

if you dont push air bubbles out push it down....so you hold the end with the hole on it DOWN because air rises, so any air bubbles in the syringe will rise to the top. When you push all the liquid in it, stop pushing. And waaaa LA! no air bubbles :)

Little ones are ok though. I see students trying to get the most minute little bubbles out, ones i can hardly see. ya, i did that too as a student so its ok for me to chuckle a little.

[GM2RN]

I think you should do what you can, within reason, to ensure no bubbles, but try as you might, you will NEVER prevent them all.

[nurseprnRN, BSN, RN]

i would step back a sec and see if you can guide them through the critical thinking about why we care.

??) why do we care? where does that bubble go?

(answer: you won't believe how many of your students, who supposedly passed anatomy, think it's dangerous because it will go right to the brain and cause a stroke. they grow up to be nurses who think that dvts are dangerous for the same reason.)

answer: follow the venous trail aaaaaaalllllllllll the way to the pulmonary capillary bed. what is the volume of that capillary bed? (liters) where does that bubble end up? does it somehow squeeeeeze through the capillary to the arterial side? no, it does not. it gets absorbed and disappears in the alveoli. as a matter of fact, you probably make a bunch of little clots peripherally every day, and even they get strained out in your pulmonary capillary bed, and no one's the wiser. no harm, no foul. it's only big things that cause trouble there. that's one reason you have a pulmonary capillary bed, and a useful thing it is, too.

yes, you can cause the vascular equivalent of vapor lock if you inject 50cc of air. 5cc, no. the minuscule bubble that sits at the bottom of the syringe plunger, probably enough to clear the needle, if that, definitely not a danger. if you can't flick it out and expel it before you inject into a venous line, no harm. why would you waste time fussing about it? better to teach them to think about why they think they should care , and why they don't have to, in the first place. it's more generalizable to other situations.

exception: people with known intracardiac defects (atrial or ventricular septal defects) with right-to-left shunt, meaning that the blood pressure in the right heart is higher than that in the left heart, causing blood to go directly from venous to arterial side without the beneficial filtering effect of the pulmonary capillary bed.

yes, many people have occult asds left over from their fetal circulation. they don't get into trouble often because the shunt, if any, is left to right, meaning no venous debris can go to the arterial side. there are sometimes the young cvas, like tedy bruschi, the heart and soul of the new england patriots defense, who had a cva probably related to a huge valsalva at the bottom of the pile, causing a r-to-l shunt. (he had it patched, his neuro deficits resolved, and he went back to playing, all better.)

so. the question is not "how do we prevent this?" but "why should we bother?" the answer is, "most all the time, we don't need to, because the anatomy and physiology tells us so." i taught ad students a long time-- most of them will understand this. the rest will, as i said, grow up to think that dvts cause cvas. no joke. you can try to fix them later.

[GM2RN]

i would step back a sec and see if you can guide them through the critical thinking about why we care.

??) why do we care? where does that bubble go?

(answer: you won't believe how many of your students, who supposedly passed anatomy, think it's dangerous because it will go right to the brain and cause a stroke. they grow up to be nurses who think that dvts are dangerous for the same reason.)

answer: follow the venous trail aaaaaaalllllllllll the way to the pulmonary capillary bed. what is the volume of that capillary bed? (liters) where does that bubble end up? does it somehow squeeeeeze through the capillary to the arterial side? no, it does not. it gets absorbed and disappears in the alveoli. as a matter of fact, you probably make a bunch of little clots peripherally every day, and even they get strained out in your pulmonary capillary bed, and no one's the wiser. no harm, no foul. it's only big things that cause trouble there. that's one reason you have a pulmonary capillary bed, and a useful thing it is, too.

yes, you can cause the vascular equivalent of vapor lock if you inject 50cc of air. 5cc, no. the minuscule bubble that sits at the bottom of the syringe plunger, probably enough to clear the needle, if that, definitely not a danger. if you can't flick it out and expel it before you inject into a venous line, no harm. why would you waste time fussing about it? better to teach them to think about why they think they should care , and why they don't have to, in the first place. it's more generalizable to other situations.

exception: people with known intracardiac defects (atrial or ventricular septal defects) with right-to-left shunt, meaning that the blood pressure in the right heart is higher than that in the left heart, causing blood to go directly from venous to arterial side without the beneficial filtering effect of the pulmonary capillary bed.

yes, many people have occult asds left over from their fetal circulation. they don't get into trouble often because the shunt, if any, is left to right, meaning no venous debris can go to the arterial side. there are sometimes the young cvas, like tedy bruschi, the heart and soul of the new england patriots defense, who had a cva probably related to a huge valsalva at the bottom of the pile, causing a r-to-l shunt. (he had it patched, his neuro deficits resolved, and he went back to playing, all better.)

so. the question is not "how do we prevent this?" but "why should we bother?" the answer is, "most all the time, we don't need to, because the anatomy and physiology tells us so." i taught ad students a long time-- most of them will understand this. the rest will, as i said, grow up to think that dvts cause cvas. no joke. you can try to fix them later.

exactly! when every minute counts in time management, the effort spent to remove every single bubble is a waste. better to know when it matters to be so precise, but this isn't it.