Re: IV air bubbles

I always worried about air bubbles, so I'm very careful. I know the little tiny bubbles are not likely to cause problems, though.

My husband recently had a some testing done by a cardiologist to see if he still had a PFO. (A little hole can increase the chances of having TIA's) He had a PIV inserted, given a liter or so of fluid, and then air was injected into his vein, I think 20 or 30 mls!
He was looking for bubbles using a transesophogeal echocardiogram. I wouldn't want to try that on a baby! I'm glad to say the test was negative.

Re: IV air bubbles

Originally Posted by AirforceRN

15-20mls of blood in a neonate? Really? That's it?

If we're talking about total blood volume in a neonate's body, estimates tend to vary between 80 and 95 mL/kg, so the neonate with only 15-20 mL TBV would likely not be viable.

Re: IV air bubbles

Originally Posted by Olivereindeer

I ALWAYS remove all the air bubbles in our neonates. If you figure that a preterm baby may have only 15-20 mls of blood as a total then a few air bubbles is significant to me.
Our neonatologists will even go as far as to add drips of fluid into the open end of a line (if they have had to open it) to ensure no air bubbles occur.

All our LIPIDS are filtered however not all our IV's are. Our pumps are also very temperamental with air so it is not worth the trouble not priming it effectively.

Sorry, but allowing 2 inches of air in a 500g neonatal line seems very careless to me.

Wow...nursing assistants doing IV's...?? We don't use assistants in our Level 3 unit.

I believe there is more than 15-20 mls of blood in a newborn. I infused 11 ml of prbcs into a 700 gram baby last time I worked. He wasn't volume depleted before the infusion, he was infused due to a low Hgb.

The baby whom I had air in his iv line was a big chronic boy, no where did I say he was a 500 gram baby. It doesn't make it ok that he was a big boy, I made a mistake and I didn't realize that I would be called careless over it or I probably wouldn't have posted. It probably was more like an inch, which doesn't make it better. I was new and I beat myself up over it for days when it happened, thankfully my coworkers were supportive and helped me realize that nobody is perfect.

Re: IV air bubbles

Originally Posted by I'mANurse!

I'm a new grad working in the NICU, and my preceptor keeps telling me that I'm too obsessed with clearing air bubbles from my IV tubing, especially when hanging TPN. She tells me that it would take a couple inches of air in the IV tubing to cause any harm, but I just cannot get out of the habit of trying to clear all the air bubbles. Consequently, it can take me forever to hang my TPN!! When I worked with another preceptor, she seemed to be a little more concerned with air bubbles, and so I think that is where part of my obsession comes with. So, I wanted to hear everyone else's opinions on air bubbles in IV lines, how much air or how big of bubbles are acceptable, and any tips and tricks you have for clearing them or preventing them in the first place!! And I know it also depends on the type of IV...PIV, PICC, art line, ect. Am I being too obsessive!??

Here's the OP

Originally Posted by elizabells

Since every person seems to tell me something different about how much air it really takes to hurt a neonate (and is that neonate 5kg, or 500g?), I'm not really buying any of it.

I have, however, been told I'm too much of a perfectionist. So take all that with a grain of salt.

Here's the original mention of a 500gm baby. Weebaby, I don't think anyone was specifically referring to your post. We were talking about it in general.

Originally Posted by WeeBabyRN

I believe there is more than 15-20 mls of blood in a newborn. I infused 11 ml of prbcs into a 700 gram baby last time I worked. He wasn't volume depleted before the infusion, he was infused due to a low Hgb.

The baby whom I had air in his iv line was a big chronic boy, no where did I say he was a 500 gram baby. It doesn't make it ok that he was a big boy, I made a mistake and I didn't realize that I would be called careless over it or I probably wouldn't have posted. It probably was more like an inch, which doesn't make it better. I was new and I beat myself up over it for days when it happened, thankfully my coworkers were supportive and helped me realize that nobody is perfect.

Nobody is perfect. We all receive valuable support and advice from our coworkers and mentors.



As far as total blood volume, Eric is correct. Neonates have 70-80 ml/kg of blood volume. The average PRBC transfusion volume is 10-20ml/kg. But you have to remember that PRBCs have had plasma and other blood components spun off, so all that's left are packed RBCs.

Re: IV air bubbles

Remember that air flows UP. When you get to your hubs, turn them upside down so with fluid fills them. I usually hit them on the table to knock the air out. Same with filters, except I don't hit them, that makes it worse. Prime the tubing slowly. Adjust your roller clamp to slow your flow down. That is what I did at first. I've done it enough now that I usually don't slow it down. Our lipids are run with our TPN, so we put a filter on it.

On our pumps, anything above the part that goes into the pump I'm not super concerned about. When I shut the pump, the air is pushed into the bag.

Re: IV air bubbles

Lately I've been so nervous about air bubbles! I'm not sure if it's just that I'm noticing them a lot more now than when I started out but they can be pretty scary. I am less worried with the PIV but mainly my UVC and especially my UAC. Our UAC's are only used for blood draws and bp monitoring. When I draw blood from my UAC we need to draw back the blood past the access port so you get a fresh sample free of a-line fluid. When I am finished and go to flush the line to clear it, I can see a small gap of air in the tubing past the access port that luckily is caught in the trap before it gets to the baby but I always worry that it won't trap and will go into the baby. What do you do if it makes it past the trap? pull back on the syringe and try again? Any thoughts?

Re: IV air bubbles

Remember this is arterial. First...close all your ports to the baby, tap the air to the top, fill with flush and go ahead, Be Calm., open the ports when you are 1000000% sure! Take your time, it's not a race, it's a life. You will get there, just have faith!