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!??

Re: IV air bubbles

If you spike the bag and let the tubing fill up, the amount of air in the line will not cause problems. It mostly just catches in the ports and filters but it is negligable amount. We can thank Hollywood for perpetuating the rumour that any air in the line causes instant death.

Re: IV air bubbles

You know, I'm that way too. And I don't really care. You'll get faster at running your TPN even with being OCD about it. From case reports I've read, an air embolism is almost the only mistake you can make as a nurse that you absolutely can't fix. Bam, it's over. And I once very nearly embolized a child with an entire UVC worth of air, because the cardiologists were rushing me. I think it's worth an extra two minutes running my lines to be absolutely sure they're okay. 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.

Re: IV air bubbles

I make sure there are no visible bubbles in my tubing when I prime it. It isn't worth the risk to me. We are fortunate where I work, our nursing assistants run the IVs for us.

Re: IV air bubbles

How long is "forever?" I mean...are we talking 10 minutes per bag, or 30? Any chance they'd let you practice with water and tubing?

I don't know how much it takes to cause real damage, so I'm pretty anal about clearing my lines. I fall on the "better safe than sorry" line of thinking, and triple check. The tricky places tend to be in the clave hubs, cartridge, and filter. If you use the cartridge kind, just open it up a little, run the TPN slowly through the tube, and flick the "joints" like crazy. It gives you more time to watch and learn where the hang-ups are, and clear them the first time.

Not to mention, one big hunk of air can screw up an otherwise really good PIV, and our babies can't take getting stuck a whole bunch of times.

At any rate - don't sweat it. You'll get faster with practice.

Re: IV air bubbles

Originally Posted by elizabells

You know, I'm that way too. And I don't really care.

Me too!
It takes forever when you are new anyway. Might as well be safe than sorry.

Re: IV air bubbles

It's great that you care enough to find out for certain before feeling comfortable with this--more people should be that way. You can never get all the little bubbles out and "thumping" on it, like we all were taught to do, will drive you nuts eventually!!! All the tubing I have ever used has a filter on it, and I can't imagine a neonatal unit ever NOT having one. That's what the filter is for--to catch the air bubbles. If for some reason it doesn't, I would question why. I always make sure to run my fluid so that any visible bubbles are through the line--meaning anything that is making an actual gap in the tubing. After that don't worry about it--the little tiny ones are not going to hurt anything. Just use common sense, which is 99% of what our job is made of. It is always better to be over-concerned and ask, though, rather that to just assume something is ok. Never hesitate to ask questions even if you think they are dumb. I have been doing this 7 years and still have questions all the time. You can never stop learning in nursing. Always err on the side of caution and make sure you absolutely understand WHY you are doing something before you do it--even if someone is trying to rush you.

Re: IV air bubbles

I would like to point out that lipids are not filtered, and I've come on to find, seriously, a good half inch of air in lipid tubing before.

Re: IV air bubbles

Originally Posted by elizabells

I would like to point out that lipids are not filtered, and I've come on to find, seriously, a good half inch of air in lipid tubing before.

We add a lipid filter to our tubing..

Re: IV air bubbles

The only thing we filter is HAL and a few meds, everything else doesn't have to have a filter. A filter is mainly used to filter particulate matter. As for the air bubbles, just concentrate on the bigger ones, the little ones will dissipate after a bit.