getting rid of an air bubble in an IV line

SillyStudent, ASN, RN · Apr 22, 2008

I was wondering this myself seeing that I hung an IV yesterday, I ran a small amount into the garbage but some air was still left in the line, I didnt want to waste the med (Vancomycin) cause it comes pouring out so fast but wasting alittle is better than an air embolus, thanks!!

I just use a NS 250 ml bag as the primary tubing and backflush the piggyback (attached to a port above the pump) by lowering it, which usually shoves the air bubbles back into the top of the piggyback. I don't seem to get any air in line when I do that. I don't like to waste those antibiotics either. :)

Tolos · Apr 22, 2008

Or if the pump has a "backflush" function you can back flush the air into the drip chamber it rises to the top.

nerdtonurse?, BSN, RN · Apr 22, 2008

I just do a couple of different things (so far, more things to learn in years to come...)

1. Put end of tubing over trash can, open clamp, hold tubing at 45 degree angle and "stretch and flick" to get the bubbles out. This works if someone's forgotten that albumin needs to be vented, and you get the "head of beer" reaction.

2. If it's a big bubble, I kink the line at the port above, and suck everything into a 10cc empty syringe. Even when a student had more air than fluid, it only took a couple of pulls to get the bubbles.

3. Let it just run thru until it's clear if it's something like NS.

4. If it's above the pump and a piggy'd med with something like NS, leave the flush hanging and open it's port, then drop med bag until you see the NS zip up into the med bag. I'd be VERY careful if it was a piggy hanging with something like potassium. You might be able to infuse with it, but maybe it wouldn't be good to let it sit together in a bag...

Now, if I could just better at sticking the patients in the first place!

danissa, LPN, LVN · Apr 22, 2008

one thing that worries me from some posts, and I have seen it before, is the flushing of the line into the trash can. Trash cans are not clean, and hanging the patient end of an IVI over one cant be a good thing!

We use a trolley, have a sterile field, or at best a clean field, where excess fluid / air bubbles, can be run into a gallipot, then reconnected to the patient.

Trash cans for trash....:uhoh21:

RNmom08 · Apr 22, 2008

one thing that worries me from some posts, and I have seen it before, is the flushing of the line into the trash can. Trash cans are not clean, and hanging the patient end of an IVI over one cant be a good thing!
We use a trolley, have a sterile field, or at best a clean field, where excess fluid / air bubbles, can be run into a gallipot, then reconnected to the patient.
Trash cans for trash....:uhoh21:

When I do this, I am usually at least 2-3 feet above the trash can. I would NEVER EVER put the end of the tubing near the trash can. I cannot see how this would be a problem the way you make it sound. My aim is usually pretty good I guess...

ontocrna · Apr 23, 2008

Pet peeve...flushing the line into a trash can. Do you want someone sticking something into you that you just ran into a trash can? Prefer to run it into the sterile iv tubing bag that you just opened. Pumps can't run a big enough bubble into someone to hurt them. We clear the line so we don't have to hear the pump alarm and because it eases patients concerns about air bubbles. Use the principle that air rises...drop the bag lower than the line, let the bubble rise to the end and out or milk the line or make sure your ports are up so bubble don't catch in them as you run the line.

rn/writer, RN · Apr 23, 2008

Pet peeve...flushing the line into a trash can. Do you want someone sticking something into you that you just ran into a trash can?

If they do it the way I do it and the way I've seen other nurses do it, I'd have no problem at all. Allowing fluid to drip three feet into a trash can doesn't create contamination. At least, I've never seen anything indicating that it does. If you're aware of any studies that say otherwise, maybe you could share them.

The idea that it's a trash can may create an aesthetic reaction, but I wonder whether science offers any evidence of actual (or even potential) contamination.

The combination of the distance(two feet or more), gravity, and the direction of the flow all suggest that the possibility of contamination is extremely low.

But as I said, if there is literature out there saying something different, I'd like to see it.

sfn2008, RN · Apr 23, 2008

How do you get rid of an air bubble in an IV line?

Even if nurses KNOW that a small air bubble will not be a problem, some patients and their families can FREAK...

I learned a trick years ago and it might help..

Take the tubing and wrap it around your pen and "walk the bubble" up the tubing. As long as you have an open valve and the ability for fluid above the bubble to move, keep twisting the tubing around the pen until the bubble goes back in the bag. :twocents:

Indy, LPN, LVN · Apr 28, 2008

Anyone ever notice how much more likely blood is to have bubbles in it than regular ole fluids? Every other unit I hang, I have bubble issues and they're never anything but fine "champagne"-like stuff that makes the pump go crazy. Fortunately it responds really well to me tapping the heck out of the line. Anyone know why the blood does that? I am wondering about the effectiveness of our tubing sets and their filters, because I don't remember this happening much on the horizon pump tubing.

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Tait, MSN, RN · May 16, 2008

I've been told by several of my ER docs at work that it takes over 10ml of air to actually cause any problems. Not that it isn't good practice to remove as much as possible, I always do.
I take a needle without a syringe on it and stick it in one of the ports below the air-the fluid and air will flow out of the port via needle, then just pull out the needle when the air is removed. It saves the time and discomfort of untaping and disconnecting the tubing to the hub.

I have done this many times. Just remember to put the plunger back in before disconnection or you get a wet foot! (Ours are needless but the same idea works). :)

gal220RN, BSN, RN · May 17, 2008

I appreciate your attention to details. After being a nurse for as long as I have, you do learn not to sweat the smallest stuff. Here are a few hints for you:

1. The best method to remove air from an IV line is one where the line is not disconnected from the patient- period. Why? Remember that one of the BIGGEST causes of hospital morbility and mortaility is blood stream infections (BSI). While BSI is referrring to central lines, any IV is access to a patient's blood stream.

2. One of the greatest causes of BSI is breaking the line connected to the patient. The less we disconnect a line (for air removal or to pass through a gown), the less we introduce pathogens into our lines.

3. A line should never be reprimed over a garbage can- period. Bugs fly.

4. The best method is to place a syringe distal to an air bubble while crimping the tubing just below the syringe (of course after cleaning the y-site with your institution's disinfectant of choice, ex CHG). Aspirate slowly and your bubble will be pulled up. If you have pulled med out of the tubing and don't want to waste, reinstill it with another sterile needle into the buretrol or bag.

5. One bubble will not hurt your patient- unless you are dealing with some cardiac patients with defects that will not tolerate any air- this is the peds nurse talking here.

6. Also remember that some medications should not be interrupted- inotropes and pressors- or you will have bigger problems than an air bubble!!

Sorry to sound like a Nazi here. BSI is one of my major responsibilites in my unit. :nurse: