Air in IV line

  1. 0 Help, I am a new nurse, work in LTC and just started administering I.V. meds. We don't have many residents on I.V. medication so there isn't alot of opportunity to get familiar with this. I seem to always end up with air in the I.V. set after priming the line. What am I doing wrong?

    I remember in Nursing school being told to invert the ports but this doesn't seem to help, I have tried priming it really slow but still sometimes get air bubbles. I was told your not suppose to aspirate the air out anymore.

    Any advice?

    Bea
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  3. Visit  beatrice1 profile page

    About beatrice1

    Joined Feb '09; Posts: 166; Likes: 37.

    10 Comments so far...

  4. Visit  GrnTea profile page
    13
    i'd give you the same advice the poison control center gave me when i called to find out what i should do when my 15-month-old ate dry dog poo off the sidewalk. "wipe out his mouth, give him a drink of water, and try not to think about it." true story.

    about the bubbles in iv, the "try not to think about it" is best. i don't know what kind of tubing you're using, but usually you can squeeze the drip chamber while the tubing below is clamped tight, release, filling the drip chamber, then flush tubing. if there are small air bubbles left in the line, you can flick them with your finger to break them loose so they'll float up, but most of the time it's a waste of time to spend a lot of energy on this. small air bubbles are completely harmless absent very specific and uncommon cardiac defects.

    they cannot cause a stroke (which is what most people think they're preventing by eliminating them).

    look at the blood flow diagram below:

    body > veins > vena cava > right atrium > tricuspid valve > right ventricle > pulmonic valve > pulmonary artery >
    [color=#ee82ee]lungs >pulmonary vein > left atrium > mitral valve > left ventricle > aortic valve > arteries > body

    given normal anatomy, i.e., no intracardiac malformations, there is simply no way for a floating object (like a clot or a small (<30cc) (yep, thirty cc) air bubble from an iv) to get from a vein to the left heart at all; it gets strained out in the pulmonary capillary bed. as a matter of fact, that's why you have a pulmonary capillary bed, to act as a strainer for all the microemboli you have in the course of an active life. little air bubbles that get caught in the capillary bed will go right through the capillary-alveolar surface and be exhaled, or their gases will be absorbed by the blood cells.
  5. Visit  DizzyLizzyNurse profile page
    0
    Do you have someone at work who can show you really quickly? I ran into that problem as well and had to have someone show me (again) how to do it and then just practice it.
  6. Visit  Bortaz, RN profile page
    1
    Quote from grntea
    i'd give you the same advice the poison control center gave me when i called to find out what i should do when my 15-month-old ate dry dog poo off the sidewalk. "wipe out his mouth, give him a drink of water, and try not to think about it." true story.

    about the bubbles in iv, the "try not to think about it" is best. i don't know what kind of tubing you're using, but usually you can squeeze the drip chamber while the tubing below is clamped tight, release, filling the drip chamber, then flush tubing. if there are small air bubbles left in the line, you can flick them with your finger to break them loose so they'll float up, but most of the time it's a waste of time to spend a lot of energy on this. small air bubbles are completely harmless absent very specific and uncommon cardiac defects.

    they cannot cause a stroke (which is what most people think they're preventing by eliminating them).

    look at the blood flow diagram below:

    body > veins > vena cava > right atrium > tricuspid valve > right ventricle > pulmonic valve > pulmonary artery >
    [color=#ee82ee]lungs >pulmonary vein > left atrium > mitral valve > left ventricle > aortic valve > arteries > body

    given normal anatomy, i.e., no intracardiac malformations, there is simply no way for a floating object (like a clot or a small (<30cc) (yep, thirty cc) air bubble from an iv) to get from a vein to the left heart at all; it gets strained out in the pulmonary capillary bed. as a matter of fact, that's why you have a pulmonary capillary bed, to act as a strainer for all the microemboli you have in the course of an active life. little air bubbles that get caught in the capillary bed will go right through the capillary-alveolar surface and be exhaled, or their gases will be absorbed by the blood cells.
    you so smart.
    GrnTea likes this.
  7. Visit  GrnTea profile page
    3
    i just grey and experienced. :spin:
  8. Visit  marycarney profile page
    2
    That's not grey! I refer to mine as 'all-natural, eco-friendly organic highlights!'
    DizzyLizzyNurse and GrnTea like this.
  9. Visit  lovenandj, RN profile page
    0
    I've had trouble similar to the OP, and generally the air sets the pump off. So that would mean the bubbles are significant right? Also what is the rational for not aspirating in these cases? That is what i generally do, since at that point the line is connected to the pt, and I hate to waste meds if its something other than fluids, though I'd also hate to be doing something wrong...
  10. Visit  bds165 profile page
    0
    If your pump cassette has a piggyback clave, after you've primed the line take a 10cc flush and squirt out the contents and attach it to the piggyback clave (keeping things sterile with swabs of course) and backprime the air out of it. If this doesn't work, keep the flush attached and draw back about 10ccs of fluid from the cassette/line and it should work. Done this many times and one or the other seems to work.

    Hope this helps.
  11. Visit  GrnTea profile page
    1
    lovenandj, if you just have a couple of cm of air, that's significant to the pump air sensor but probably not to the patient, absent the congenital heart probs as noted above. the pump doesn't know whether that cm of air is the first of a thousand or just a small bubble, so it alarms. that's fine, but you don't need to spend a lot of time on it.

    the rationale (note sp) for not aspirating them is that if it isn't harmful for the patient, you need not do something that increases the chance of infection, however slight.
    Bortaz, RN likes this.
  12. Visit  lovenandj, RN profile page
    0
    Quote from GrnTea
    The rationale (note sp) for not aspirating them is that if it isn't harmful for the patient, you need not do something that increases the chance of infection, however slight.
    Thanks, that makes sense. And regarding rational/rationale that was a typo, or perhaps my phone auto-corrected without my noticing. I swear I can spell!
  13. Visit  picurn10 profile page
    0
    I'm sorry but you have the pathophys on this all wrong! We aren't worried about stroke from air in the line, we're concerned about air embolism. This can be caused by a pocket of air entering the right atrium/ventricle (prior to making it to the lungs) and either completely obstructing the blood flow to the lungs, and then subsequently the rest of the body, or lodging itself in the heart/lungs/brain of a pt. The "bubble" of air (and really its more a bolus than a bubble) can cause fatal arrhythmias even if it doesn't block off blood flow. The increased PA pressure created by an air bubble in the right side of the heart shuts off flow because the hearts circulation requires certain pressure gradients to function properly. Yes, the capillaries in the lungs can filter some of this, but it can also cause pulmonary edema from the excess pressure forcing the blood into the capillary beds and permanently damaging them.

    It is true that the small bubbles in IV lines aren't enough to cause it, basically the entire IV tubing would have to be nothing but air to cause it in an adult PIV, but if you are using a central line or talking about a child, its far less air to cause a fatal rhythm or air embolism. Some documented cased with as little as 5ml causing problems in central lines.

    That said, I don't worry about the little bubbles at all. If I've primed my tubing and there are some bubbles, I don't think twice. The other night I primed NS for what looked like was going to be rapid IV boluses to prevent my pt from crashing (pressures dropped from 110's to 50's in like 45sec) and I connected it to her PIV. I didn't give them because she came around on her own, but my charge nurse looked at my line (with less than two inches of air at the end) and said "well she didn't code but she would have if you infused that". I didn't argue with her at the time, but I knew she was wrong, because its sort of nursing "urban legend" that small bubbles of air will kill a pt. That portion of the line was maybe 1/2ml, and it was going to a PIV. Not losing any sleep over that one!

    I have found that priming slowly makes all the difference. Once I started slowing down, I never had an issue with excessive bubbling.

    Sorry for any spelling errors, I can't figure out how to get my spell check to work


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