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
  2. 10 Comments so far...

  3. 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.
  4. 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.
  5. 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.
  6. 3
    i just grey and experienced. :spin:
  7. 2
    That's not grey! I refer to mine as 'all-natural, eco-friendly organic highlights!'
    DizzyLizzyNurse and GrnTea like this.
  8. 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...
  9. 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.
  10. 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.
  11. 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!


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