Air bubble in Heart chamber

[FREDhp]

Hi all.

I'm a new nurse and am currently having my orientation in a hospital. One of our topics is IV therapy and we tackled on complications such as air embolism which resulted from air in the IV line. Our preceptor told us that once air is introduced in the circulation, we should immediately turn the patient to his left side with the head of bed elevated.

Me: What would happen next after that, doesn't the air get reabsorbed or something?

Preceptor: There is nowhere where it could be reabsorbed.

Me: What would be the management or procedure to remove the air bubble that is trapped, supposedly, in the heart?

Preceptor: It cannot be removed. What could we do, stab the heart with a syringe and aspirate the air bubble? It will forever remain in the patient's heart chamber. (She answered jokingly and condescendingly?)

Me: WHAT??? i said to myself. Does that mean the patient will remain in that position FOREVER?? I dare not ask any more questions. I get the vibe that she is annoyed and thinks that my question is stupid... which I suppose it is.

I know that you have to inform the doctor immediately after positioning the patient. But.. what would happen after that?

I still don't get it. I've searched the internet yet discussions end up to positioning only. I think that the turbulence in the heart chamber will break the bubble into tiny pieces for it to be reabsorbed in the lungs. Though I have nothing concrete for this.

Help me understand please. I know I'm missing something crucial. thanks!

[Zookeeper3]

UMN, NO, blood returning to the heart from a peripheral IV will go from the right atrium, to the right ventricle and to the lungs to diffuse ..... any few excess bubbles are left here and adsorb.

IN a central line infusing rapidly to the right atrium and right ventricle in a rapid flow, may be pushed past this ... having to go though all the cappillary ONE CELL diffusion of the lungs before passing upon the left atrium, now left ventricle and THEN become an air embolis to cause damage... possibilities..??/?? LOW.

While you have an instructor who wishes to scare you about the dangers of an air bubble, and they exist, they happen and they are true complications.... re read my post. There is strength in having a respect for air embolis and the complications and there is stupid. No more to say.

[Emergency RN]

Gas diffuses directly into liquids and freely mixes, even if you don't see it. The classic example of this would be a fish tank. If anyone has ever owned one, all one needs to see is the bubble aerator to understand this principle; the pump pushes air directly into the tank of water via a tube; the air then exits the tube in the form of bubbles. Though the bubbles rise to the surface and is seemingly all released into the air, enough of the air actually mixes and is absorbed directly by the water. If this did not happen, all the fish in the tank would die from lack of oxygen.

To the OP, next time ask your instructor if air "cannot" dissolve into blood, then what is the purpose of a blood gas study?

[wtbcrna, MSN, DNP, CRNA]

Gas diffuses directly into liquids and freely mixes, even if you don't see it. The classic example of this would be a fish tank. If anyone has ever owned one, all one needs to see is the bubble aerator to understand this principle; the pump pushes air directly into the tank of water via a tube; the air then exits the tube in the form of bubbles. Though the bubbles rise to the surface and is seemingly all released into the air, enough of the air actually mixes and is absorbed directly by the water. If this did not happen, all the fish in the tank would die from lack of oxygen.

To the OP, next time ask your instructor if air "cannot" dissolve into blood, then what is the purpose of a blood gas study?

Sometimes it is better to just nod and grin as a student.

[azhiker96, BSN, RN]

To the OP, I think your question has been answered. Also, you have probably figured out that instructors are not immune to giving out bad information. I'm sure she is very knowledgable on a lot of nursing subjects.

Also, one probing question is appropriate but most instructors will feel they are being attacked if you question the validity of their information. It's best to just seek another source so that you know the correct information. In my opinion, it's not worth the pain and effort to correct an instructor who feels their authority is being threatened.

Side note. In my classes I missed a test question because the instructor defined an attenuated vaccine as containing dead virus. Attenuated is a live virus but I couldn't win the arguement because she made the rules. I just know that if I was facing two outcomes from a procedure I'd prefer to be attenuated than dead.

[CCL"Babe", BSN, RN]

Sometimes during tests such as a TEE transesophogeal ecchocardigram you purposely put bubbles into the IV line so they can watch them on the echo.

Agree with several posters: Asking questions is a way of learning. If the instructor feels threatened- find your info elsewhere-especially if you will be coming into contact with that person frequently in your job.

[FREDhp]

Thanks all for your support and helping me discover the answer to my queries.

As much as possible I will avoid introducing air into my IV line.

Guess i'll have more questions along the way. and i'll appreciate your continued patience.

God Bless everyone!

:D:D:D:D:D:D:D

[bridgesbuff]

I realize that this blog thread is quite old but it came up in my research for an event which occurred yesterday. My baby sister who was 51 years old died on the operating table. She was in for a routine gall bladder surgery which went well. Then a GI doc used and endoscopy procedure to remove the stones from the common bile duct. This was also effectively accomplished. The doctor withdrew his equipment and the team began to get ready to prep my sister to leave the OR. Immediately she had what the doctors have called "a catastrophic event". Sudden loss of BP and monitors alerting. The episode took place in 20 - 30 seconds. Lots of people called in stat including cardiac and thoracic specialists among others. A camera view of the heart showed that the right side of the heart had an air embulism which would not allow blood to enter. The left side of the heart continued to try and pump. After opening four different access points and trying to get the air to move on, they were unsuccessful. The air was compressed and laying her in different positions did not alter the air enough to allow blood to enter. The doctors had never seen anything like it they said. The working theory is that air infused the liver and backed its way up into the heart restricting blood flow. The county coroner is autopsying my sister as I write this. It was an absolutely horrendous turn of events. I am sharing the story here because I thought it might be a case example for your reference and, perhaps, one of you may have an alternate theory on what happened. Thank you all for the work you do interceding for the ill.

[rkitty198, BSN, RN]

Oh my goodness...

I am so sad for your loss.

As a nurse working on a surgical floor we get patients post-op all of the time from gallbladder surgeries. This is something so rare, I almost never think about it happening. I thank you for posting here because it will make me more viligant that this can happen.

I am so sorry.