Air Embolism in Infant

[kk2021]

Alright, so I am a nursing student in my pediatric rotation. Today was the second day of this clinical for us, so everything is still pretty new. My patient was 5wks old, only 7.6 pounds. Early in the shift, my instructor came with me to put a new secondary line in the room as the first one had been damaged somehow. Because there was no medications running through that line at the time, we left it coiled up with the tape around it so that the next person to use it would know it had air in it and needed to be primed. A few hours later, we went in to set up the med..my classmate was doing it and I was observing from the back (this was the first time either of us had done this). My instructor was walking through the methods with the other student, and I noticed that they did not prime the line, so I asked "shouldn't she prime that line?" She said "No, it's already been done." I assumed that since I was standing in the back, I may have missed when my classmate did this. The second we walked out, I asked her if she primed it, she said no. We immediately went to the teacher to tell her that an IV line full of air was about to infuse into this patient, and she just acted like it was no big deal. She calmly got up and walked down the hall to fix the error, and did not say a word about it to either of us afterwards. Am I crazy or could this have been a fatal mistake? Both of us said something in the room about it, and it's like she didn't take us seriously because she's the teacher and we are just the students. Any advice on what I should do about this, if anything?

Sidenote--this was not one of those pumps that the line runs through that can detect when there is air in the line..it's one of the ones that you attach the syringe to and the line connects directly to a port on the primary line and then you set a time to be infused (sorry I don't know all the technical name of everything..clueless student here!)

[Esme12, ASN, BSN, RN]

Without actually knowing the actual details it is impossible to know what to say.

Yes, IV's have to be flushed. No, they won't run without being flushed. Finally, I would not use an exposed IV tubing (coiled on a table or whatever) as it may be contaminated so I would throw it away. Your instructor probably went down the hall just to be sure after what you said but found everything to be fine. If there was an air amboli....you'd know pretty quick.

Medscape: Medscape Access VAE (venous air emboli) requires registration but it is free and a great resource.

[xoemmylouox, ASN, RN]

I agree that I would NEVER use something that was sitting out in the open. It could have been contaminated or tampered with.

[kk2021]

I appreciate both of your responses, and I will definitely remember to not use an IV line that had been sitting out for a few hours. However, the line was full of air. My instructor immediately stopped the infusion (luckily before it had really started infusing), disconnected it from the port, got a basin and primed the line. And like I said, this was not a pump where the line runs through it so it can detect air. It was a syringe attached to a pump, connected to the line which was directly connected to a port on the primary line going into the patient. So are you saying that it still would not begin infusing if there was air in the line? How would it know to not infuse? I'm sorry I have so many questions about this, but like I said this was only my second day in this rotation, and as you can probably tell my instructor is not the most helpful.

[Esme12, ASN, BSN, RN]

I am hesitant to answer as I don't know the pump. I don't know the tubing involved. Many come here looking for explanations for legal reasons, without personal knowledge I can't answer your question.

Again ALL IV's need to be flushed of air. I would NOT use a tubing that had been laying around. Attention to detail is the nurses responsibility and a nurse is responsible for her actions. The instructor is responsible for her students actions. I never hook up an IV to any pump until I see fluid out of the distal port. On infants and children I start the pump, look for fluid, then hook up.

I gave you a link for air embolisms. It is usually a lot more air than you would think to cause harm unless there is a septal defect....which is common in children.

What are you looking for....

[kk2021]

I get the point about not using tubing that had been out. I should have known better and there's no real excuse except for the fact that my instructor told me to do it this way (still not excusable and I won't do it again). I also understand that all IVs need to be flushed of air..that was the main issue here-that the teacher did not instruct my classmate to do so, and said no when we both asked about it in the room.

From your link.. "However, complications have been reported with as little as 20 mL of air^[7] (the length of an unprimed IV infusion tubing) that was injected intravenously."

^This combined with the fact that this was a tiny infant makes me feel like this could have been a really serious issue had the infusion continued.

I guess I am looking for reassurance that I'm not crazy and that she did make a mistake/my classmate and I did the right thing. This instructor is literally ZERO help. She laughed at us when we did a calculation "wrong" (it was NOT wrong, but that is a whole different story that I won't go into). I take clinical very seriously and do not want to come out more confused than before; however, I'm getting nothing back from this teacher, and I feel like this is an important issue. Also I'm wondering if I should report this incident to my course coordinator, but if I was wrong about how important of a safety issue is, then I don't need to do so.

[kk2021]

PS-I know I could just go to the course coordinator initially, but these teachers are all friends and have worked together for years. So I don't want to bring this up if it's not as big of a deal as I suspect. That's why I'm coming here to ask for advice and insight from experienced nurses.

[wooh, BSN, RN]

It sounds like a syringe pump. Syringe pump tubing generally only requires 1-2ml to prime, thus wouldn't have been that big of a deal.

[kk2021]

All I needed was clarification about that so thank you! That makes me feel a lot better about the whole situation.

[NicuGal, MSN, RN]

Yes, syringe pump tubing can be anywhere from 0.2ml to 2ml, would it have killed the baby, probably not, but it should still be looked at as a lesson, one the instructer should have pointed out. That being said...we did have one infant ( a preemie that was about 3lbs) that had a PFO and a line didn't get primed correctly and an air embolism went thru the forman and up to the head...the baby arrested but was luckily okay after being pretty critical for about a week. We saw the line that had multiple areas of air and no filter on it and when they did the CT you could see the air in the ventricle. The only reason we did the CT was because the father was a neurologist and insisted on one