Air Embolism

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It was announced in a staff meeting that it was determined that the cause of death for a patient who had died on our unit was air embolism caused by the IV. No further details were given as to the amount of air found, etc. I had always been told that small amounts of air in the tubing are inconsequential. I would like to know how much is too much air. When should I be concerned and purge the line of air and when can I allow it to infuse?

Thankyou.

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Did the patient have a peripheral IV or a central line. Patient's with CVL's and open-ended PICCs can get air emboli if the cap on the end (for example the CLC2000 that we use) gets loose and comes off. I've always understood that it's very difficult for someone to get an air embolism from a PIV. Someone would have to be pushing a syringe of air in, or so it seems.

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We were told that it was a peripheral IV but we were not told many details.

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It takes a LOT of air to cause death. 50cc or more. The only ones I have heard of involved misuse of blood salvaging equipment. I think you have a right to ask for more details. Without knowing how it was done and how to prevent it, it is only a scary story.

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Specializes in Clinical Infusion Educator.

Nellie,

Small amounts of air in IV tubing usually is inconsequential, however, there has been reports of pts dying, especially if they are elderly and infirmed, with as little as 7 cc of air.

As far as a peripheral IV is concerned, a patient can suffer from an air embolism if he or she is flailing their arms around creating negative pressure when they have an open connection, but it is more likely to occur with a centrally placed catheter. It is important to make sure all connections are leur-locked, not slip locked.

Hope that helped.

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For a patient to die of an air embolism only it would have to be a bolus large enought to block the pulmonary artery. On the other hand it could cause other symptoms with a smaller bolus. Usually the smaller boluses get trapped in the lungs. It would be very rare that PIV couls cause air embolism as the flow would most likely cause the blood to exit from the catheter and not draw air in.

Randy

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Specializes in ICU.

I had a patient many many moons ago who was on home dialysis. His story was that he woke to find the venous line disconnected and the machine pumping air. (He was known to be somewhat lax in his own care). Now this guy did not come straight into hospital - he had a shower first, and had a fit while showering - did he call an ambulance then? No, he went and had a lie down, and fitted again, so he decided to DRIVE himself into hospital, got into the car and fitted again, by this time he thought he might be a little ill so he called an ambulance. Now, by this time it was 12 hours AFTER he saw the air in the dialyisis machine that he arrived in ED only to have a full on cardiac arrest!!!!!

When we saw him to do an emergency dialysis on him his shunt arm was at least twice it's normal size from fingertips to shoulder with surgical emphysema.

Lord alone knows how much air was pumped into him and all I can say is some people are just plain meant to live!!

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I had a patient who developed a 150 pulse minutes after another nurse removed a RIJ catheter from her while sitting upright. Does anyone have experiences like this?

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Specializes in ED, CTSurg, IVTeam, Oncology.

http://everything2.com/index.pl?node_id=930159

I just found the above and thought it, well... quaint.

Anyway, as far as I know, it takes a tremendous amount of air rapidly injected via periph IV if one wanted to use that as a way of killing someone. Not a very effective means. BTW, oral-lady partsl sex may give pregnant women deadly air emboli, because of the presence of the placenta.

Ralph

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Also take a look at the allnurses air_embolism_iv_therapy thread: https://allnurses.com/forums/f27/air-embolism-iv-therapy-96687.html, it has a references that explicitly talks about how much is too much air, and mechanisms of complications.

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Specializes in Infusion Nursing, Home Health Infusion.

I would ask for more details. In order to learn how to prevent this in the future your staff need to know exactly what went wrong. Here is my experience. It is very rare to get a fatal air embolism from a peripheral line especially now with the air alarms on all pumps. Was this an older model pump or one that an air alarm was bypassed. Usually an air embolism occurs from a disconnected central line or one that is not properly removed. There is a difference between atmospheric pressure and chest pressure allowing air to be sucked into the vein. So what do you do......Prevention is the best...use only leur loc connections and caps.......check all connections at start of shift and prn (anything can come loose)....investigate and leaks on the extension legs of any CVC......instruct pt on how to ambulate with pumps.....or go with them....never bypass or shut off air alarms on your pumps.....respond to call lights promptly......know what to do if you discover a disconnected line and pt is symptomatic....place pt on left side with head down in trendelenburg..someone contact MD..stay with pt...o2 keep an IV open

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hi, i was just wondering...if the drip chamber of peripheral line gets too full and you turn the bag upside down and squeeze the drip chamber to force some of the fluid back down into the bag but you forget to close the roller clamp?? is this dangerous?? can the patient have vae?? please help[color=#ffffff]tto o [color=#ffffff]to force some of the fluid back down into the bag[color=#ffffff]force some of the fluid back down into the bag

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