Air in IV line

nurseprnRN, BSN, RN · Jul 20, 2012

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 (

DizzyLizzyNurse · Jul 20, 2012

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.

Bortaz, MSN, RN · Jul 21, 2012

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 (you so smart.

nurseprnRN, BSN, RN · Jul 21, 2012

i just grey and experienced.

meanmaryjean, DNP, RN · Jul 21, 2012

That's not grey! I refer to mine as 'all-natural, eco-friendly organic highlights!'

Guest321574 · Jul 21, 2012

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...

bds165 · Jul 21, 2012

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.

nurseprnRN, BSN, RN · Jul 21, 2012

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.

Guest321574 · Jul 22, 2012

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! :)

picurn10 · Aug 3, 2012

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 :)