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Air in Line

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by megcmo megcmo (New Member) New Member

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When using an Alaris IV pump and it says Air in Line, how to aspirate the air from the IV tubing using an empty syringe? I have tried doing this many times, and it never works for me, so I must be doing it wrong. 

Can someone please explain in great detail because I am very confused on how to do this. 

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Rose_Queen is a BSN, MSN, RN and works as a Staff nurse educator.

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The best option here would be to reach out to your nurse educator or a trusted coworker for guidance, as they will be familiar with the specific equipment and can demonstrate the appropriate method. Additionally, your facility may have policy/procedure that spells out how to do so.

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I will trade you.  I will answer your question, but then I have a question for you.

What you want to do is called back priming.  This varies from pump to pump, but a simple google search shows this video.

 

Now, my question. What kind of environment are you working in?  This is a very common task. How come you don't just ask a co-worker?

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I have asked two coworkers, and both of them demonstrated it for me. They both did it so quickly that I didn't really get a clear understanding of how to do it. I'm a new nurse but no longer in training, so I feel like I'm sort of expected to know how to do this by now. I'm embarassed to ask another coworker again! 

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I agree that an in-person demo is probably best...but I'll take a shot at explaining it!  The Alaris pumps at my facility (and everywhere?) use Primary tubing (the piece that you actually clip into the air-in-line sensor; it has a blue removable cover around the part that goes in the pump door) and Secondary tubing (which you screw on to a needleless connector above the pump). If that doesn't sound familiar, stop here because none of the rest of this will make sense!

The primary tubing also has a one-way valve in it between the spike and the connector for the secondary meds. This prevents your secondary meds from flowing back into your flush/main IV fluid. It also prevents you from chasing air bubbles back up the primary line and into the bag. 

You can remove them with a syringe at the secondary port, before they hit the air sensor.  It is prudent to disconnect the line from the patient first!  Then, scrub the port with alcohol and screw on a clean, empty syringe.  The goal is to remove the air at the same rate the fluid is flowing...watch as the air approaches the port and gently pull back on the plunger.  (If you pull too hard, you'll pull air in from the distal end of the line...you can fix this by allowing fluid to flow to the end of the line before re-connecting.  If you don't disconnect your patient you will pull their blood back into your line & maybe blow their IV.)

If the air is already down below the secondary port and it's a lot of air, I usually disconnect the patient and re-prime the line over the sink if the med/fluid is safe to disconnect. It takes a minute,  but better than constantly silencing alarms!

The reference in hherrn' s post to backpriming is a good way to chase bubbles out of your secondary tubing and back up into the secondary bag. It may also be the way you prime your secondary tubing if you don't prime it with the medication. 

Good luck! But seriously, ask a co-worker. Soon you'll be the one showing new folks the tricks.

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Are you talking if you run the line dry or air bubbles?

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Ddestiny has 6 years experience as a BSN, RN and works as a ICU RN.

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I'm going to assume that you're needing to re-prime the tubing around the level of the pump, not just the area immediately below the drip chamber. This method will work for both, but if you're just getting a little air below the drip chamber then you can re-prime with a syringe without having to pull the tubing out of the pump -- just pause it. Below is a longer way, to be used if the bubbles are down below the secondary port  in the tubing (the port immediately above the pump). You don't need to unhook the line from the patient to do this.

1. Pause the pump.

2. Clamp the roller clamp immediately below the pump (I'm assuming that all Alaris tubing is the same? Maybe not?)

3. Open the door on the pump channel and pull the tubing out of the channel. There will be a blue clamp that will be active/closed when you pull the tubing out and you will need to re-open it. (Make sure Step 2 is done before Step 3 to keep more fluid/med from running into the pt and bringing your air level lower.)

4. Squeeze and fill your drip chamber.

5. Connect the empty syringe to the port on the tubing that is below the part of the tubing that goes into the pump. It is usually right above the roller clamp.

6. Pull back on the plunger of the syringe. You should see fluid/med dripping into the drip chamber. If it is not, you have missed a step somewhere. Just keep pulling back until you get all of the air out. You will end up with some of the med/fluid in your syringe. No big deal.

7. Put the tubing back into the pump chamber, release the roller clamp below the pump, and restart the infusion.

 

If your secondary tubing goes dry, you can back-prime it with the primary fluid by simply making sure that the clamp on the secondary tubing is open, then lowering the secondary medication below the level of the primary fluid. You'll immediately see the tubing start to backprime. This can be done when the fluid is still running, without pausing the pump.

Hope this helps!

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103 Likes; 4,075 Visitors; 329 Posts

What everyone else has said, but one tip to add- you usually can't get all of the air out unless you pop the tubing/white part of the cassette out of the pump. Don't forget to clamp your line down by the patient though because you'll bolus your patient with whatever is hanging if you just pop the cassette out while it's connected. 

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227 Likes; 1 Follower; 44,084 Visitors; 2,941 Posts

There are You Tube videos, even one from Alaris, about how to remove air in an IV  line

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hppygr8ful has 15 years experience and works as a RN - Adolescent Psych.

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On 2/17/2019 at 2:36 PM, megcmo said:

I have asked two coworkers, and both of them demonstrated it for me. They both did it so quickly that I didn't really get a clear understanding of how to do it. I'm a new nurse but no longer in training, so I feel like I'm sort of expected to know how to do this by now. I'm embarassed to ask another coworker again! 

In teaching one should demonstrate the skill then have the student repeat the demonstration until they feel competent doing it. Not many take the time to help new nurses in this way. I had great preceptors and mentors in my early nursing career and always try to pay it forward. I do mostly psych now but will never forget what it's like to be green as grass and not know who to talk to get clarification

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Kallie3006 has 6 years experience as a ADN and works as a Jack of all trades, master of none.

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2 hours ago, hppygr8ful said:

In teaching one should demonstrate the skill then have the student repeat the demonstration until they feel competent doing it. Not many take the time to help new nurses in this way.

This right here.  I do this with nursing students as well as new nurses, whether new period or new to the facility and the equipment being used.  When I started doing home infusions I came across many pumps that I have never seen before, some I'm sure that were one of the first ones made (HAHA).  Having a basic understanding of how infusion pumps, in general, give an advantage to troubleshooting the unfamiliar while providing concurrent prudent nursing care.  Google and youtube have also been an effective resource in understanding the workings of those unfamiliar and unable to troubleshoot alone.  

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