Central lines and air embolism ?

IVRUS, BSN, RN · Nov 12, 2014

If you have a well fitting leur-locked needleless connector on the end of the lumen, the patient will NOT suffer an air embolism, unless that lumen is severed, or develops a hole in it where air can enter. Now, you say you used a stopcock. Well, as a FYI, stopcocks are implicated in numerous infections and their use should be discouraged, however, if you turned "off" the stopcock to the catheter's lumen, you should be fine. I personally would just remove the stopcock and attach a well fitting leur-lock (screw on male/female) cap onto its end. So, should all clamps be shut, when the catheter isn't in use... Definetly. Lessons learned help patient outcomes, for sure.

SopranoKris, MSN, RN, NP · Nov 12, 2014

Once you realized what happened, did you contact the patient's nurse so she could go check on your pt and look at the equipment?

mrsboots87 · Nov 13, 2014

As the PP said, have you contacted anyone to check on this patient? When you realized the error, that would be the first thing done for the patient's safety. As a side note, this right here is exactly why students in my area cant proctice anything beside basic care without a nurse or our instructor present. Furthermore, we do not do anything with central lines because of the risk involved. Obviously the mistake has been made at this point and cant be changed and I just pray the patient wasnt harmed. That being said, mistakes happen. This is potentially a pretty big mistake but we are students and still learning. To prevent further mistakes, always pull of the procedure guidelines before doing something to double check the steps so you dont miss anything. Or request a nurse go with you to monitor you and ensure you are practicing safely.

StudentOfHealing · Nov 13, 2014

I'm sure your patient is alive.

Breathe ... Relax ... Glass of wine ... Chinese takeout. Breathe & ...... Repeat.

Honestly chances are your nurse caught it. She or he... SHOULD be flushing both ports every four hours.

VANurse2010 · Nov 13, 2014

O such pearl clutching! Do you people realize just how much air is actually needed to cause an air embolism?

StudentOfHealing · Nov 14, 2014

Well over 10 cc ... Most air dissolves.

People, surprise (we have blood gases).

mrsboots87 · Nov 14, 2014

I was not implying (and Im sure no one else here was either), that minute amounts of air would cause an air embolism. The point was to tell them that instead of worrying if the patient would be harmed and coming here to ask, they should have called the instructor or the hospital directly just to double check since that would be the responsible thing to do. Sure, nurses are supposed to do everything at certain times, but realistically they cant because most just have too much to do. 4 hours can easily turn into 6. And our blood gases are being transported on blood cells, hence the name blood gasses. Not just freely moving through the vasculature. So sure, small amounts will likely get absorbed into the blood before reaching the heart, but we dont know this patient's disease process or the state of their blood. Most patients can tolerate a few mL of air in their system no problem. But some could have air reach their heart and cause problems with very little. And a central line is pretty darn close to the heart leaving not much time for the oxygen to be absorbed.

StudentOfHealing · Nov 14, 2014

I was not implying (and Im sure no one else here was either), that minute amounts of air would cause an air embolism. The point was to tell them that instead of worrying if the patient would be harmed and coming here to ask, they should have called the instructor or the hospital directly just to double check since that would be the responsible thing to do. Sure, nurses are supposed to do everything at certain times, but realistically they cant because most just have too much to do. 4 hours can easily turn into 6. And our blood gases are being transported on blood cells, hence the name blood gasses. Not just freely moving through the vasculature. So sure, small amounts will likely get absorbed into the blood before reaching the heart, but we dont know this patient's disease process or the state of their blood. Most patients can tolerate a few mL of air in their system no problem. But some could have air reach their heart and cause problems with very little. And a central line is pretty darn close to the heart leaving not much time for the oxygen to be absorbed.

I'm a nurse and I'm in and out of every room a lot more than every 4 hours. I usually check everything automatically every time I'm in there. Not sure what nurse let's 6 hours go by without checking their patients - not a very prudent nurse... or a nurse with a 7+ patient load.

Cook23 · Nov 14, 2014

Thank you everybody for your answers ! When I realized I wasn't sure about the clamps I went back to check the patient and I found a nurse. She told me the patient was fine and the central line was removed amd she was sent home. She was alright so nothing happened eventually ! I remembered what I did and I remembet putting the cap and clamping the single lumen and turning the stopcock in a way that it was blocking the other lumen which was also capped. My question was if the caps are not enough and the lumens need to be clamped also. I know they always must be but I was wondering what the chances of an air embolism to occur would be if only the caps were on blocking the opening of the lumen ?

VANurse2010 · Nov 14, 2014

Thank you everybody for your answers ! When I realized I wasn't sure about the clamps I went back to check the patient and I found a nurse. She told me the patient was fine and the central line was removed amd she was sent home. She was alright so nothing happened eventually ! I remembered what I did and I remembet putting the cap and clamping the single lumen and turning the stopcock in a way that it was blocking the other lumen which was also capped. My question was if the caps are not enough and the lumens need to be clamped also. I know they always must be but I was wondering what the chances of an air embolism to occur would be if only the caps were on blocking the opening of the lumen ?

The chances are slim to none. This sort of thing happens all the time. You need to do your due diligence, but it's not something to get too upset over.

KelRN215, BSN, RN · Nov 15, 2014

Thank you everybody for your answers ! When I realized I wasn't sure about the clamps I went back to check the patient and I found a nurse. She told me the patient was fine and the central line was removed amd she was sent home. She was alright so nothing happened eventually ! I remembered what I did and I remembet putting the cap and clamping the single lumen and turning the stopcock in a way that it was blocking the other lumen which was also capped. My question was if the caps are not enough and the lumens need to be clamped also. I know they always must be but I was wondering what the chances of an air embolism to occur would be if only the caps were on blocking the opening of the lumen ?

The patient is not going to get an air embolism through the positive pressure caps on the end of each lumen. Kids play with the clamps on the end of their lines all the time with no air embolisms developing. The line MUST be clamped when you are changing caps and it's open to air but, otherwise, it's not going to hurt your patient if it isn't.