Flushing a central line

Air embolus is a risk with central lines, but it takes a lot more air than you might think. There has to be enough air there for the bubble to get lodged in the RV enough so that it stops blood flow to the lungs -- not sure if how much has been documented, but the colloquial amount that I have heard tossed around is something in the range of an entire IV line worth of air.

Not sure if your "push/pull" technique is correct. Where did you read that was what was done? Generally when drawing, you want to pull back smoothly. A push/pull technique may agitate the blood in the tubing and inadvertently infuse air from the syringe. Was absolutely appropriate to discard the air you pulled out and flush with another. I usually pull back until blood return is observed (don't have to pull blood all the way out), push your med (OK if there is blood still in the tubing), and then flush with saline to clear the line at the end.

Not sure how many ml a "big" air bubble is as you reported. I work with central lines on a daily basis, and it's fairly frequent that I will get some small bubbles out before I get blood return -- maybe some air got in from a previous IVP or infusion. I usually don't stress about it unless I am getting a cc of air out or more.

Somtimes it seems like you are pulling back air when in fact you aren't pulling back anything. It is usually correct policy to aspirate blood before begining an infusion/IVP, but like the OP said it is not neccessary to pull blood all the way into the syringe. The best way I've found, push-pause-push flush the catheter, then apply gentle steady pressure to aspirate blood. If no blood return can be observed, dispose of syringe and reclean port, repeat flush and have pt take a deep breathe while again attempting to aspirate. If still no blood return, it is our facilities policy to instill altepase into the ports and then reattempt (there are detailed instructions regarding how long to leave it in for). If that doesn't work its usually an x-ray to verify placement/patency.

All central lines are different, some need to be heparinized, others like Groshong's usually dont. Refer to your facility's policy to CYA.

What you saw was probably a vacuum, not air, due to something preventing aspiration, such as a fibrin sheath. You'll still occasionally see the "push-pull" technique recommended as a general flushing technique, although there really isn't any rationale for it unless you are flushing with heparin or TPA, since the push-pull technique can help these circulate around the tip of the catheter to break up external occlusions. The "pulse" technique is sometime called the "stop-start" and is used to flush lines with a valve such as a SOLO-PICC.

Refer to your facility's policy to CYA.

Oh, that's a good one. I keep getting told to look in the manual. Can't find anything in there and it hasn't been updated since 1986.

Thanks, all, for your input. I'g going to continue to flush the way I do a PICC. I don't know how much air I'm getting, but it always looks like I've got a big, honkin' bubble in there. That's a technical term.

You can put a pretty good amount of air from a blood sample, esp if exposed to a vacuum.

Call your pharmacy for their recommendations.

Sue, you are using a 10 ml syringe...

Sue, you are using a 10 ml syringe...

Damn, you got smart fast, girl!

Yes, I am. Why?

SNORT!!!!

Just wondering... cause your 'sposed to nurse Jackie!

Bubbie;

For what it's worth, our protocols for flushes were updated in 09 and for central lines not in daily use the protocol is to flush the lines with 5 ml NS followed by 5 ml 10 unit/ml heparin (except Groshongs , then no Hep) twice weekly and prn with meds (SASH). Of course yo know with a 10cc syringe! LOL Hope this helps. If you use a IV specialist nurse for midline/PICC placements she could probably get you a copy of the most recent INS approved protocols.

FLArn, I'm in LTC/skilled rehab. We don''t have no steenkin' specialists.

Who is your main pharmacy or which pharmacy provides your IV meds?

A couple of the SNF's I worked at used private IV nurse companies to place midlines and PICCs because it was cheaper than sending the patient out for them. I thought yours might also 'cause we all know it's always about saving a buck!