Forgetting to prime peripheral IV line...

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Hi All! I have been dealing with this in my head all night!! I've searched the internet, but would like your input. If you forget to prime a peripheral IV line that infuse by gravity on a child, what would happen? Severe coughing? Would the child be ok? Any insight will be greatly appreciated.

Good luck OP. Hopefully this child is OK and im sure it will never be a mistake you make again. Thankyou for sharing your experience as it reminds all of us to stay focused at work.

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Did you tell anyone about this? I get the feeling that you just kind of left it and hoped nothing happened, because if you had let someone know, you wouldn't be having to come here for answers. An ED doc or other coworker could have given you some info.

Wow. Its sad that this is your response and alot of others responses. Someone is asking for help and instead you scold them, and after not having read the entire post where she address this! She feels terrible about it and still does. A more productive response would be to give advice on time management or maybe not say anything if you dont know the answer. Think about that next time you make a mistake. Im sure your a ball to work with.

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Specializes in ER.
Buretrol (at least) always and only enough fluid to last for one hour at the most. Last time I did little PEDS was 12 years ago.

Mistakes happen and I am not one to judge. That said.....if it were my child, then you would be in front of the board.

Please be more careful.

Please rethink your comments- that's an unhelpful and threatening response.

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Specializes in lots of different areas.

Would that much air to gravity (even 10-12cc's) run through the IV catheter filter? I'm sorry, I've never considered it. I'm fairly new to the ER, most of my background is in ICU where EVERYTHING is run on a pump. Recently, I've started floating in ER and cath lab. Different worlds!! Working in ER offers so much insight. Each is different and stressful in their own ways. AND I admit I cannot stand taking care of kids in the ER. bah! Luckily, we aren't a pediatric hospital, so if they're critical we ship 'em out! But, I'd rather pop up the tubing and run the bag to gravity, I have to admit! Pumps should be stationed to each room, and not removed. Chin up, thanks for the thread and reminder to pay attention to the tubing!

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Specializes in CVOR, CVICU/CTICU, CCRN-CMC-CSC.
Our level I trauma center ED policy is to never infuse anything by gravity on a kid, never.

We have the same policy in our backwoods CAH as well. Would have thought it was a pretty universal standard to avoid putting kids at risk like that ...

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As other posts have said, most IV tubing holds between 15-25 cc. Some more, some less... but your goal should NOT be to run 30cc through to ensure all bubbles are out. Think about it this way, you have a tubing which holds 15 cc, and your bag of IVAB is 50 cc... If you run 30cc out of the tubing, you are seriously dumping most of the antibiotic in the trash. What your goal should be is to spike the IV bag with the IV tubing, fill 1/3 of the drip chamber by squeezing it, then SLOWLY allow the fluid to purge the IV tubing all-the-while keeping an eye on the fluid level as it runs through the tubing. This way, once it hits the end of the tubing you can promptly close the clamp and never loose a single drop of this precious fluid.

This is just with saline. I don't do that with added medication. Should've clarified that.

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Specializes in Vascular Access.
This is just with saline. I don't do that with added medication. Should've clarified that.

I am confused now too! So, if you did NOT have a primary bag of NSS, but rather just had an IVAB with a primary set you wouldn't follow the above procedure?

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I am confused now too! So, if you did NOT have a primary bag of NSS, but rather just had an IVAB with a primary set you wouldn't follow the above procedure?

I was referring to the amount being wasted while priming the tube. The 30 ml I mentioned previously was a little over exaggerated. I prime slower when priming any type of added medication as not to waste any.

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Specializes in Critical Care/Trauma.

it takes approximatly 60cc of air into the peripheral vein for an air embolus to form in an adult patient. However if it is a central line it is only 6cc

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One should suspect an air embolism with the sudden onset of dyspnea, continued coughing, breathlessness, chest pain, hypotension, jugular venous distension, tachyarrhythmias, wheezing, tachypnea, altered mental status, altered speech, changes in facial appearance, numbness, and paralysis. Clinical events from air emboli can produce cardiopulmonary and/or neurological signs and symptoms.

All IV tubing needs to be primed prior to use - for adults or pediatrics.

You were blessed that this did not end up in a fatal event.

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Specializes in ER, Med Surg, Ob/Gyn, Clinical teaching.

I have a question that has been bugging ma mind as it concerns the volume of the primary alaris pump tubing and you sure did answer it.

however, how can one be sure that a pt gets a full dose of some i.v. medications such as, clindamycin or even zosyn that come in 50ml vol when the primary tubing has to be used because this particular pt isn't getting any other fluids e.g. normal saline, in which one can then use the secondary tubing.

I usually turn off the i.v. pump once it begins to beep due to air in the line because the medication has run empty... but most times I fear for the air embolism... so my question is.. if the i.v medication runs thru and the pump beeps due to air in line, will the pt still be at risk of air embolism?

Also, sometimes, while priming these i.v. drugs that come in very small vol.. 50cc.. I find difficult to get rid of air bubbles when the exist , because while trying to run the fluid thru the medication is just wasting and for sure the pt will not get the appropriate dose of this medication..

Any clarification or skill will help .. Thanks . :)

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Specializes in ER, Med Surg, Ob/Gyn, Clinical teaching.
This begs the question, what was the volume of the tubing that you used? Every package of tubing states the end to end volume of the tubing. In adults, primary alaris pump tubing has a volume of ~25-30mL.

If you had run whatever you were running on a pump that would have avoided the problem because the pump would have alerted you to air in the line.

I have a question that has been bugging ma mind as it concerns the volume of the primary alaris pump tubing and you sure did answer it.

however, how can one be sure that a pt gets a full dose of some i.v. medications such as, clindamycin or even zosyn that come in 50ml vol when the primary tubing has to be used because this particular pt isn't getting any other fluids e.g. normal saline, in which one can then use the secondary tubing.

I usually turn off the i.v. pump once it begins to beep due to air in the line because the medication has run empty... but most times I fear for the air embolism... so my question is.. if the i.v medication runs thru and the pump beeps due to air in line, will the pt still be at risk of air embolism?

Also, sometimes, while priming these i.v. drugs that come in very small vol.. 50cc.. I find difficult to get rid of air bubbles when the exist , because while trying to run the fluid thru the medication is just wasting and for sure the pt will not get the appropriate dose of this medication..

Any clarification or skill will help .. Thanks . :)

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