IV air bubble compensation

Those bubbles that you see in the IV tubings that enter the vein make their way to the chambers of the heart (remember that the veins carry blood heading back to the heart) where the turbulence causes them to break apart into even smaller bubbles. Those miniscule bubbles of air are too small to do any occlusion or occlusive damage in the body. They eventually get absorbed into the tissues of the body.

Now, having said that doesn't give nurses free rein to permit this to happen. Efforts should be taken to prevent air from getting into the IV line and the patient's vein. You should know the immediate first aid for a large amount of air that enters the blood stream: turn the patient onto their left side with the head of the bed elevated to trap the air bubble in the upper right atrium of the heart.

I was nationally certified in IV therapy at one time. I've always been a kind of nurse geek seeking out answers to questions like this. I just happened to know the answer to this one because I had thought of it before myself. It used to bother me to watch nurses nonchalantly let all kinds of air bubbles run into people's veins without a second thought. I would hang around a room waiting for these patient's to have strokes or heart attacks. Well, it never happened and I was determined to find out why, not that I wasn't thrilled for the patients and that they survived a major cataclysm! I can't remember the total amount it takes to cause a vessel to occlude and cause infarct of the surrounding tissue. I do remember that it took more than a full 1 milliliter bolus. That's a full bubble of 1-milliliter. IV tubing holds about 3-5 milliliters, so that's a lot of air. Most pumps will detect even the tiniest amount of air. Occassionally, a miniscule and undetectable bubble of air in the plastic of the IV tubing for IV pumps will set off the air detector in an IV pump. This is due to a defect in the manufacture of that one IV tubing that you just can't see with your eye. If you have an IV pump whose air detector keeps going off and you can't find an air bubble, just change the tubing.

The easiest way to get air out of IV tubing is still to use a needle, or the equivalent needleless substitute. I used to carry a few needles in my pocket for these emergencies. Uncap the needle, swab off a Y-port between the patient and the air bubble, take the tubing out of the IV pump (if it's on a pump), insert the needle, open the clamp on the IV tubing and atmospheric air will do the rest. It will pull all the IV fluid including any air bubbles down and out through the hub of the needle, so you need to have a trash can, a towel or something to shoot the works into unless you want a mess to clean up. D5W is very sticky when it dries. When the air is out, pull out the needle, readjust the IV flow clamp and/or put the tubing back into the IV pump and the IV will resume infusing--air bubbles will be gone.