IV air bubble compensation - page 3
Hello, I hope someone can help me with this question. I am a nursing student and it's been bothering me for a long time. What happens to air that enters the blood stream through a peripheral IV? I... Read More
Nov 20, '06Occupation: Nurse Educator: love those students! Specialty: Med/Surg,ER,L&D,ICU,OR,nrs. educator ; Joined: Apr '02; Posts: 968; Likes: 42Quote from MurseNeutronMeasurable?you would have to try way to hard.
I would just be careful to check all lines of an alarming IV pump, and not allow more than an inch or so of air into any patient.
Central line extractractions need special site care (the "sucking hole" theory).
Nov 22, '06Joined: Nov '06; Posts: 22; Likes: 2The horrer of being told in nursing school that the slightest speck of air must be retrieved from regular IV tubing stuck with me for the first 3 years of my nursing career.
then in a recent critical care course... this question was answered.... according to a HD RN she said an arm's length of Dialysis tubing would be long enough to cause a problem.... i was skeptical so i inquired further...
I am careful enough not to let that happen...
Nov 22, '06Occupation: RN Specialty: 15 year(s) of experience ; Joined: Oct '02; Posts: 4,763; Likes: 845Quote from DaytoniteGreat explanation, Daytonite.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.
Nov 22, '06Joined: Jul '05; Posts: 10; Likes: 8I work in a Cardiology office where we do testing. When we need to do echocardiograms specifically on patients who may have a septal defect, we inject air bubbles on purpose to better trace the blood flow. there are no adverse effects to the patient. You need to inject a large amount of air (more than 25 cc's) before you see adverse reactions.
Nov 22, '06Occupation: CURRENTLY SELF IMPROVEMENT Specialty: 31 year(s) of experience ; Joined: Nov '06; Posts: 41; Likes: 8DAYTONITE IS RIGHT ON--- EVERY EFFORT SHOULD BE MADE TO PURGE THE IV LINES BEFORE STARTING THE FLOW. IT TAKES 20cc AIR TO CAUSE DAMAGE BUT DON'T TRY IT.
Nov 24, '06Joined: Dec '05; Posts: 6; Likes: 2I too was taught that it would take a whole tubing full of air to harm a patient, Nevertheless, I try to remove anything that is more than a "tiny" air bubble - for my patient's peace of mind and mine.
Nov 24, '06Joined: Sep '06; Posts: 1this incident of bubbles in IV tubing reminds me of my dad's unexpected death in the ward 3yrs ago.
He was a healthy and independent 95yrs old. The night before his admission to A and E he had 2 episodes of vomiting and rigor. The next morning he felt so weak that he was unable to stand up. We sent him to A and E. Full investigations were done including ECG and cardiac enzymes. All results were negatives. The doctor decided to hospitalised him for observation. An I.V. drip was set up as he was dehydrated. He had to stay in "short stay" ward in casualty for 6 hrs until the bed was available in the medical ward in the late afternoon. He was fully orientated and his only complaint was feeling hungry as he was not allowed oral intake.
Prior to his transfer to the ward I noticed that the IV drip had ran through and half of the tubing was filled with air. I alerted the nurse and she clamped the tubing. On arrival to the ward I informed the nurse about the I.V drip. She put up a new pint hastily.The houseman who examined my dad assured us that he was alright and that we can go home. We said goodbye to my dad and promised to bring his belongings later in the evening.
While on the way home (only 10 minutes after we left ) the hospital called to say that they found my father dead. The houseman could'nt give us the answer for the cause of his death. The coroner decided not to do an autopsy in view of his old age.
I could'nt help thinking at the back of my mind-did my dad died of heart attack or air embolism ? was there a negligent--
Should the nurse disconnect and flushed the tubing thoroughly before continuing the regime since half of the tubing was filled with air. From my experience it is takes time to expel all the air from the tubing by tapping and she took less than 15 seconds. I am not blaming everyone for my dad's death but to alert all our colleagues. Please be more vigilant.
Nov 25, '06Occupation: Happily in Nursing Education! Specialty: 13 year(s) of experience in Education, Acute, Med/Surg, Tele, etc ; From: US ; Joined: Oct '04; Posts: 2,757; Likes: 415HEY!!!!!!!
Okay...so I never ever go on the the internet with my hospital computers...but we had this lady that got freaked out badly with a micro bubble in her IV line and about had a heart attack from it!!!!!!!!
I said...wow...you know I just saw a forum post about this...and logged on! ALL the nurses..and I mean ALL..wanted to see this post!!!!!!!!!! It is like we were all told something different and wanted a fact or two! They were THRILLED!!!!!!!!!!
Thank you all that responded and showed your reference!!!!!!!!!! Some of the RN's I know are 'by the book' and they looked it up! Others are like me and do give credit to those that actually take the time to type it!
Guess we are going to get a few members... LOL!!!!!!!!!!!!!
This was a very good question..thanks for asking it!!!!!!!
Nov 25, '06Occupation: Registered Nurse - LTC Specialty: 4 year(s) of experience in Developmental Disabilities, LTC ; Joined: Nov '06; Posts: 428; Likes: 84My instructor and I recently sat down and talked about this one to one (following my dreadful "Start an IV" skills check off). She told me that, no, small air bubbles aren't going to kill a patient, but the more comfortable you become leaving even those small air bubbles in the tubing or syringe or whathaveyou, the more comfortable you'll get leaving bigger and bigger air bubbles in - and those are the ones that obviously can cause air emboli. Her theory was that even if you see small air bubbles, always try and get them out, otherwise you'll just get too comfortable leaving them in...hope that makes sense.
Mar 24, '07Occupation: RN Specialty: 9 year(s) of experience in CWOCN ; From: US ; Joined: Apr '06; Posts: 91I just found this cartoon on nursing students and bubbles in the tubing line.
Mar 24, '07Occupation: RN Specialty: High Risk In Patient OB/GYN ; Joined: Apr '06; Posts: 738; Likes: 161I had a woman call our ADN because she had a *tiny* bubble go through her PIV when I hooked a (fully primed) line up to her SLIV. Didn't want to hear one word about it not being a problem. She was near hysterics and made me do serial BPs about 10 times--asymptomatic, VSS, etc etc etc. She called the ADN and threatened to sue...she'd "own the place" by this time next year. Emotional distress and whatnot. ADN made us do q15m vitals x4hrs then hourly to shut the Pt up.
No, I'm not joking.
Mar 24, '07Joined: Jan '07; Posts: 17; Likes: 10I remember being SO scared of this during my first clinicals in school. And patients are always watching closely and freaking out if there is the tiniest of bubbles when giving IVP meds. I think it comes from something out of the movies. Can't you just see the bad guy sneaking in and injecting a sleeping pt with air and then the monitor goes flatline? Anyway, I was told in school that the entire IV tubing would have to be filled with air for you to really worry.
So now I am confused though- which is the better position to trap the air in the R atria if something should happen, left lateral with head of bed up or tendelenburg or something else? Anyone know for sure?
Mar 24, '07Occupation: RN Joined: Nov '99; Posts: 2,950; Likes: 620I have always been cautious about air bubbles but not to an extreem. We know full well small bubbles are harmless. Though in peids I am extra cautious about this.
HOWEVER, I have always had a problem with being told that a central or picc line could receive zero air as it was very very dangerous to get even a tiny amount of air in. This NEVER has made sense to me. The Central or PICC is going into the left venterical for heaven sake. To me it should be less of a risk because of this for the reasons already cited. (large chamber means nothing to block and turbulance breaks up the bubble.
Yet, everyone I meet seems to believe the tinyest bubble in this type of iv is extreemly dangerous. Now I would not introduce air deliberately nor would I uncap a line without clamping it but lets get real.
Am I somehow off base with my thinking?