IV air bubbles

[I'mANurse!]

I'm a new grad working in the NICU, and my preceptor keeps telling me that I'm too obsessed with clearing air bubbles from my IV tubing, especially when hanging TPN. She tells me that it would take a couple inches of air in the IV tubing to cause any harm, but I just cannot get out of the habit of trying to clear all the air bubbles. Consequently, it can take me forever to hang my TPN!! When I worked with another preceptor, she seemed to be a little more concerned with air bubbles, and so I think that is where part of my obsession comes with. So, I wanted to hear everyone else's opinions on air bubbles in IV lines, how much air or how big of bubbles are acceptable, and any tips and tricks you have for clearing them or preventing them in the first place!! And I know it also depends on the type of IV...PIV, PICC, art line, ect. Am I being too obsessive!??

[AirforceRN, RN]

If you spike the bag and let the tubing fill up, the amount of air in the line will not cause problems. It mostly just catches in the ports and filters but it is negligable amount. We can thank Hollywood for perpetuating the rumour that any air in the line causes instant death.

[elizabells, BSN, RN]

You know, I'm that way too. And I don't really care. You'll get faster at running your TPN even with being OCD about it. From case reports I've read, an air embolism is almost the only mistake you can make as a nurse that you absolutely can't fix. Bam, it's over. And I once very nearly embolized a child with an entire UVC worth of air, because the cardiologists were rushing me. I think it's worth an extra two minutes running my lines to be absolutely sure they're okay. Since every person seems to tell me something different about how much air it really takes to hurt a neonate (and is that neonate 5kg, or 500g?), I'm not really buying any of it.

I have, however, been told I'm too much of a perfectionist. So take all that with a grain of salt.

[Imafloat, BSN, RN]

I make sure there are no visible bubbles in my tubing when I prime it. It isn't worth the risk to me. We are fortunate where I work, our nursing assistants run the IVs for us.

[ilstu99]

How long is "forever?" I mean...are we talking 10 minutes per bag, or 30? Any chance they'd let you practice with water and tubing?

I don't know how much it takes to cause real damage, so I'm pretty anal about clearing my lines. I fall on the "better safe than sorry" line of thinking, and triple check. The tricky places tend to be in the clave hubs, cartridge, and filter. If you use the cartridge kind, just open it up a little, run the TPN slowly through the tube, and flick the "joints" like crazy. It gives you more time to watch and learn where the hang-ups are, and clear them the first time.

Not to mention, one big hunk of air can screw up an otherwise really good PIV, and our babies can't take getting stuck a whole bunch of times.

At any rate - don't sweat it. You'll get faster with practice.

[UTVOL3]

You know, I'm that way too. And I don't really care.

Me too!

It takes forever when you are new anyway. Might as well be safe than sorry.

[IttyBittyBabyRN]

It's great that you care enough to find out for certain before feeling comfortable with this--more people should be that way. You can never get all the little bubbles out and "thumping" on it, like we all were taught to do, will drive you nuts eventually!!! All the tubing I have ever used has a filter on it, and I can't imagine a neonatal unit ever NOT having one. That's what the filter is for--to catch the air bubbles. If for some reason it doesn't, I would question why. I always make sure to run my fluid so that any visible bubbles are through the line--meaning anything that is making an actual gap in the tubing. After that don't worry about it--the little tiny ones are not going to hurt anything. Just use common sense, which is 99% of what our job is made of. It is always better to be over-concerned and ask, though, rather that to just assume something is ok. Never hesitate to ask questions even if you think they are dumb. I have been doing this 7 years and still have questions all the time. You can never stop learning in nursing. Always err on the side of caution and make sure you absolutely understand WHY you are doing something before you do it--even if someone is trying to rush you.

[elizabells, BSN, RN]

I would like to point out that lipids are not filtered, and I've come on to find, seriously, a good half inch of air in lipid tubing before.

[texas2007, BSN, RN]

I would like to point out that lipids are not filtered, and I've come on to find, seriously, a good half inch of air in lipid tubing before.

We add a lipid filter to our tubing..

[BittyBabyGrower, MSN, RN]

The only thing we filter is HAL and a few meds, everything else doesn't have to have a filter. A filter is mainly used to filter particulate matter. As for the air bubbles, just concentrate on the bigger ones, the little ones will dissipate after a bit.

[Imafloat, BSN, RN]

I would like to point out that lipids are not filtered, and I've come on to find, seriously, a good half inch of air in lipid tubing before.

Once I ran my lipids and there was no air in the tubing. A few minutes after I hung them, the pump was beeping. I looked at the tubing and there was a couple of inches of air near the syringe, I was mortified. Another nurse told me there was probably an air bubble at the top of the syringe that I missed, egads!

[iluvivt, BSN, RN]

I do not think you are too concerned considering your patient population. If you are using a .22 micron filter it is bacterial,particulate retentive and AIR eliminating. If you have placed just before the IV site or the most distal it will trap any air just before entering the pts body. Just for the record a .22 micron filter can not be used for Lipids,but you can use a !.2 micron for Lipids if you desire as well as for 3 in 1 admixtures. Lipids attract all kinds of bacteria so the filter is nice but do no use the tubing for more than 24 hours. Now to the air problem. Most air embolisms occur in relation to Central lines,either during insertion,cap changes and care,or upon discontinuation where it can lodge against the pulmonary valve and block the flow of blood from the ventricle into the pulmonary arteries. An adult with a open CVC or a needle in their subclavian vein or any opening for that matter can suck in 20 ml per second. Gravely ill individuals can die with as little as a 70 cc bolus of air (3.5 sec). Most adults however need about 250 ml of air to become symptomatic. Air embolism is rare with peripheral IVs but can occur with large volumes that stay together and do not dissipate. Also you do not have intrathoracic pressure differences to suck in the air. Now with a neonate or infant it would require a lot less air if an ill adult can die with as little as 70 ml. I can not give you an exact amount but I will research it some an let you know if I can find an estimate. It is not something anyone can actually perform clinical trials on. Are you using a final .22 micron filter on your patients. Also there is some new research about microbubbles and how they may lodge in the brain vasculature and may affect functioning. I just copied the article but have been unable to read.