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!??
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.
As a student, posts like yours are very important to me.
Maybe I'm still looking through nursing with rose colored glasses, and I know that time is of the essence with some procedures, but one of the things that I have noticed since I have been on this message board, is that some senior nurses post that they have never had such-and-such happen to them, and some of the newer ones post that they have went through 3 hospital jobs in 2 years due to errors.
There has to be a reason why some nurses constantly make errors and some don't or are so rare and minor at the end of the day, they are insignificant.
I read posts like yours and start thinking...is remembering the basics and not always looking for the short cut the key to the whole thing?
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.
The other problem with bubbles as they pertain to the NICU population is that many of the kids still have PFOs. Straight shot, basically, from the right atrium to the carotid and then the brain. Emboli of any kind, air or otherwise, are much more dangerous with a PFO or ASD. There's some interesting evidence out there right now regarding PFOs and thrombotic strokes.
One way I have found to reduce air bubbles in IVF is to prime them SLOWLY. Instead of letting the fluid run through in 5 seconds, take a full minute. I rarely get bubbles that way. Flicking the bubbles usually makes it worse :)
As previously said, better safe then sorry, and you'll get faster with time. Can't be TOO cautious with our tiny babies. I worry about tiny little bubbles too. I've been doing this 2 years and still feel like I'm brand new. Always learning, and loving it!!! Good luck!
Specializes in OT, Palliative, ICU, NICU, Wound Care,.
I ALWAYS remove all the air bubbles in our neonates. If you figure that a preterm baby may have only 15-20 mls of blood as a total then a few air bubbles is significant to me.
Our neonatologists will even go as far as to add drips of fluid into the open end of a line (if they have had to open it) to ensure no air bubbles occur.
All our LIPIDS are filtered however not all our IV's are. Our pumps are also very temperamental with air so it is not worth the trouble not priming it effectively.
Sorry, but allowing 2 inches of air in a 500g neonatal line seems very careless to me.
Wow...nursing assistants doing IV's...?? We don't use assistants in our Level 3 unit.
I always worried about air bubbles, so I'm very careful. I know the little tiny bubbles are not likely to cause problems, though.
My husband recently had a some testing done by a cardiologist to see if he still had a PFO. (A little hole can increase the chances of having TIA's) He had a PIV inserted, given a liter or so of fluid, and then air was injected into his vein, I think 20 or 30 mls!
He was looking for bubbles using a transesophogeal echocardiogram. I wouldn't want to try that on a baby! I'm glad to say the test was negative.
15-20mls of blood in a neonate? Really? That's it?
If we're talking about total blood volume in a neonate's body, estimates tend to vary between 80 and 95 mL/kg, so the neonate with only 15-20 mL TBV would likely not be viable.
I ALWAYS remove all the air bubbles in our neonates. If you figure that a preterm baby may have only 15-20 mls of blood as a total then a few air bubbles is significant to me.
Our neonatologists will even go as far as to add drips of fluid into the open end of a line (if they have had to open it) to ensure no air bubbles occur.
All our LIPIDS are filtered however not all our IV's are. Our pumps are also very temperamental with air so it is not worth the trouble not priming it effectively.
Sorry, but allowing 2 inches of air in a 500g neonatal line seems very careless to me.
Wow...nursing assistants doing IV's...?? We don't use assistants in our Level 3 unit.
I believe there is more than 15-20 mls of blood in a newborn. I infused 11 ml of prbcs into a 700 gram baby last time I worked. He wasn't volume depleted before the infusion, he was infused due to a low Hgb.
The baby whom I had air in his iv line was a big chronic boy, no where did I say he was a 500 gram baby. It doesn't make it ok that he was a big boy, I made a mistake and I didn't realize that I would be called careless over it or I probably wouldn't have posted. It probably was more like an inch, which doesn't make it better. I was new and I beat myself up over it for days when it happened, thankfully my coworkers were supportive and helped me realize that nobody is perfect.
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!??[/quote']
Here's the OP
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.
Here's the original mention of a 500gm baby. Weebaby, I don't think anyone was specifically referring to your post. We were talking about it in general.
I believe there is more than 15-20 mls of blood in a newborn. I infused 11 ml of prbcs into a 700 gram baby last time I worked. He wasn't volume depleted before the infusion, he was infused due to a low Hgb.
The baby whom I had air in his iv line was a big chronic boy, no where did I say he was a 500 gram baby. It doesn't make it ok that he was a big boy, I made a mistake and I didn't realize that I would be called careless over it or I probably wouldn't have posted. It probably was more like an inch, which doesn't make it better. I was new and I beat myself up over it for days when it happened, thankfully my coworkers were supportive and helped me realize that nobody is perfect.
Nobody is perfect. We all receive valuable support and advice from our coworkers and mentors.
As far as total blood volume, Eric is correct. Neonates have 70-80 ml/kg of blood volume. The average PRBC transfusion volume is 10-20ml/kg. But you have to remember that PRBCs have had plasma and other blood components spun off, so all that's left are packed RBCs.
justme1972
2,441 Posts
As a student, posts like yours are very important to me.
Maybe I'm still looking through nursing with rose colored glasses, and I know that time is of the essence with some procedures, but one of the things that I have noticed since I have been on this message board, is that some senior nurses post that they have never had such-and-such happen to them, and some of the newer ones post that they have went through 3 hospital jobs in 2 years due to errors.
There has to be a reason why some nurses constantly make errors and some don't or are so rare and minor at the end of the day, they are insignificant.
I read posts like yours and start thinking...is remembering the basics and not always looking for the short cut the key to the whole thing?