IV airbubbles in bloodstream

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Hello everyone,

I am a student just recently started learning about IV and I have been told that a tiny bubble or 2 is not going to kill the patient. But I am wondering even if the patient is in my/your care and there was a tiny bubble and it went in, will it ever be secreted from the bloodstream? or will it remain in the bloodstream forever? How would it be removed (if it is removed)? and if not won't this just add to the patient if he/she is ever admitted again and it just keeps on accumulating.

Thank you

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Specializes in ICU.

air bubbles of death. »

Great article on air bubbles in IV lines.

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Thank you for the article, it cleared up all my questions and was very helpful. :)

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Specializes in Nurse Leader specializing in Labor & Delivery.

I didn't see where the article addressed where all those little air bubbles go - your body metabolizes them. The air bubbles don't just stay in your veins for the rest of your life.

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Specializes in ER, Addictions, Geriatrics.
air bubbles of death. »

Great article on air bubbles in IV lines.

I was browsing through the comments at the bottom of that article... I want to bang my head against the wall now.

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Specializes in NICU, ICU, PICU, Academia.

The outlier here is the pediatric patient with a congenitally jacked-up heart. In these cases (Tetralogy, single ventricle with any stage of repair, VSD, ASD.....) these air emboli can be quite problematic as the blood flow does not follow the standard 'follow a drop of blood through the heart' we all learned in A&P.

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The air will be trapped within the lungs and absorbed. Now there are issues with the ability of the lungs to absorb based upon the bubble's size, shape, total volume of air, and speed of the air entering circulation...not to mention the health of the patient's lungs.

If the patient has a foramen ovale, which is about 10-30% of adults, the air bubble may actually pass from the right to the left side of the heart where it can either travel and impede coronary circulation or enter and impede the brain's circulation. Now the bubble can pass by coronary circulation and the brain but it has to go somewhere and will become lodged, somewhere. The kidneys and lungs do not adsorb free air very well.

Generally, 50mL to 20mL rapidly infused is considered lethal. I have personally seen air embolisms less than 5mL cause significant adverse clinical S/S though.

There is a great article in the Journal of Infusion Nursing written by Linda Cook MSN, RN, CRNI called Infusion-Related Air Embolism in the January/February issue of 2013.

According to Robert Wilkins MBChB, FRCA and Martin Unverdorben MD, PhD a 2.7mm diameter bubble will take 20-30 minutes to absorb and a 1.7mm diameter bubble will take 9-13 minutes, all depending upon the shape. They wrote Accidental Intravenous Infusion of Air: A Concise Review in the 2012 November/December issue of the Journal of Infusion Nursing.

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Body > Veins > Vena Cava > Right Atrium > tricuspid valve > Right Ventricle > pulmonic valve > Pulmonary Artery > LUNGS >Pulmonary Vein > Left Atrium > mitral valve > Left ventricle > aortic valve > Arteries > Body

Given normal anatomy, i.e., no intracardiac malformations, there is simply no way for a floating object to get to the left heart at all; it gets strained out in the pulmonary capillary bed. As a matter of fact, that's why you have a pulmonary capillary bed, to act as a strainer for all the microemboli you have in the course of an active life. Air bubbles there, unless so huge that they completely fill a pulmonary artery, will be absorbed and vanish in short order.They will not accumulate over the course of a lifetime. :)

The only way a venous DVT (or a bubble in an intraVENOUS line) can get to the cerebral arterial circulation is if there is a direct connection between the venous side and the arterial side in the heart AND the venous pressure is HIGHER than the arterial pressure.

Anyone with an atrial or ventricular septal defect AND a right-to-left shunt, would be at risk for arterial embolus of venous origin, and this would be bad. However, since in most people, the left heart pressures are significantly higher than right heart pressures (by a factor of five to ten, more or less), any air or clot in the right heart keeps going right on out the pulmonary artery to the capillary bed. Unsuspected ASDs are a known cause of stroke in younger people who lack other risk factors-- think of the much-beloved erstwhile heart and soul of the Patriots' line, Tedy Bruschi, whose stroke fortunately resolved and whose ASD was repaired endoscopically; he went back to football for the rest of that season and all of the next one (although he has since retired to TV commentating). His clot probably got over to his left side when he was crushed at the bottom of the pile-- think a major Valsalva, which would make right sided pressure momentarily exceed left sided pressure, resulting in a R-to-L shunt.

As a matter of fact, most ASDs are found by accident or on post for unrelated issues, since the left-to-right shunt doesn't do much harm unless it's so huge that you get bad pulmonary hypertension and capillary bed damage (seen in single ventricle, for example).it is very important to realize that because left heart pressures are much higher than right heart pressures, a bubble (or clot) in the right side will not travel to the left side. This is one reason you have a pulmonary capillary bed, to strain out such things (You have little clots traveling about all the time; they don't grow bigger in the lungs because there are natural anticoagulants manufactured there for that purpose. Anyone remember when all our heparin came from beef lungs?)

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