IV bag ran dry?

dudette10, MSN, RN · Apr 9, 2018

Next time you wonder about that, take a look at the bag. When empty, it's completely collapsed, right? That's what it is supposed to do--prevent against inadvertent air embolism when the bag runs dry.

That's also why one should never "re-spike" a bag if the spike should become accidentally dislodged. It can allow air to enter the bag, no longer rendering it protective against air embolism. Using an infusion pump with an "air-in-line" detector would mitigate that, but it's still not good practice infection-wise.

akulahawkRN, ADN, RN, EMT-P · Apr 9, 2018

When you spike a bag and prime the line, you generally don't take the air out of the bag. When the bag empties, sure it will collapse but the air/fluid level will drop in the line until it reaches equilibrium. The line won't run completely dry. The way I spike and flood my IV lines, there's no air in the bag so when the bag is empty, it collapses and shuts off flow. This keeps the drip chamber and IV line primed. You do NOT want to unspike that bag without clamping off the line. Spiking a new bag and removing air from it is not easy because you have to unspike the bag, squeeze the air out (remember, keep that end UP at all times) and respike the bag before you flip the bag over into a normal position. Unspiking the bag is a bit dangerous because it can take a bit of force to do and you can inadvertently spike yourself or strike another object nearby, contaminating the spike. The advantage of removing air from the bag is that the IV line stays primed. Even if you have something else running into a port, the line will stay primed.

When I run a piggyback on a line I've primed, I take the air out of the piggyback setup too. The only place air resides in my lines is the drip chamber so that I can see the dripping... Piggyback lines are setup and run normally. When these bags run dry, they collapse and their flow stops and the primary line starts up again. This works even if I'm using a pump. In fact, once the bag runs dry, I usually get an upstream occlusion alarm. It just works well for me.

This is a system I've used for nearly 20 years, going back to my days as a Paramedic. It's just a habit that I picked up. One downside to doing this is that it is not easy to gauge how much fluid remains in the bag as there's no air/fluid level in the bag.

PurifiedNurse · Apr 9, 2018

Thanks for the great information. I was just worried because the bag went bone dry and collapsed and was connected to the zosyn tubing at the y port and the zosyn was running through a module. Makes me feel better. Thank you so much.

Rocknurse, MSN, APRN, NP · Apr 9, 2018

The patient has a blood pressure, which is going to be a greater pressure than the bag. In fact the bag is under negative pressure which is why it's collapsed. It's more likely for the blood to track back up the line due to the positive arterial pressure, than it is for air to push into the patient.

AnnieOaklyRN, BSN, RN, EMT-P · Apr 9, 2018

No, only the tubing above the Y site would have air, below it would be the zosyn.

Also getting air in a PIV is not life threatening unless it is a very large amount in an adult! I have only heard of one death from this and that was because they introduced air into an IV bag when they re-spiked it and then put in on a pressure bag on a child, and then failed to recognize that the fluid had run out, thus air was being forced through the tubing into the vasculature. This occurred in the UK with a helicopter flight crew.

Annie