Need help with answers about air embolism pls!!!!!

BelgianRN · Feb 27, 2012

Try this,

Most of your questions seem to be answered in this link: Air embolism

I have to admit I skimmed the article and looked at their sources randomly it seems to check out and it was one of the first things coming up on a Google search.

I feel that at the very least as a nurse we should clear air out of an IV line when using it. I agree that in an emergency that little bubble of air in my syringe due to hastened drawing up or because the meds foam a bit are not my major concern, but when possible and attainable I always try to remove excess air.

Nsg student2012 · Feb 27, 2012

Thank you for replying! I am still a little bit confused. My question is after the air has infused would we see symptoms right away??? Because none of the articles cite this

brownbook · Feb 28, 2012

I am NOT any expert on this subject. BelgianRN's reference was spot on. In my 25 years of various areas of acute care nursing I have come across one case. The patient had to be sent to the bigger hospital across town. I think air embolisms are pretty rare. As for symptoms, Google pulmonary air embolisms, you should be able to find references to the signs and symptoms, though my very quick look just showed that symptoms can be vague and vary. The one quick case I glanced at implied the patient had been having vague symptoms for 4 days. I'm guessing unless it was some massive amount of air, over 200 cc, the patient wouldn't wouldn't show symptoms right away, and they would be vague.

With the thousands of central lines put in, and the millions of IV lines, I feel comfortable reaffirming that they are really rare. I am not at all "careful" with getting all the air out of my IV tubing.

But please remember I am just trying to reassure you and give my off the cuff vague answers.

nurseprnRN, BSN, RN · Feb 28, 2012

by definition, any bubble of any size in a blood vessel is an embolus. embolus means something floating in a blood vessel. not all emboli are dangerous. as a matter of fact, we all have little thromboemboli all the time, and they get strained out in the pulmonary capillary bed and then dissolve. there is no way for them to get over to the arterial circulation and cause a stroke without the presence of an atrial or ventricular septal defect and a right-to-left shunt, meaning the pressure in the right side of the heart is higher than the left side so venous blood is shunted through the defect to the arterial side. rare. an issue if you work with children with heart defects-- no teeny bubbles at all allowed for them.

if you are asking, how much air is needed to cause a serious problem, it depends on where the air is. a pretty small bubble,

if you want to seriously interrupt blood flow to the pulmonary artery/lungs you'd need a bubble of at least 20cc according to my anesthesia friends, and that makes sense if you follow the blood flow and see where it goes.

Esme12, ASN, BSN, RN · Feb 28, 2012

What she said. I agree with GrnTea....it depends on where and how the air enters the system as well as the age/size (pedi/neonates) that make the difference. A peripheral IV with a few air bubbles it should be fine. Key word here SHOULD be fine. Always purge air from a peripheral IV....be safe rather that sorry and ALL AIR form anything that says artery.

How quickly you will have symptoms depends on where and how the air was instilled. I saw air accidentally injected during a cardiac cath and the patient had instantaneous crushing chest pain and luckily he didn't code, die or stroke. But in the shceme of things it is pretty fast.....the air goes in and the time it takes to go from the area of the body where it was instilled to the heart or brain is the onset of symptoms.

Did something happen?

Nsg student2012 · Feb 28, 2012

Thank you all for the replies! I was just asking as a curious nursing student this topic has never been covered in depth at school. As a student I follow many nurses and always wondered whenever I see bubbles in the tubing how big of a bubble would cause an air embolism. I want to make sure I practice safely once I become a nurse. I know whenever there are pumps it alerts about bubbles but if the IV is hung to gravity it doesn't alert about bubbles and I've always wondered. Sometimes I want to ask the nurses but I don't want then to think that I am questioning their practice or correcting them.

nurseprnRN, BSN, RN · Feb 28, 2012

any bubble causes an air embolus. (terminology is important.) but it takes a really big one to be dangerous.

if the iv is hung to gravity, what happens when the bag is dry and the fluid runs down the tubing? is there any pressure in the vein? is it a vacuum so it would keep sucking air into the vein? try a thought experiment to figure it out. let us know, and we'll tell you if you're right.

Nsg student2012 · Feb 28, 2012

Well according to what I've researched since I don't have much clinical experience is that if the IV is hung to gravity once all of the fluid had infused the bag collapses and air does not enter the vein because the pressure in the vein is higher than in the IV. It is like putting a straw in a glass of water. I am correct? lol

nurseprnRN, BSN, RN · Feb 29, 2012

Perfect. Those of us old folks who somehow managed to give a lot of IVs without pumps remember that when the IV ran dry, there would be several cm of fluid in the tubing above the insertion point. Exception: direct line into the thoracic cavity ( like subclavian or IJ), in which case the negative pressure in the chest developed in spontaneous (but not ventilated) respiration could make for air being sucked into the chest via trachea, open chest wound, or IV. (where's all the colors and fonts today?)

BelgianRN · Mar 7, 2012

GrnTea said:
Perfect. Those of us old folks who somehow managed to give a lot of IVs without pumps remember that when the IV ran dry, there would be several cm of fluid in the tubing above the insertion point. Exception: direct line into the thoracic cavity ( like subclavian or IJ), in which case the negative pressure in the chest developed in spontaneous (but not ventilated) respiration could make for air being sucked into the chest via trachea, open chest wound, or IV. (where's all the colors and fonts today?)

And then you have these nice colleagues that open the air hole to the IV tubing. Never got why people would do that on bags but then I like pretty vacuum bags over air filled ones ^^.

We had a period where we had many massive air emboli and we went running to the hyperbaric chamber every week at least twice.

We referred to them as "sink incidents". It turned out that a ward let patients with huge diameter introductors in situ roam freely as opposed to removing them once they left the step down unit. Patients with introductors in their IJ or subclavian were ambulated and set at a sink to wash themselves. And they figured they could stand up, disconnect the tubing as the nurses do and reconnect. Most of them failed to reconnect in that period .