Nursing Student- Unclear Answers

[msygrnbw]

I am a second semester nursing student at an accredited university, but there are many questions that I have asked in clinical and classes that I have gotten unclear/conflicting answers to.

I realize that this may be second nature for some of you, but I want to make sure I learn it the right way. I realize that the luer-lock saline flushes are pressurized (We are just at the very beginning of med passing) and I have had two teachers and two nurses give me conflicting views on the pressurized saline syringes. We have just learned about PICC and CVC lines and I want to start off on the right foot.

One professor told me that it is specifically designed for PICC and CVC lines and that I did not need to depressurize/get rid of the air bubble. I felt very uncomfortable with this as my lab teacher told me to absolutely get rid of the air, so each time I have made sure to get rid of the air bubble. Both nurses I have flushed lines with have said to get rid of the air bubble and depressurize. I cannot find a specific answer in either my fundamentals or medsurg book and I just want to make sure that I am serving the patient right. I realize that this is a bit of a rudimentary question, but I do not want to feel unclear on it. I have had trouble finding an exact answer on my own, and I was hoping you could help me understand the science behind the pressurized saline flushes. I would really appreciate it, so that next time I can go into my clinical confident that I am doing the correct thing even if my professors views seem to conflict.

All except one line (A peripheral line) I have flushed have been patent with no signs of infiltration or phlebitis. They were all patent with only one without blood return.

Also, If there are any experienced nurses on here who would not mind a nursing student who has many questions (I read a lot, but talking and asking questions really helps me - I am a kinetic learner for sure - while my clinical instructor helps some, there is limited time and access to our teachers) just clarify items and procedures, I would appreciate it to a degree I cannot even explain. I know it is a lot to ask, but I am learning and I want to make sure I am understanding both the daily thought process, activities, and prioritization of experienced nurses.

Thanks!

[msygrnbw]

I apologize. I did not realize there was a student nursing forum. Sorry! I do not not know how to edit/delete my post, but I will head over there instead. =)

[Esme12, ASN, BSN, RN]

Well....you are having trouble finding information because the jury is still out on this one. Technically speaking the teeny tiny little bubble in the med "cassette" will not cause any harm. Many believe that due to the dives themselves and the luer lock caps that the "air bubble" will never reach the patient and to purge it, and therefore wasting a minuscule amount of med, and therefore is unnecessary. Even if that tiny little bleb of air entered the system is will not cause any harm.

Purging the air bubble doesn't cause any harm, unless of course you use the strength of a gorilla and waste a ton of med thereby decrease the theraputic dose, so the indirect answer is to do what your instructor tells you to do while in school because both of them is right.

Feel free to post any questions here there are several of us to really enjoy answering student questions and have the time to do it. Or you can PM me or any of us for that matter. I believe that if you don't have a paid membership you may need to wait until you have x amount of posts before you can PM....I think. When you post, those of use who are regularly answer check at least once everyday usually twice and give your pants about 24 hours or so to be answered, we'll find them eventually....so just post in the student section it is easier to find. Also, use the search feature you'll find amazing information on old posts as well on questions we have answered in the past. But remember......this is a public forum so be cautious....you can tell regular contributors by clicking on the stars by our names or our names and you can see how many post and likes we get.

Welcome!!!!!:hug:

[nurse2033, MSN, RN]

Small air bubbles will not hurt the patient. Someday you might witness a bubble echocardiagram, which blew my mind the first time I saw it. You agitate 10ml of water with 10ml of air through a special connector, then push it fast to visualize the bubbles as they pass through the heart. This causes no harm. So if 10ml of air is tolerated with no problem, that little bubble in the luer lock is nothing.

[Good Morning, Gil]

Tiny air bubbles will not hurt a patient, but you're probably talking about that little air bubble at the end of the syringe. Yes, you should expel the air, and use positive pressure flushing when flushing a PICC or CVC (positive pressure: push/stop/push/stop)....you don't want to insert air into any line, but especially a central line. Not worth the risk of air embolism for your patient. The jury's out on exactly how much air will cause an air embolism, but most sources say it's something like 5 ml of air? Not sure on the exact amount, but from what I've heard experienced nurses say, it's a bunch. Still...every patient is unique, so you just expel the air. And, always prime your lines (and prime them well, b/c even those tiny air bubbles will make your pump beep every other minute lol, so it's a time saver technique, too, to do it right the first time).

I love teaching other nurses. However, I am not experienced, experienced (been a nurse for 1.5 years), so I do not know everything, but I have encountered a lot thus far (and the things I don't know, I'll just tell you lol). Always learning, though. If you have any questions, feel free to message me. Don't know what your area of interest is, but I am now working in the ICU (and this will be my home now, love it :)), so if you have any questions about starting as a newer nurse there, I may have some tips.

And, no, you don't have to work in m/s prior to working in ICU. It just depends on your comfort level, and your motivation. It's really a personal decision; if you feel comfortable starting there, then do it. (make sure it's a good orientation) Otherwise, get experience first. You really have to study at first and be self-motivated to be successful in the ICU as a new nurse. And, seek new opportunities on the unit, like "hey guys, if you have anyone that needs an IV, let me start it. Or, if you're setting up an a-line on your pt tonight, let me do it." etc