Qs! bubbles, IVs etc

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Questions from today's shift:

(1) What do you do if you have attached a syringe to a Y-site port to admin a IV push med and you begin to push and you notice an air bubble flowing from the port?? This happened to me when I went to give Gravol I chose to use the second IV port on the tubing and 2 bubbles came out..were they hiding in the port when it had been primed?? I continued to infuse the med because I had already begun and secondly I wouldn't have known what to do anyways (plus one nurse told me the only way to seriously harm a pt with air is if it was close to a full tubes length of air). ANYWAYS for the future if a bubble shows up in the tubing how can I get rid of the darn thing?

(2) If you have to admin 2 IV push meds and they are incompatible with eachother, however both compatible with the existing running infusion sltn, do you need to flush with 10 ml b/w meds?? Or does it depend on the rate the infusion is going at? if it was going at a good clip it would just flush for itself right?

(3) What is the rationale for being able to give IM meds together in the same syringe however when meds are given IV push they must be given seperately. I understand that we don't give IV push meds in the same syringe because the med takes affect almost instantly and if a reaction were to occur we would need to know how much med was administered and which med caused the reation. BUT couldn't that be a problem with IM?? --the med is absorbed slower but if a reaction were to occur how would be know which med caused it?? (I think I confused myself with this one...sort of feels like I'm just overthinking it but if there is a sensible answer I would love to know!)

(4) I went to give an IV push med today and I automatically kinked the tubing above the port before attaching the syringe. The RN with me told me "no you don't kink it, the med is gonna flow the right direction anyways". So I just attached it and infused it over the correct amount of time and removed it (NO kinking, no clamping, NOTHING!)...so I looked up the policy on this and it says to pinch off IV tubing above the port to be used, or clamp off tubing in the roller clamp while injecting the med. -- IM CONFUSED don't you want the med to be diluted as you are administering it by leaving the infusion running? isnt that the point!

(5) How can you prevent blood backflow into tubing when removing IV med syringe?? I removed a syringe today from a tubing port and blood backed up quite a bit and than went down as the sltn ran thru. Is that just what happens or is there something that can prevent it? The pt told me it usually backs up a little bit for a second but she said it had never backed up as much as when I did it.

Thanks a bunch ppL!:D

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Specializes in being a Credible Source.
questions from today's shift:

(1) what do you do if you have attached a syringe to a y-site port to admin a iv push med and you begin to push and you notice an air bubble flowing from the port?? this happened to me when i went to give gravol i chose to use the second iv port on the tubing and 2 bubbles came out..were they hiding in the port when it had been primed?? i continued to infuse the med because i had already begun and secondly i wouldn't have known what to do anyways (plus one nurse told me the only way to seriously harm a pt with air is if it was close to a full tubes length of air). anyways for the future if a bubble shows up in the tubing how can i get rid of the darn thing?

as you were told, a few bubbles don't hurt anything. however, if you really want to clear it, you can draw back on a syringe on the port, disconnect your syringe and purge the bubble, and then push the remaining fluid back in.

it's a waste of time, though.

(2) if you have to admin 2 iv push meds and they are incompatible with eachother, however both compatible with the existing running infusion sltn, do you need to flush with 10 ml b/w meds?? or does it depend on the rate the infusion is going at? if it was going at a good clip it would just flush for itself right?

it's quicker and safer to just flush it. if the infusion is flowing fast enough and/or you wait long enough then it will flush itself, though. i suppose you could still have a small bit of medication left up inside the needless port, though, even if the fluids are running, and that could cause a problem if you followed with an incompatible drug.

it's just safer to flush.

(3) what is the rationale for being able to give im meds together in the same syringe however when meds are given iv push they must be given seperately. i understand that we don't give iv push meds in the same syringe because the med takes affect almost instantly and if a reaction were to occur we would need to know how much med was administered and which med caused the reation. but couldn't that be a problem with im?? --the med is absorbed slower but if a reaction were to occur how would be know which med caused it?? (i think i confused myself with this one...sort of feels like i'm just overthinking it but if there is a sensible answer i would love to know!) i don't know.

(4) i went to give an iv push med today and i automatically kinked the tubing above the port before attaching the syringe. the rn with me told me "no you don't kink it, the med is gonna flow the right direction anyways". so i just attached it and infused it over the correct amount of time and removed it (no kinking, no clamping, nothing!)...so i looked up the policy on this and it says to pinch off iv tubing above the port to be used, or clamp off tubing in the roller clamp while injecting the med. -- im confused don't you want the med to be diluted as you are administering it by leaving the infusion running? isnt that the point!

you don't need to kink it upstream since you have either the hydraulic pressure from the hanging bag or the force of the pump upstream and no resistance at all downstream. if you're not sure, try kinking it downstream and see what happens (i just did this inadvertently).

not all meds need to be piggybacked, some can just be pushed (though i usually dilute things in a saline flush).

(5) how can you prevent blood backflow into tubing when removing iv med syringe?? i removed a syringe today from a tubing port and blood backed up quite a bit and than went down as the sltn ran thru. is that just what happens or is there something that can prevent it? the pt told me it usually backs up a little bit for a second but she said it had never backed up as much as when i did it.

just clamp the extension before disconnecting the syringe. if you disconnect while you still have some fluid in your syringe and are maintaining pressure on the plunger as you disconnect it, you generally won't get backflow of blood.

it's best to just clamp it while you're flushing, though. that way you know that you're not getting any blood up in the catheter.

thanks a bunch ppl!:D

my thoughts...

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questions from today's shift:

(1) what do you do if you have attached a syringe to a y-site port to admin a iv push med and you begin to push and you notice an air bubble flowing from the port?? this happened to me when i went to give gravol i chose to use the second iv port on the tubing and 2 bubbles came out..were they hiding in the port when it had been primed?? i continued to infuse the med because i had already begun and secondly i wouldn't have known what to do anyways (plus one nurse told me the only way to seriously harm a pt with air is if it was close to a full tubes length of air). anyways for the future if a bubble shows up in the tubing how can i get rid of the darn thing?

aspirate first to get rid of the bubble. just for your fyi a small amount of bubbles will not hurt the pt. the patients lungs can process about 20ml/minute of air without a problem. your pt may be able to feel a rapid infusion of 10ml of air but typically it takes up to 100ml of a rapid infusion to cause bad things.

(2) if you have to admin 2 iv push meds and they are incompatible with eachother, however both compatible with the existing running infusion sltn, do you need to flush with 10 ml b/w meds?? or does it depend on the rate the infusion is going at? if it was going at a good clip it would just flush for itself right?

as habit always flush before, between and after no matter the medication. as a rule i generally do not administer push meds into an already infusing line unless indicated otherwise. there is a question of how much med was infused how fast and how thoroughly that iv line was flushed. infusion pumps do not "flush" well. just administer something with color and you will see what i mean.

(3) what is the rationale for being able to give im meds together in the same syringe however when meds are given iv push they must be given separately. i understand that we don't give iv push meds in the same syringe because the med takes affect almost instantly and if a reaction were to occur we would need to know how much med was administered and which med caused the reation. but couldn't that be a problem with im?? --the med is absorbed slower but if a reaction were to occur how would be know which med caused it?? (i think i confused myself with this one...sort of feels like i'm just overthinking it but if there is a sensible answer i would love to know!)

the rationale is a poor one. the theory behind mixing im injections is that it is so painful they only want to poke once instead of multiple times. this negates the ability to monitor what you previously stated. i do not personally mix meds, if im needs to be given then i have lidocain ordered and attempt to get the route changed if possible.

not to mention the reasons you stated before but as a general practice it is not wise to mix meds in pushes. #1 it is not necessary, the only rationale is to be a time saver. #2 creates a dangerous habit.

besides if you are administering an iv push with 2 meds mixed and that iv become comprimised half way through now you just half administered 2 meds instead of 1.

another thing to consider is if the meds are vesicants, even if they are compatible have you checked the ph levels and osmalarity? seperate those meds may not be vesicants, together they may be.

(4) i went to give an iv push med today and i automatically kinked the tubing above the port before attaching the syringe. the rn with me told me "no you don't kink it, the med is gonna flow the right direction anyways". so i just attached it and infused it over the correct amount of time and removed it (no kinking, no clamping, nothing!)...so i looked up the policy on this and it says to pinch off iv tubing above the port to be used, or clamp off tubing in the roller clamp while injecting the med. -- im confused don't you want the med to be diluted as you are administering it by leaving the infusion running? isnt that the point!

good practice to clamp.

(5) how can you prevent blood backflow into tubing when removing iv med syringe?? i removed a syringe today from a tubing port and blood backed up quite a bit and than went down as the sltn ran thru. is that just what happens or is there something that can prevent it? the pt told me it usually backs up a little bit for a second but she said it had never backed up as much as when i did it.

the advantage of postitive or neutral pressure connectors. clamp the extension as previously stated and watch that plunger while your removing the syringe carefully and slowly.

thanks a bunch ppl!:D

asystole rn, infusion therapy

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Specializes in Gerontological, cardiac, med-surg, peds.

Awesome post, Asystole RN!

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Specializes in being a Credible Source.
It's good practice to clamp.
You clearly know your stuff.

Could you elaborate on this point? My initial thought was that it wouldn't matter since the push will follow the path of least resistance. What am I missing?

Thanks.

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You clearly know your stuff.

Could you elaborate on this point? My initial thought was that it wouldn't matter since the push will follow the path of least resistance. What am I missing?

Thanks.

An infusion does not necessarily mean pump with safety lock and one way valve.

There are Dial-A-Flows that require gravity pressure and simple straight drips, monitoring flow by counting drips.

Most tubing has a loop in it, where the excess tubing hangs off the bed before meeting the patient, heavier solutes in the medication tend to settle in these loops and again, a constant infusion is a very poor "flush". For example, watch how blood cells settle in the loop when the tubing gets backflow into it. If you ever infuse or push something with color you will see how it will tend to settle in these loops.

Depending upon the type of catheter, CVC or PIV, the locations, patency, gauge and patient position will all effect which has the least pressure, the bag or the patient.

For example, hang a straight bag of saline without a one way valve (most hospital tubing does not have a one way valve) into a 22g in the hand with it dangling off to the side. Push 10ml of saline into the unclamped tubing and watch the drip chamber...you will see that 10ml of saline just pushed upstream.

These basic principles do not take into account specific situations, they are rather general safe practice principles designed to be habits of safe practice.

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Thank you both for your replies!!

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Specializes in ER, progressive care.
questions from today's shift:

(1) what do you do if you have attached a syringe to a y-site port to admin a iv push med and you begin to push and you notice an air bubble flowing from the port?? this happened to me when i went to give gravol i chose to use the second iv port on the tubing and 2 bubbles came out..were they hiding in the port when it had been primed?? i continued to infuse the med because i had already begun and secondly i wouldn't have known what to do anyways (plus one nurse told me the only way to seriously harm a pt with air is if it was close to a full tubes length of air). anyways for the future if a bubble shows up in the tubing how can i get rid of the darn thing?

as you know, a few little air bubbles isn't going to harm the patient. otherwise, just aspirate the air.

(2) if you have to admin 2 iv push meds and they are incompatible with eachother, however both compatible with the existing running infusion sltn, do you need to flush with 10 ml b/w meds?? or does it depend on the rate the infusion is going at? if it was going at a good clip it would just flush for itself right?

first check to see what solution is hanging and check if it is compatible with what you're going to give. if the solution is compatible, you can go ahead and push the first med. i would then flush with ns (unless you have something like ns already running) then push the second med. if the iv solution that is hanging is not compatible with the drugs you are pushing, you need to stop the iv, flush with ns, push the 1st med, flush again, push the 2nd med, and then flush once more before restarting the iv.

(3) what is the rationale for being able to give im meds together in the same syringe however when meds are given iv push they must be given seperately. i understand that we don't give iv push meds in the same syringe because the med takes affect almost instantly and if a reaction were to occur we would need to know how much med was administered and which med caused the reation. but couldn't that be a problem with im?? --the med is absorbed slower but if a reaction were to occur how would be know which med caused it?? (i think i confused myself with this one...sort of feels like i'm just overthinking it but if there is a sensible answer i would love to know!)

not sure about this one. all i can think of is that it would be too painful to stick the patient twice, which is why you would mix meds in the same syringe. you need to check drug compatibilities, tho.

(4) i went to give an iv push med today and i automatically kinked the tubing above the port before attaching the syringe. the rn with me told me "no you don't kink it, the med is gonna flow the right direction anyways". so i just attached it and infused it over the correct amount of time and removed it (no kinking, no clamping, nothing!)...so i looked up the policy on this and it says to pinch off iv tubing above the port to be used, or clamp off tubing in the roller clamp while injecting the med. -- im confused don't you want the med to be diluted as you are administering it by leaving the infusion running? isnt that the point!

clamp, i guess? kinking the tubing doesn't seem like a sure-fire way, imo.

(5) how can you prevent blood backflow into tubing when removing iv med syringe?? i removed a syringe today from a tubing port and blood backed up quite a bit and than went down as the sltn ran thru. is that just what happens or is there something that can prevent it? the pt told me it usually backs up a little bit for a second but she said it had never backed up as much as when i did it.

not sure about this one, but i see there are some answers :)

thanks a bunch ppl!:D

hope this helps!

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Ok you nursing students God love ya. Please, please I don't ever want to hear I went ahead and did it anyway because I already started. Is that a good rationale to kill your patient. Bubbles bubbles bubbles. Of course you should always make sure pushing a med that its compatible with the fluid. You better know that if your giving it.Well if you start to push it's not too late to pull back and push some saline and disconnect the port further down and let it drain. When in doubt ask. There are a hundred little secrets nurses use. AND no a couple little bubbles won't hurt but why risk it with a patient already with multiple diagnosis. smile keep going and head up.

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Specializes in IMCU.

Nice questions excellent answers. Thanks.

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