Question in the ER/IV

AnnieOaklyRN, BSN, RN, EMT-P · Apr 7, 2016

You should always fill the drip chamber before priming the tubing, otherwise yes you will get air in the line. This isn't a huge issue if you are talking about a gravity hung IV going through a peripheral IV. However if it involves a pump, you will have to listen to a lot of beeping if there is to much air in the line. Also you want to avoid any significant air in the line going through a central line.

Some air going through the IV line isn't going to harm the patient. When I was an EMT about to transport a labor and delivery patient down to a tertiary care facility with a nurse, I watched the nurse prime the whole line of air INTO the patient. Nothing happened. Remember you have gasses regularly diffusing into the your blood in your pulmonary circuit, so it can be absorbed. It would take a lot to do serious harm.

But never be complacent, always do you best to the get the air out; however don't panic if only a small amount is in the line.

Respiked bag fatal for child: coroner | Mackay Daily Mercury

Annie

amoLucia · Apr 7, 2016

IV trick - learn to always always always FIRST clamp off new tubing when you open the delivery set (even as you're detangling the long tubing). And move the clamp up toward the spike. So while your hand is up there spiking the bag, you can then just 'move on down ' to the drip chamber & squeeze to start priming.

It'll become second nature after a while.

cc2016 · Apr 7, 2016

To clarify, it was a gravity hung bag. I spiked the bag and let the fluid run through the line before I let the line get attached to his AC line. =)

akulahawkRN, ADN, RN, EMT-P · Apr 7, 2016

As others have said, a few small bubbles will not hurt the patient. While I now do a couple things a little differently than I used to, one of the things I still often do is clamp a new IV line before priming it. I do it while I'm detangling the new line right out of the package. This way no fluid will move when I spike the bag. Something else I do out of habit is pinch the tubing basically at the base of the drip chamber by bringing the tubing up alongside the chamber tightly and I keep that pinched until the bag is spiked and the drip chamber has filled to the appropriate level. No fluid gets past that pinch point. By doing this, even if I have accidentally left the roller clamp open, the line will flood normally and all I must do is remember to find the end of the line and clamp it off before too much of a mess is made.

If you're using a pump, the hardest thing to do is to ensure that no bubbles are in the line above the pump. Since you typically have a Y site above the pump, you have to evacuate air from that site. The way I do it is after spiking the bag and filling the drip chamber, I grasp the line right near the Y site, put a little traction on it to eliminate any bends and invert the line so that the port of the Y site is facing the floor. I then slowly open the roller clamp and allow the fluid to flow slowly. The slow rate (at first) allows fluid to slowly enter the Y site and displace any air from it, fill it, and then continue along the line. Once that first Y site is flooded successfully, I then will open the clamp to wide open and flood the rest of the line normally. No bubbles will be present above the pump and therefore no "air in line" messages will happen. I flood the line the same way for gravity drips simply because I want to stick with one priming method. That and it's always possible that I could end up putting that line on a pump anyway...

amoLucia · Apr 8, 2016

To akulahawk - you and I think alike.

One other trick for those little itty bitty line bubbles - pull the tubing straight & taut and finger snap/flick the tubing so the little bubbles will rise up to the drip chamber.