"Bleed" an IV line

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Quick question.

the other day day I was hooking up an insulin drip to a patient and a nurse asked me "Did you bleed the line already?" I assumed she meant did I prime the line already so it was free of air.

As I thought about it later I wondered if she was asking something else? What say you?

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That would be my guess.

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Nope.

IV lines absorb a certain amount of insulin.

Many hospitals have a policy regarding running a certain amount of insulin through the iine prior to administering it so that the patient gets a full dose.

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That's a really old timer way of saying 'prime'.

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Nope.

IV lines absorb a certain amount of insulin.

Many hospitals have a policy regarding running a certain amount of insulin through the iine prior to administering it so that the patient gets a full dose.

Our insulin comes in 100 cc bags. Between the tubing volume and some waste volume, we'd need another bag before long.

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Specializes in Emergency Department, ICU.
Our insulin comes in 100 cc bags. Between the tubing volume and some waste volume, we'd need another bag before long.

Most places use the 100 mL bags; to the point where there have been studies published about how much priming is needed before it becomes wasteful....

"Waste not, want not": determining the optimal priming volume for intravenous insulin infusions. - PubMed - NCBI

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So I read that study but am still unclear on what I would do differently. I will look into policy. But policy aside, for theoretical purpose: I put 100 units regular insulin into 100 cc bag. I prime it so that the insulin reaches the end of the line and is now pouring out. If I prime out another 20+ cc into the waste bin, then I waste and lose 20 units of insulin, now leaving my bag 80 units of insulin. However, the ratio of 1 unit of insulin to 1cc of NS remains the same. I understand the tubing may absorb some of my insulin, but what now?

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Specializes in Emergency Department, ICU.
So I read that study but am still unclear on what I would do differently. I will look into policy. But policy aside, for theoretical purpose: I put 100 units regular insulin into 100 cc bag. I prime it so that the insulin reaches the end of the line and is now pouring out. If I prime out another 20+ cc into the waste bin, then I waste and lose 20 units of insulin, now leaving my bag 80 units of insulin. However, the ratio of 1 unit of insulin to 1cc of NS remains the same. I understand the tubing may absorb some of my insulin, but what now?

I mean you'd have to check the unit policy to see how your unit wants it done. Most places you just set the pump accordingly based on having 80 units of insulin in 80 mls.... This topic has been discussed before here on AN if you want to search and read :) It sounds like some units also use low sorb tubing for their insulin drips.

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So I read that study but am still unclear on what I would do differently. I will look into policy. But policy aside, for theoretical purpose: I put 100 units regular insulin into 100 cc bag. I prime it so that the insulin reaches the end of the line and is now pouring out. If I prime out another 20+ cc into the waste bin, then I waste and lose 20 units of insulin, now leaving my bag 80 units of insulin. However, the ratio of 1 unit of insulin to 1cc of NS remains the same. I understand the tubing may absorb some of my insulin, but what now?

Now give the insulin as ordered.

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Thanks all. I didn't even know there was a policy for draining a portion of the insulin bag. But I searched and found we do. It's 50cc. Seems silly to me to fill 100 units of insulin in a 100 bag and then waste half the entire bag. But if that's what evidence shows is best practice then that's what I'll do.

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Specializes in Med-Tele; ED; ICU.

To me, bleeding the IV line is the same as bleeding my brake lines... get rid of the air.

There doesn't seem like much point to "priming" the line with some amount of insulin to account for absorption since you're checking q30m or q1h sugars and titrating anyway.

I'm on my 4th hospital and none of them (small, medium, and large) have required anything like that.

I'll stick with 'bleed the air'

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is it just me, or is the tubing absorbing some insulin not really affecting the patient at that time. if the tubing does absorb some insulin, the patient will still get checked every hour, and adjustments made. at the end of the day, does it hurt the patient in any way?

let the ICU nurses figure that one out

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