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Discussion

Saline Flushes

Recently I saw a 9 month old patient with a Broviac central line. As I was about to flush the catheter with a prefilled 10cc syringe of NS, the mom asked me to remove that little bit of air from the syringe. I have never done this before; but it got me to wondering if I should be? I usually just attach the syringe and push. I figure the amount of air is so small, but again, this was a pediatric patient. Any suggestions on how I should be doing this?

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    I find that those syringes are so hard to use without first pulling back to break the seal. Then I push all that air out before using it. What's in there probably won't do anything to an adult, but I don't work with the pedi population, so I don't know about that.

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    I pull back and push out air even with the adults bc thats what our policy is. With peds IDK but with adults really doubt itd hurt anyone.

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    Risk of venous air embolism increases with proximity to the heart, which also means that the amount of air needed to cause harm is reduced. Most likely an air bubble that size would be trapped and diffused in the pulmonary circulation, but if the person has a heart defect such as a PFO or ASD, then the risk of the air getting into the arterial system is increased. It only takes a small amount of air to occlude the coronary circulation or the cerebral circulation. Because of this, I would be a lot more cautious with a central line than I would with a peripheral, and go ahead and purge that air bubble.

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