Student Nurse - Clinical skills questions - IV's

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Hello, I am a nursing student and hoping someone could clear a few things up for me.

First, I am terrified of causing an air embolism via IV line - I know to prime tubing to get air bubbles out - but when it is time to flush a line the pre-filled syringes always have an air bubble in it - if I push the bubble through won't that cause an air embolism too? If I don't push it through then the patient will not receive the 3cc's there supposed too.

Secondly, they say IV tubing at my clinical facility is good 24 hours - but let's say the patient has IV piggyback I am ready to hang the second dose - the tubing has not yet expired but won't re-spiking the bag with the same spike introduce bacteria? Should I be getting all new secondary tubing each time?

Lastly, I am getting confused on setting the IV pumps. Let's say my patient is getting piggyback antibiotic 50 ml/hr and the total bag to infuse is 100 ml. I understand how to set the piggyback - but I know they told us to run NS after the secondary dose is finished to make sure they have received all the medication - at what rate and what amount to infuse am I setting the primary bag?

Thanks for reading - all help would be appreciated!!! :clown:

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A tiny air bubble will dissipate almost immediately. Even an entire line of air wouldn't kill a patient. I promise a few bubbles in a peripheral line is okay!

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Specializes in Emergency Department.

Even if the air bubble doesn't dissipate immediately, it likely will by the time it hits that great filter known as the lungs. It really does take a lot of air to even cause harm to a patient, let alone kill one. That being said, do your best to minimize air intrusion into the line.

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Specializes in Critical Care, Trauma, Transplant.

As far as the air emboli, no worries on a little air. Even a few mL's of air will not harm patients. There is actually a cardiac study called a bubble study in which you inject saline with bubbles in it to see how the heart is functioning...

For spiking a new bag of fluids, just try not to contaminate the spike by touching it. Odds are you wont introduce any bacteria that will cause a problem (Im an ICU nurse, we spike multiple ABX using the same tubing.)

For the secondary/primary question, if I understand this right, your secondary is running at 50mL/hr, and your primary will run afterwards at 100/mL? Practice in my unit is to set a little extra on the volume to be infused for the antibiotic (say you have 50 mL of antibiotic, set it to infuse 60 mL to ensure they get all of the drug) After the antibiotic is infused, your pump running at 100 mL/hr is plenty to flush in the drug.

Hope that helps!

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Specializes in ER/ICU/STICU.
Hello, I am a nursing student and hoping someone could clear a few things up for me.

First, I am terrified of causing an air embolism via IV line - I know to prime tubing to get air bubbles out - but when it is time to flush a line the pre-filled syringes always have an air bubble in it - if I push the bubble through won't that cause an air embolism too? If I don't push it through then the patient will not receive the 3cc's there supposed too.

Secondly, they say IV tubing at my clinical facility is good 24 hours - but let's say the patient has IV piggyback I am ready to hang the second dose - the tubing has not yet expired but won't re-spiking the bag with the same spike introduce bacteria? Should I be getting all new secondary tubing each time?

Lastly, I am getting confused on setting the IV pumps. Let's say my patient is getting piggyback antibiotic 50 ml/hr and the total bag to infuse is 100 ml. I understand how to set the piggyback - but I know they told us to run NS after the secondary dose is finished to make sure they have received all the medication - at what rate and what amount to infuse am I setting the primary bag?

Thanks for reading - all help would be appreciated!!! :clown:

1.Don't sweat the air embolism in a peripheral IV. To actually cause one you need a lot of air and not just a few bubbles. Push the air out of the flush and then flush the IV.

2.Re-spiking the bag will not introduce bacteria unless you touch it. Changing bags and re-spiking is sterile. By that I don't mean you have to put on sterile gloves, but you prep your new bag pull out the spike from the old one and immediately spike the new bag without having the spike touch anything.

3. If you're running something piggyback than it is going into a main fluid that is already running. If this is the case you don't need to flush the line because the primary fluid will flush the rest of the meds in.

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A tiny air bubble will dissipate almost immediately. Even an entire line of air wouldn't kill a patient. I promise a few bubbles in a peripheral line is okay!

I wouldn't put a whole lot of faith into the bold statement...

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Specializes in Emergency/Cath Lab.

1. Hold the syringe upside down and get rid of the air with flushes. Problem solved.

2. 24 hours really? we do 72 hours. And no as long as you dont touch the spike, lay it down anywhere etc etc it should be fine.

3. I always run my carrier fluid at 100ml/hr for 20 ml total dose to flush the meds out of the line.

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I've never seen a prefilled syringe with 3cc of air in it. The bubble is maybe 1/2 a cc, and won't kill a patient. I usually push the air out, otherwise when you turn the syringe over, the air goes to the back and I just don't push it in.

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