Jump to content

What to do when the IV bag runs dry?

Posted

New grad RN here. Well, we hang our bags to gravity and the other day I got busy and I guess bag was dripping faster than I had planned because when I went back the bag was bone dry. Before I always worked with IV pumps that beeped loudly and went to KVO till you had a chance to get back in the room.

Does this really hurt the pt: ie is there a bunch of air in the vein now - enough to hurt pt? What is the safest, most comfortable way to fix this?

I ended up using a 10cc syringe to try to pull back and get any air out plus check for a blood return, then I flushed the line to ensure patency and clamped it. Then I hung the new bag, re-primed the line, rehooked, unclamped, flushed again then restarted the drip and that seemed to work fine.

Melissa

Even though the bag ran dry, the tubing does not. If you look closely, you will see that a small amount of fluid remains in the tubing, thus, no air gets into the patient. Just make sure that you re-prime the tubing before connecting a new bag using the same tubing.

Oh good thanks, I was afraid this was a stupid question but as a new grad I am always terrified I am going to do something wrong and hurt the pt.

Thanks!

Melissa

NewEastCoastRN said:
Even though the bag ran dry, the tubing does not. If you look closely, you will see that a small amount of fluid remains in the tubing, thus, no air gets into the patient. Just make sure that you re-prime the tubing before connecting a new bag using the same tubing.

Daytonite, BSN, RN

Specializes in med/surg, telemetry, IV therapy, mgmt. Has 40 years experience.

Did I understand correctly? You had air in the IV tubing all the way to the needle hub? That doesn't always happen because the back pressure of the blood in the patient's vein will reach an equal pressure with the air so things are just stalled and blood usually backs up into the IV tubing.

The fastest way to get air out of an IV line is to:

(1) Hang your new IV bag and fill the drip chamber with IV fluid

(2) clamp the IV tubing with a pair of hemostats close to the hub of the cannula.

(3) Open the flow clamp of the IV tubing.

(4) take a plain old needle or remove one from a syringe and insert it into a Y-port of the IV tubing below the air. Atmospheric pressure will automatically pull the air out through the end of the needle along with the new IV fluid. Have a towel ready to catch any IV fluid because it comes down and shoots out through that open access needle very fast.

(5) To try to save your IV site you did the correct thing. With a 10cc syringe or larger gently attempt to get a flush of blood back into the tubing. If that fails I would try to very, very gently attempt to flush the IV line with some saline. If you feel any kind of pressure do not continue to push because you will push any blood clot from the cannula into the vein. Your IV is lost and will need to be restarted. However, if you are able to flush the line I would use a 20 or 30cc syringe of saline and give the line a nice, slow continuous flush to clear it and make it patent.

In the days before we were allowed to put all IVs on pumps or drop counters we all used to carry a few needles in our pockets for these occurrences. Also, when you are running IVs by gravity you really need to check them--at least once an hour. With gravity drips I always found that no matter how accurately I first set the drip rate I always found it running faster when I went back to check it. I don't know why that happened. Maybe there's an IV fairy out there causing this havoc, but after having a couple of IV's running faster than they should have I learned to re-check my IV's 10 or 15 minutes after I reset their rate to make sure they were still dripping at the right rate. Most of the time they needed to be slowed down a bit. We also used to mark the IV bottles and bags by hour so we knew what level of fluid the IV needed to be at by a certain time. To this day I don't know why this happened. Today we are lucky to have the pumps.

The vein can tolerate a small amount of air, but don't let the patient know that. Most of them have seen a movie or TV program where a killer injected air into a victims IV and he died a most horrible death. I had a dobutamine stress test recently and if I'm not mistaken they shot 1cc of air through my vein so it intentionally would lodge in my right atrium and they could see the cardiac structures more clearly on the echo. I suffered no ill effects and am still alive. :o

This was GREAT info! When I looked, the tubing appeared to be dry all the way down but I may have missed seeing it toward the end of the line. I have noticed the IV fairy too and also sometimes IVs are positional too. Thanks 🙂

Melissa

Daytonite said:
Did I understand correctly? You had air in the IV tubing all the way to the needle hub? That doesn't always happen because the back pressure of the blood in the patient's vein will reach an equal pressure with the air so things are just stalled and blood usually backs up into the IV tubing.

The fastest way to get air out of an IV line is to:

(1) Hang your new IV bag and fill the drip chamber with IV fluid

(2) clamp the IV tubing with a pair of hemostats close to the hub of the cannula.

(3) Open the flow clamp of the IV tubing.

(4) take a plain old needle or remove one from a syringe and insert it into a Y-port of the IV tubing below the air. Atmospheric pressure will automatically pull the air out through the end of the needle along with the new IV fluid. Have a towel ready to catch any IV fluid because it comes down and shoots out through that open access needle very fast.

(5) To try to save your IV site you did the correct thing. With a 10cc syringe or larger gently attempt to get a flush of blood back into the tubing. If that fails I would try to very, very gently attempt to flush the IV line with some saline. If you feel any kind of pressure do not continue to push because you will push any blood clot from the cannula into the vein. Your IV is lost and will need to be restarted. However, if you are able to flush the line I would use a 20 or 30cc syringe of saline and give the line a nice, slow continuous flush to clear it and make it patent.

In the days before we were allowed to put all IVs on pumps or drop counters we all used to carry a few needles in our pockets for these occurrences. Also, when you are running IVs by gravity you really need to check them--at least once an hour. With gravity drips I always found that no matter how accurately I first set the drip rate I always found it running faster when I went back to check it. I don't know why that happened. Maybe there's an IV fairy out there causing this havoc, but after having a couple of IV's running faster than they should have I learned to re-check my IV's 10 or 15 minutes after I reset their rate to make sure they were still dripping at the right rate. Most of the time they needed to be slowed down a bit. We also used to mark the IV bottles and bags by hour so we knew what level of fluid the IV needed to be at by a certain time. To this day I don't know why this happened. Today we are lucky to have the pumps.

The vein can tolerate a small amount of air, but don't let the patient know that. Most of them have seen a movie or TV program where a killer injected air into a victims IV and he died a most horrible death. I had a dobutamine stress test recently and if I'm not mistaken they shot 1cc of air through my vein so it intentionally would lodge in my right atrium and they could see the cardiac structures more clearly on the echo. I suffered no ill effects and am still alive. :o

As a patient several years ago I had an IV run dry. I was very sick: septic with staph, etc after a C-section. I also had pelvic thrombo phlebitis but it had not been dx'd yet. Well, my veins were completely shot by all the heavy antibiotics - infiltrations, etc. When that IV ran dry, it could not be saved, and I cried. After hours of trying, finally a central line was started. Just thought I'd share.

When fluids are hung to gravity you might want to check the bag, drip rate and IV site about 15 minutes after infusion begins. I think you responded admirably.

meownsmile, BSN, RN

Specializes in Med/Surg, Ortho.

You could just make sure there is a lock at the needle hub, then it is very easy to unscrew the tubing from the lock site, reprime the tubing with the new bag of fluids and reconnect to the site. Just remember that the tubing DOES have to be reprimed before you open another bag to gravity.

Why do all your iv fluids hang to gravity anyway? This is kind of a archaic way of giving fluids and does nothing for rate monitoring. It is actually a bit dangerous to let IV fluids continue to gravity without a pump.

Here's something that I was shown by an anesthesiologist and CRNA's. When you spike your bag of IV fluid (holding bag upside down) pull the spike back out and squeeze the air out of bag so fluid bubbles up- then reinsert spike (don't contaminate spike). Now there is no air in bag. When the bag runs out, it sort of "vacuums" shut or collapsed on itself. No air in bag, no air in line. Great for times when you are super busy. Now, with this method it is harder to tell precisely how many cc's are left in the bag towards the end but if it is that important - should be on a pump anyway! SG

meownsmile, BSN, RN

Specializes in Med/Surg, Ortho.

agreed enfermaera. Good suggesting and i agree with the IV pump conclusion. If a patient is getting more than 1 liter of fluids they should be on a pump anyway.

I work on a postpartum floor and we get the moms over from L&D already stuck so I can't do anything about making sure there is a lock site although there *usually* is.

Our floor is the only one in the hospital where we don't use pumps. I don't know why - all our csection moms need at least three bags of fluid when we get them so a pump would be nice.

I will have to try to trick of getting air out of the bag given above. That sounds like a good trick.

Melissa

meownsmile said:
You could just make sure there is a lock at the needle hub, then it is very easy to unscrew the tubing from the lock site, reprime the tubing with the new bag of fluids and reconnect to the site. Just remember that the tubing DOES have to be reprimed before you open another bag to gravity.

Why do all your iv fluids hang to gravity anyway? This is kind of a archaic way of giving fluids and does nothing for rate monitoring. It is actually a bit dangerous to let IV fluids continue to gravity without a pump.

I'm a frequent hospital inmate because of dialysis. Occasionally my IV will go dry and the blood starts backing up into the bag. My question is, is it safe for me to close the clamp when I see the blood start to go up after I've called the nurse? I've had to wait five or six minutes for a nurse to answer the call, and while that might not seem like a long time to the nurse, for a patient watching her blood go into an empty IV bag, it's pretty darned scary! I'd feel better if I could do something for myself while I wait for the nurse.

meownsmile, BSN, RN

Specializes in Med/Surg, Ortho.

NO,, no reason for you to worry about that as a patient. The blood will only back up so far,, not like you will fill the bag with blood. The backflow is as someone else posted normally just a small length then it evens out with gravity.

They should however, flush your port before they put up a new bag if you have blood backup in the tubing.

meownsmile, BSN, RN

Specializes in Med/Surg, Ortho.

mstigerlily said:
I work on a postpartum floor and we get the moms over from L&D already stuck so I can't do anything about making sure there is a lock site although there *usually* is.

Our floor is the only one in the hospital where we don't use pumps. I don't know why - all our csection moms need at least three bags of fluid when we get them so a pump would be nice.

I will have to try to trick of getting air out of the bag given above. That sounds like a good trick.

Melissa

Sure you can,, unscrew the IV tubing from the catheter hub and screw on a primed lock, then reattach the iv tubing, whella.

Our facility uses a "dial-a flow" device that is an extension with a dial on it which can be set to deliver a certain amount per hr. They are NOT precise but can help alot if not using a pump. The rate is more carefully monitored than if no device is used. A flow contol device whether this or a pump is required by my hospital so we put them on every post op. If the patient is on a critical drip we obtain a pump immediately if not already on one.

Hhhmm..interesting. Thanks enfermeraSG for the info! ^_^