Why no air bubbles in IV lines for cardiac patients?

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Quick question...I understand there should be no air in any IV line, however, why is it especially crucial to not have air bubbles in IV lines for cardiac patients?

Thanks!

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A few bubbles, even a one inch gap of air in the IV tubing is not harmful to anyone. It will make the IV pump alarm but I don't think that is what you are referring to?

Or are you referring to a central venous line? Even there I have never heard of a few bubbles being an issue.

I never worked in a post-op cardiac surgical unit? Is that what you are referring to? Otherwise, a routine r/o MI "cardiac" patient is no different from any patient. I am not even sure about post-op cardiac units, I was just trying to think why, where, it would be an issue?

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Specializes in New PACU RN.

Nursing school makes you think that even a little bit of air is going to cause an air embolism and kill your pt. I remember freaking out about every little air bubble and spending a lot of time either sucking it out with a syringe or unlocking the line and letting the fluid out until the bubble also got out.

However in the real world you learn that an air bubble might be a problem if it's half way or as long as the whole IV line itself. I'm still kind off obsessed about it but now I think my pt will live :D

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Specializes in CRNA.

Look up right to left shunts and this will give you a good idea of the people at risk. The majority of the time a small amount of air in the venous system goes to the right side of the heart, into the pulmonary artery and gets blown out in the lungs. It doesnt matter if they are "cardiac" patients or Lance Armstrong.

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I should have been more specific. I am referring to pediatric congenital heart defects where there is "right-to-left" shunting. The docs are big on making sure there are no air bubbles in the lines.

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Specializes in CCU, CVICU, Cath Lab, MICU, Endoscopy..

Art lines and PA catheters no bubbles bad stuff :smokin:

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Specializes in CRNA.
I should have been more specific. I am referring to pediatric congenital heart defects where there is "right-to-left" shunting. The docs are big on making sure there are no air bubbles in the lines.

If there is a communication between the left and right heart and right sided pressures exceed left, air can get into the aorta where it enters the arterial circulation. This is bad. Actually, air in the heart can do some interesting things when there is a defect. You should go to youtube and check out some echos where bubble tests are performed.

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Specializes in ER, Trauma.

When measuring art line pressures, air is compressable, fluid isn't. Air bubbles can throw off pressure readings, but I suspect the difference is too slight to be critical.

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Paradoxical embolism is definitely a concern with CHD patients where there is an abnormal venous to arterial communication to the arterial circulation. This can also be an issue in adults with a PFO.

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Specializes in ED, CTSurg, IVTeam, Oncology.

Air emboli injected into a large pool of mixing churning blood (such as that going from the Vena Cava into the Right Atrium or Right Ventricle) is not a big deal. The air bubble is usually diluted by and then rapidly diffuses into the comparatively larger body of blood. However, if an air bubble is allowed to go from the right atrium into the left atrium (as through an Atrial Septal Defect) or from right ventricle into the left ventricle (as through a Ventricular Septal Defect), then there exists a good possibility that the air bubble is then ejected from the left heart into systemic arterial circulation.

An air bubble coming out from the heart can follow the path of systemic arterial blood flow to anywhere that arterial blood can go. It can go directly into the coronary arteries where the air emboli would likely cause a Myocardial Infarct; or it may go into the cerebral circulation where it would cause a Stroke. The problem is with the nature of arterial circulation itself; the amount of blood relative to the amount of air bubble is rapidly diminished as it travels along arterial anatomy, which is the exact opposite of that seen with venous circulation. Thus, the air bubble is much more dangerous to the point that it is potentially lethal as there is less chance for it to mix and become dilute. It would stay intact and its surface tension would block blood flow, the classic definition of embolic event. In this case, it would be referred to as (like respondent GreyGull alluded out) a Paradoxical Air Embolus. (Note: A Paradoxical Embolus is when a venous blood clot enters arterial circulation, usually via some right to left shunt like an ASD/VSD.)

Sources:

http://ccforum.com/inpress/CC2362

http://bja.oxfordjournals.org/content/84/1/112.full.pdf

In Hollywood movies, when the killer injects an air bubble into the victim's IV line, and the victim suddenly grabs at his chest and dies; you laugh at the artistic license. But, if the plot has it that the victim had a known Atrial Septal Defect, and the killer who was aware of this, injected air and kills him; you say, "damn... but that's some excellent script writing." LOL...

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Specializes in CCU, Geriatrics, Critical Care, Tele.

I went to youtube and looked up the echo bubble study :)

[YOUTUBE]

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Specializes in ER.
Paradoxical embolism is definitely a concern with CHD patients where there is an abnormal venous to arterial communication to the arterial circulation. This can also be an issue in adults with a PFO.

I thought PFO was an ER problem...as in "please f____ off." What's the medical diagnosis?

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