quick tip: keep air out of your IV line.
By impactEDnurse • Feb 7th, 2008 • Category: the nurses desk:, tips and tricksHow much air is it safe to have in your IV line?
And what about those bubbles?
Check out: air bubbles of death.
impactEDnurse is also known as Ian Miller, a nurse with over 26 years experience working in a busy emergency department in, Australia. This site in no way reflects the opinions of that hospital.
All stories (although based on actual experiences) have been changed to protect patient confidentiality.
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I was always given to believe you’d need at least 60ml of air to cause problems; maybe more. Incidentally I’m told you need special cuts through the heart at pm to find it…
I have only seen air emboluses back in the 80’s from glass bottles attached to central lines that came apart pre luer lock,we had to tape our tubing. We were supposed to turn the pts on the right(?) side in trendelenberg so the air would “float” back toward the feet instead of the head.The pt’s usually recovered without problems although it was scary for everyone involved.
I’ve heard similar rules of thumb (that a small amount of air isn’t that big a deal, especially with a peripheral IV) but I’m still diligent about removing air from my lines, almost to the point of obsession.
One reason is that when working with an alert and oriented patient–or one with a family member standing nearby–their seeing an air bubble floating through the line, regardless of its size, can instill a sense of unease and make the patient/loved one lose confidence in the care they’re receiving. Sure, you could explain that, according to conventional wisdom, an air bubble of 5cc or less is no worry, but I find purging the line carefully vs. dismissing concerns of already-anxious patients/loved ones goes a long way toward palliating their worries, especially if they have a previous beef (or even concern) about the care they’ve gotten.
Have a good shift!
Great tip. They should be teaching that to the student medics and nurses!
amazing tip!!!!!!!!!!!!!!
Some people say about 100mL of air infused into a peripheral IV line is about the threshold guaranteed to cause major problems. Other sources quote a figure of roughly 1mL/kg, which given the tendencies of our population’s average BMI these days is probably going to be in the same neighbourhood as the first, rough & ready guesstimate above.
Physiologically, badness will ensue from one (or more) of the following dilemmas:
1. You entirely fill your right heart with gas rather than blood. Let’s be generous and call it 50 or 60mL, all arriving in the right heart in one big bubble. Not strictly guaranteed to kill you, but certainly very likely to give rise to a Very Bad Day ™.
2. You don’t fill your right heart with gas, but you pump enough of it through the right heart to give yourself a haemodynamically significant pulmonary embolism. Same problem as a normal PE, but heparin ain’t helping you out of this one.
3. You’re one of the 10-25% of the population who have a functionally patent foramen ovale (you poor bastard), or maybe even an ASD or VSD (dude, don’t you EVER go diving) and even small bubbles can, under certain circumstances, happily bypass your lungs, migrate to the left heart and give rise to an arterial gas embolus. If you happen to be even remotely upright when this happens, said bubble has a >90% chance of finding its way to one of your middle cerebral arteries and a significant chunk of the old grey matter goes bye-byes. In this context, even a few mL of adventurous gas can have rather dramatic consequences. As well as causing an embolic stroke, air bubbles cruising through your brain also do a great job of stripping the vascular endothelium, inciting a vigorous leucocyte-mediated response and result in an almost total loss of cerebral perfusion pressure autoregulation in the affected area for at least 5 hours. Bonus.
…as to Shroom’s comment above about special cuts through the heart at autopsy to find the gas…
It’s not so much the cuts are special, but you have to open the chest underwater. For forensic reasons it’s handy to videotape the dissection, so there’s an objective record of the bubbles escaping when they slice into the heart.
Gives the term “underwater seal” a whole new spin…
So, what do you do when that bag runs out and you have to hang a new one with the same tubing?? I’ve been doing this when I hang a bag with new tubing, but not sure what to do when the first bag runs out.
Thankfully our pumps have a back prime button, so we don’t have to reprime the tubing when air runs through it, the pump pushes it up into the secondary line instead.
So yesterday, my nurse squirted a tiny bit of air through my cannula as she was flushing it. I heard it go into my hand, and then a while later I heard it go up my neck! I swear!
’twas quite fascinating discovering how quickly blood from ones arm ends up in the other bits of ones body.
So does that mean I have a three letter acronym? Or an active imagination? Either way, the bubbles dissolved.
i few months ago i was in coffs harbour health campus with an infection i caught in the hospital.i went there for an simple operation .the nurse come in and connected me to the drip and the whole drip line from the pump was all air and this nurse couldnt get the air out of the line she was shaking it and was spinning out because she couldnt get it out .so she just put it into my arm and i yelled at the nurse to take it out and she said its ok and walked out. i tryed to pull it out of my arm and couldnt and watched all that that air go into my arm.my brother was horrified and see n this.i then had shoulder pain then heart pain.i was horrifield.and i was scared a reprisals as i had to stay in the hospital for some time.and on another accasion a nurse had no gloves on changed drips and attending to other ifected patience she never wore gloves or washed her hands .now since i left the hospital i have been dizzy and have to have injections of vit b because my body wont absorb it for tghe rest of my life.and i am due to have anothe rop at the same hospital and im so scared i wont go .its a wonder i didnt die from all that air in my system.cn some one help me about putting a complaint in.i have night mares about this since the op headaches and more problems when i come out than when i went in . i caught mrsa in coffs harbour health campus..max