How much air is it safe to have in your IV line?
And what about those bubbles?
Check out: air bubbles of death.

16 Responses to “quick tip: keep air out of your IV line.”

  1. Hi, so I got the bit about tiny air bubbles not killing u .. but I am wondering about if you are in the hospital with an IV .. when the IV bag is completely empty of liquids .. is it harmful to you when the air in the bag is left and the nurse is gone for 3 hours .. before she finally comes back to change it??

  2. Thank you for this wonderful info. I am a mother of a very ill 17 year old with a PICC line and a nurse who is less than sympathetic to the “bubble fear”. Was considering staying up all night to monitor the thoughtless nurse and am relieved to find this wisdom. THANK YOU & sweet dreams to all!

  3. Thank you! I’m a nervous parent who has been googling like crazy because my 3 year old has a Picc line and just had bubbles in line last night. I’ve been sick about it for the past 12 hours. Feeling much better now!

  4. Hi Ian

    What a great Tip! I am a first year student nurse and find the information and ideas you share on your site brilliant. They do not teach you this at Uni. I hope you produce more of these practical and informative videos. There is nothing as good as learning from the experts. Thanks

  5. As a student, so glad I came across that!

  6. I have the joy of being both a nurse and a constant patient. I currently have a PICC line in my left arm and am doing 3 (20ML) injectons of IV Antibiotics and two saline flushes per dose, so I get to put alot of time into preparing my own line now, as opposed to patients. I remember in nursing school going over the frequently asked question of air in the line/air embolisms. It is no wonder considering that TV has made a huge deal out of it for decades. How many of us have seen films where evil nurses or mad scientists have killed patients by injecting small air bubbles into their lines? I for one grew up thinking that the smallest air bubble in my vein would surely turn fatal and when I became a patient, I clearly remember being horrified at watching the tiny bubbles creeping towards my arm and wondering…”Is this nurse trying to kill me, not paying attention, or is this safe?” So I would ask and always get the same answer….”It’s fine don’t worry.” As a nurse I remember relieving the nurves of countless other patients who had the same fears, seems TV has done a great job at instilling this air bubble fear deep into our minds.

    It’s odd because now that I am a chronically ill patient with a PICC who does my own IV meds and flushes, I still take the extra time to tap the heck out of my syringes to minimize the air going into my line, even though I know an air embolism would take FAR more air than that to cause me any harm, it is almost a primal, intrinsic fear. When I was a nurse I worked hard at minimizing the air in the line to calm the fears of patients, but even the best of nurses are not going to be able to squeeze every single microscopic bubble out, and we will all at some time in our career get the air embolism question, and I feel for these people. I try not to make them feel silly, they are scared and it is a life time of negative reinforcement that has taught the general public that air in the veins is bad. Calming nerves and hand holding is just as important in nursing as making sure you put a line in right. Even the most seasoned of us will have these primal fears, and even the most stoic of patients are still frightened. I know some nurses hate getting this question, but the way I see it…it’s my job to care first for my patients, and that means holistically. Fielding questions and soothing anxiety can be so much more productive than allowing a patient to sit uninformed in fear, watching their childhood fear unvieled before their eyes, and choking back the desire to ask out of embarrassment. Now it is my policy that when I start a line and am not able to get every bubble out, that I tell the patient, no matter whether they are a junky off the street, a child, or even another medical professional….”See those little bubbles in your line, don’t worry about those, they are harmless and will not hurt you in anyway.” You would be suprised how many patients breathe a sigh of relief, because they secretly were scared and too afraid to ask.

    Now…I’m off to flush my own line, and perhaps I will sing “Tiny bubbles” everytime I do…you know just as a cheesy inside joke.

    Have a wonderful day & good health to you all.

  7. 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 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 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

  8. 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. :)

  9. 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.

  10. …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…

  11. 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.

  12. amazing tip!!!!!!!!!!!!!!

  13. Great tip. They should be teaching that to the student medics and nurses!

  14. 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!

  15. 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.

  16. 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…

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