# Does Any One Squeeze the Air Out of their I.V. Bag???



## RanchoEMT (May 1, 2011)

I was working with a guy awhile back who would spike the i.v. bag and turn it upside down to let the air escape, so when the i.v. was ready there was no air in the bag what so ever.... Has anyone heard of this or know what it is called???? I failed to ask him and have since never seen him.


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## medicRob (May 1, 2011)

RanchoEMT said:


> I was working with a guy awhile back who would spike the i.v. bag and turn it upside down to let the air escape, so when the i.v. was ready there was no air in the bag what so ever.... Has anyone heard of this or know what it is called???? I failed to ask him and have since never seen him.



Hold the bag upside down when you spike it, pull the spike back out squeezing the air out, reinsert the spike (without contaminating it). Make sure to prime your tubing as well. 

Not sure if there is a name for it.


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## Shishkabob (May 1, 2011)

Iv bag? No. 


Tridil (nitro) infusion? Yup, always.


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## DrParasite (May 1, 2011)

RanchoEMT said:


> I was working with a guy awhile back who would spike the i.v. bag and turn it upside down to let the air escape, so when the i.v. was ready there was no air in the bag what so ever.... Has anyone heard of this or know what it is called???? I failed to ask him and have since never seen him.


umm why?  Anytime a bag is spiked, there is almost always open space at the top of the bag.  Not only that, but the bag is NEVER drained completely, it is always changed when it reaches the 100mL or so mark.


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## JPINFV (May 1, 2011)

DrParasite said:


> umm why?  Anytime a bag is spiked, there is almost always open space at the top of the bag.


Not only that, but you have to have air at the top of the drip chamber, or else it's no longer a drip chamber.


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## RanchoEMT (May 1, 2011)

medicRob said:


> Hold the bag upside down when you spike it, pull the spike back out squeezing the air out, reinsert the spike (without contaminating it). Make sure to prime your tubing as well.
> 
> Not sure if there is a name for it.



Why would this be used??? All i can think of is something to do with air entering the line or maybe something to do with an i.v. pump....


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## akflightmedic (May 1, 2011)

Sounds like an overcomplicated method to keep air out of the line and I do not recommend spiking, removal and then respiking. Anytime we can reduce one more possible chance of contamination we should. I know we do this when changing bags but that is necessary, to reduce air in the line it is not.

Here is what I do and teach:

1. Roll the clamp to the very top of the line and clamp it BEFORE spiking the bag.
2. Spike the bag.
3. Squeeze the drip chamber till it fills half way.
4. Open the clamp on the line.
5. Move the clamp to the distal end. As you do this, there will be NO air in the line. Your line will be filled with fluid and there is minimal wasting of the fluid.
6. Once the line is completely filled with fluid, return the clamp to the normal position and set rate.

Job done!


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## HotelCo (May 1, 2011)

DrParasite said:


> Not only that, but the bag is NEVER drained completely, it is always changed when it reaches the 100mL or so mark.



Not true. Med bags are usually left to fully drain, and around here, so are NS bags. Why waste it?


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## Veneficus (May 1, 2011)

Bleeding the air out of the bag was common when it was to be pressure infused. 

The thinkng of the time was that the infusion device may infuse the air after the fuid ran out.
(not sure if that was true or not, but we did it all the same)

Never saw or thought to do it on a bag that wasn't going to be infused.


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## RanchoEMT (May 1, 2011)

Veneficus said:


> Bleeding the air out of the bag was common when it was to be pressure infused.
> 
> The thinkng of the time was that the infusion device may infuse the air after the fuid ran out.
> (not sure if that was true or not, but we did it all the same)
> ...



Past tense? Is this no more completely or when you 'used to do them' past tense? What is Pressure Infusion?


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## Veneficus (May 1, 2011)

RanchoEMT said:


> Past tense? Is this no more completely or when you 'used to do them' past tense? What is Pressure Infusion?



In the past it was believed that SBP correlated with perfusion status.
(Some agencies still do, scary thought.)


In order to maintain SBP at about 120mmhg, even on patients still bleeding, we could add pressure to the crystaloid iv bags via anything from squeezing the bag with 2 hands, standing on it, placing the bag under the backboard of a patient on it, using an inflatable device specifically made for it, wrapping a blood pressure cuff around it, or even using a powered device called a rapid infuser.

http://www.smiths-medical.com/catalog/fluid-warming/fast-flow/hardware/level-1-h-1200.html

In our efforts, we poured fluid into people, 16L of NaCl is the most I ever saw on a trauma patient. From the time EMS got to them to when they arrested in the ED. (With a person on the team whose sole task was changing out empty bags)

Anyway, aside from proving we could maintain SBP with water, the outcome was death. 

If you are not familiar with the term "bleeding cool-aid" it is because with so much crystaloid going in, the blood coming out of the wounds was so diluted it looked like red or pink cool-aid.

A couple of wars later, knowledge has improved a bit and we now know rapid crystaloid is only indicated in specific cases, like burns.

The rapid infusion of blood products, crystaloid, and medications in various patients is still indicated and useful, but the days of infusing crystaolid in every patient still bleeding trying to maintain SBP is outdated. (though as pointed out, some haven't caught on yet)

There are many practicioners still creeping around who were part of those days. Sometimes, particularly EMS providers, would bleed the air out of the bags "just in case" whenever they inserted an IV and hung fluids.

I am not surpised to hear people still routinely doing it, but aside from specific cases, it is a waste of effort.

Technique wise, those exceptionally skilled could spike a bag, withdraw the spike ever so slightly while simultaneously inverting and squeezing the bag removing the air, maintaining a water seal, and only spilling a few drops of the fluid before returning the spike to the full in position.


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## lightsandsirens5 (May 1, 2011)

Sixteen LITERS??? You are kidding! That is crazy? When was that?


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## Veneficus (May 1, 2011)

lightsandsirens5 said:


> Sixteen LITERS??? You are kidding! That is crazy? When was that?



2002 in Ohio.

and in fairness, 4 units of blood.


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## fast65 (May 1, 2011)

medicRob said:


> Hold the bag upside down when you spike it, pull the spike back out squeezing the air out, reinsert the spike (without contaminating it). Make sure to prime your tubing as well.
> 
> *Not sure if there is a name for it.*



I know there was a nurse during one of my clinicals that referred to it as "burping the bag", not sure if that's the correct term that's just the one I know of. Same nurse decided to berate me about it in front of a patient.

I've really only seen very few nurses do it, most just spike the bag and flush the tubing.


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## zmedic (May 1, 2011)

The only real reason to do this is in busy ERs, where the patient may not have close nursing care. If you get the air out and you come back 4 hours later and the liter finished 45 minutes ago, there is no air in the line. You could do something similar by spiking the bag and holding it upside down, squeezing the air out and then turning it rightside up and flushing the line. No air in the bag, no problem with contamination.


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## medicRob (May 1, 2011)

fast65 said:


> I know there was a nurse during one of my clinicals that referred to it as "burping the bag", not sure if that's the correct term that's just the one I know of. Same nurse decided to berate me about it in front of a patient.
> 
> I've really only seen very few nurses do it, most just spike the bag and flush the tubing.



You burp a colostomy bag. We always just squeeze the chamber, let it fill halfway then run a little fluid out the tubing.


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## rhan101277 (May 1, 2011)

medicRob said:


> You burp a colostomy bag. We always just squeeze the chamber, let it fill halfway then run a little fluid out the tubing.



Same


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## HotelCo (May 1, 2011)

zmedic said:


> The only real reason to do this is in busy ERs, where the patient may not have close nursing care. If you get the air out and you come back 4 hours later and the liter finished 45 minutes ago, there is no air in the line. You could do something similar by spiking the bag and holding it upside down, squeezing the air out and then turning it rightside up and flushing the line. No air in the bag, no problem with contamination.



Well, apparently Detroit is ahead of the rest of the world in this. If you spike a bag, and let it run out, there will be no air in the line.


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## fast65 (May 1, 2011)

medicRob said:


> You burp a colostomy bag. We always just squeeze the chamber, let it fill halfway then run a little fluid out the tubing.



That's how I do it as well


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## RanchoEMT (May 1, 2011)

*hmmm.*



zmedic said:


> The only real reason to do this is in busy ERs, where the patient may not have close nursing care. If you get the air out and you come back 4 hours later and the liter finished 45 minutes ago, there is no air in the line. You could do something similar by spiking the bag and holding it upside down, squeezing the air out and then turning it rightside up and flushing the line. No air in the bag, no problem with contamination.



What about the drip chamber? Do you leave it 3/4 full or fully full?



HotelCo said:


> Well, apparently Detroit is ahead of the rest of the world in this. If you spike a bag, and let it run out, there will be no air in the line.



If an IV Bag is not attended to when it runs out does air have the potential to enter the line and into the vein?  Is this "Burping the Line" a good Prevention technique for handing a patient off to a nursing staff that is known to be lazy/distracted???


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## medicRob (May 1, 2011)

In all fairness, if the patient needs more than 1 Liter of fluid, I am gonna put it on a pump anyways.


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## mikie (May 1, 2011)

*pressure*

(In my experience): They do it on every bag that gets pressure (manual or automatic) infusers, cause as people already mentioned, there is residual air and when manually pressure infusing, that air will get infused in once the liquid is gone (after all, air if a fluid too).  

I can't really see this happening if using a proper pressure bag (not a BP cuff) even if you don't "spike the air out."


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## jwk (May 2, 2011)

RanchoEMT said:


> What about the drip chamber? Do you leave it 3/4 full or fully full?
> 
> 
> 
> If an IV Bag is not attended to when it runs out does air have the potential to enter the line and into the vein?  Is this "Burping the Line" a good Prevention technique for handing a patient off to a nursing staff that is known to be lazy/distracted???



If the drip chamber is full, then it's not a drip chamber.


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## DwayneEMTP (May 6, 2011)

zmedic said:


> The only real reason to do this is in busy ERs, where the patient may not have close nursing care. If you get the air out and you come back 4 hours later and the liter finished 45 minutes ago, there is no air in the line. You could do something similar by spiking the bag and holding it upside down, squeezing the air out and then turning it rightside up and flushing the line. No air in the bag, no problem with contamination.



Agreed. Overseas it was not uncommon to have a patient on fluids in another room, out of sight, while treating other patients and lose track of the exact time to change a bag. 

I would spike it, turn it upside down, push the air into the line, flip it back over, purge the line like normal and be done. I can't imagine ever pulling the spike to do so. And I have no idea if it was even necessary, as I doubt the little bit of air that the line can hold would have been detrimental to the patient, but it made me feel better to know it was fluid only that I was delivering...

Dwayne


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