# Air in Lines?



## CANDawg (May 28, 2012)

I've been doing a lot of self-study and research, prepping for my EMT training, and lately I've been studying IV's. One thing I've noticed in watching different videos online is that some people leave quite a significant amount of air in the line that ends up going right into the patient's vein. 

I'm sorry, that just really freaks me out. I have visions of strokes and heart attacks. Is it not something to be concerned with? How much work do you put into removing any bubbles before connecting the line?


----------



## dastri (May 28, 2012)

I belive more air is required than in a line. I think it was like 30cc if air was needed to be aconsiderable risk. Could be wrong though. It is,still allways best to bleed out the,excess air.


----------



## Akulahawk (May 29, 2012)

While the standard is zero bubbles in the line, the reality is that a few small bubbles will have no adverse effect. You would basically have to prime a line while it's attached to a patient to come close to the amount of air that will cause problems. I will not attach an unprimed line to a patient, so that really is not an issue, at least for me. If you're really worried about having bubbles in the line, prime the line and use a syringe to remove any bubbles that remain at Y-sites.


----------



## EMT John (May 29, 2012)

I've read cases as low as 20ml being injected that killed them and as high as 300ml that survived so it's possible... I flush my lines well but I'm not going to spend 10min trying to flick every bubble out of the line.


----------



## Akulahawk (May 29, 2012)

EMT John said:


> I've read cases as low as 20ml being injected that killed them and as high as 300ml that survived so it's possible... I flush my lines well but I'm not going to spend 10min trying to flick every bubble out of the line.


Quite frankly, neither would I. I'd just prime the line and go because those small remaining bubbles will not be an issue.


----------



## ffemt8978 (May 29, 2012)

Same here, although I do make an effort to remove any air bubbles larger than a quarter.


----------



## bigbaldguy (May 29, 2012)

There is also a difference between air in a line in a vein and air in an artery I believe. I think and I could be wrong a lot of the hype of air in the line comes from tv shows showing people being offed by someone sticking a needle in their neck and injecting them with air to kill them. I was also at one time under the impression that the slightest amount of air in your blood system would kill you but that's apparently not the case.


----------



## mycrofft (May 29, 2012)

Just make sure if you use a pump that it will not cause it to shut down and alarm.


----------



## Akulahawk (May 29, 2012)

mycrofft said:


> Just make sure if you use a pump that it will not cause it to shut down and alarm.


Every pump I have ever used have been really horrible about bubbles and really complain about them. So... I just make sure that there are zero bubbles in or above the cartridge or wherever the pump and tubing interface. Problem solved on that end...


----------



## Dwindlin (May 29, 2012)

Most IV tubing sets are 20-30mL.  To cause a clinically relevant air embolism would almost take the entire length of the tubing.


----------



## Shishkabob (May 29, 2012)

dbo789 said:


> I've been doing a lot of self-study and research, prepping for my EMT training, and lately I've been studying IV's. One thing I've noticed in watching different videos online is that some people leave quite a significant amount of air in the line that ends up going right into the patient's vein.
> 
> I'm sorry, that just really freaks me out. I have visions of strokes and heart attacks. Is it not something to be concerned with? How much work do you put into removing any bubbles before connecting the line?



Many sources state you need 5cc/kg of air before any issue is to occur.  I've even seen some places go as high as 20cc/kg.


On a 150lb adult, that's at minimum, 380cc and up to 1360cc.  If you're infusing more than a can of soda in to a patient of nothing but air, you have issues.  Little bubbles are nothing.  And the more peripheral you are, the less risk.


----------



## mycrofft (May 29, 2012)

I doubt we can have a good solid figure on a fatal air embolism due to:
1. Individual idiosyncrasies and differences in age/wt/height/etc.
2. Lack of actual (ethical) research. Bet the Nazis tried it out.
3. Anecdotes will usually contain some degree of mistakes or untruth as most stories do which may have bearing on a death on one's watch or one's territory.

How exactly _*would*_ an air embolus kill? Does the circulatory system get "vapor lock"? Why wouldn't the following fluid just push it along until it is absorbed or returned to the heart where it would be churned and dissipated? Does a bubble trigger clotting?

EDIT: I googled it, here's a really good article, mostly about venous air embolism, but also touched upon arterial:

http://emedicine.medscape.com/article/761367-overview


----------



## Ewok Jerky (May 29, 2012)

I don't worry too much over mictobubbles but to the OP here is a buublefree way to flood a line,

Hang the bag
Pull out tubing and push the flow-regulater-clampy thing up to the chamber and roll it to closed position
Spike the bag
Flood chamber about 1/3
roll the clamp to wide open
finé


----------



## hawkinstyler (May 29, 2012)

I was always taught that as well, (that it would take at least the entire length of tubing unprimed) in order to cause an air embolism. Yet undoubtedly, it's better to err on the side of caution as with anything else. It's certainly not difficult to flush the tubing so I always flush it out well. There will always be a negligible amount of air trapped in there, but nothing to be concerned about in my opinion. Basically, don't prime the line directly into the patient, flush it, and you're good to go.


----------



## Sasha (May 29, 2012)

It's too time consuming to sit there and flick out every bubble. A few bubbles aren't going to hurt the patient.


----------



## MasterIntubator (May 29, 2012)

As long as you prime the line per the instructions on the package with good technique..... you will minimize all that stuff.


----------



## EMT John (May 29, 2012)

MasterIntubator said:


> As long as you prime the line per the instructions on the package with good technique..... you will minimize all that stuff.



Instructions? Who needs stinking instructions!!!


----------



## d_miracle36 (May 29, 2012)

Anyone know why a dialysis patient with suspected air embolism you place them in the left lateral position?


----------



## MasterIntubator (May 29, 2012)

EMT John said:


> Instructions? Who needs stinking instructions!!!





Sounds like half of our crews...


----------



## MasterIntubator (May 29, 2012)

d_miracle36 said:


> Anyone know why a dialysis patient with suspected air embolism you place them in the left lateral position?



Google.....

http://cmbi.bjmu.edu.cn/uptodate/critical care/embolic disease/air embolism.htm

"....(Durant maneuver) and Trendelenburg position. This helps to prevent air from traveling through the right side of the heart into the pulmonary arteries, leading to right ventricular outflow obstruction (air lock). "


----------



## 18G (May 29, 2012)

The few little air bubbles in an IV line get dissolved in the blood before even making it to the heart or the brain. I always try to get as many air bubble out as possible though. 

It really sucks when you have a med in a small 100cc bag and you almost waste half the med just priming the line and getting bubbles out. The Mini-MedIII pump is crazy stupid for alarming due to air!


----------

