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Kristine Selck
Air Embolism

Is there any evidence to support the removal of all air in IV fluid/medication/blood product bags before the bag is hung to prevent air embolism?  Our institution has traditionally done this with arterial line bags on pressure devices, but not bags hung on venous lines for infusion with or without pumps.

Thank you,

Kristine Selck, RN

 I do not know of any such

 I do not know of any such evidence. I also think this is technically impossible to do without risking contamination of the fluids. There is always overfill in these containers. When you program the infusion pump to infuse a max volume of 999 or even 500 mLs, the air will not reach the patient because the end of the programmed volume to be infused will be reached and the pump will alarm and go into a very slow TKO rate before all fluid is infused. Air may enter the drip chamber and top of the IV set, but not the patient. The pump also has an air-in-line alarm. So even if the level of fluid in the tubing gets so low that the air reaches this air sensor, the pump shuts down and alarms. If you are still concerned about air, the best choice would be to put an IV filter in the IV set, which will also eliminate air. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

 I'm not aware of any

 I'm not aware of any evidence on the subject, when we reviewed this a few years ago we referred to AACN recommendations to still leave some air in the drip chamber, the rationale was that the benefit from the ability to assess the flow of the line during a flush outweighed the risk of air embolism.  Unfortunately air filters aren't an option on pressure lines, unless someone makes one that is compatible that I'm not aware of.  In theory, the chance of an air embolism on an art line is unlikely.  By the time the bag empties to the point that just air is remaining, the pressure bag won't be exerting much force, and would be unlikely to overcome the much higher arterial pressures.  

The "double spike" method is still common for removing air from a pressure line fluid bag, although I agree it's potentially an infection concern.  

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