Forum topic

4 posts / 0 new
Last post
Kristine Selck
De-airing IV bags

My hospital is debating the removal of all air from IV bags given as pressurized infusions (either with a pressure bag or rapid transfusion device).  We have traditionally removed all air from IV fluid bags used on arterial and CVP lines, but not from other types of infusions,  such as boluses used for fluid resuscitation, which is being proposed. Are other institutions doing this and if so,  can you describe what the process might be for removing air from subsequent bags on the same IV line?  It has been suggested that we spike, unspike and drain air, then respike.  Thank you so much for any info provided. 

Kristine Selck, RN, BSN 

lynncrni
 I think you are asking for

 I think you are asking for contamination if you do that. I would strongly recommend against this as the risk of the air entering the bloodstream is far less than the risk of infection. Are all of your infusions given on an electronic infusion pump? If so, all of those pumps have an air-in-line alarm. If the fluid container empties and air runs down the IV set, it will stop when the air reaches this sensor on the pump. If that is not enough reassurance, then you can put an air eliminating filter inline. Those are the only methods I would consider safe enough. Frankly with the pump technology and possibly the filters, there is no reason to remove this air in any fluid container. Lynn

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Kristine Selck
Lynn, We are only talking

Lynn,

We are only talking about pressurized infusions, not infusions on a pump (either with a pressure bag or rapid transfusion device).    For example a pt. in the ED being fluid resuscitated with mulitple liters on pressure bags.  I would appreciate your thoughts on this and any evidence you know of related to air emboli from IVF bags. 

Thank you so much,

Kristine Selck

We are developing a midline policy.  Do any other institutions restrict midline placement to a patient that's been afebrile for 48 hours?

Thank you,

Kristi

lynncrni
 An electronic rapid infuser

 An electronic rapid infuser device would have a mechanism to prevent infusion of air. A manual pressure bag system may or may not have some mechanism to prevent air from entering the bloodstream and thus would be a reason to avoid its use without continuous monitoring by the nurse. Both of these devices would force a large volume of fluid into the patient within minutes. In the case of a patient that requires such a rapid volume replacement, I do not see any way to manually remove the air from the fluid container successfully without easy contamination. This means you would need to have an electronic device with a mechanism to prevent air embolism. It has been about a year since I last searched the literature on air emboi, but I have done numerous searches over the years on this complication. Air emoblism occurs from central venous catheters during insertion, during incorrect procedures for changing the IV set or needleless connector, when the IV set or connector is not correctly secured to the catheter hub and upon removal of the CVAD without an air occlusive dressing with a petroleum based dressing. I do not recall ever seeing a case of air embolism associated with any fluid container. You would need to do a literature search to see if this has been documented. Many years ago when IV fluid containers were connected together in a manner that is no longer used, the risk of AE was present. Changing these methods of connecting multiple containers together, the use of electronic infusion flow control devices with mechanisms to prevent air from entering and appropriate patient position and techniques can prevent air emoblism associated with catheters. It can and does happen but it is primarily associated with incorrect patient position or incorrect technique during CVAD insertion, change of IV sets or CVAD removal. Lynn

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Log in or register to post comments