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nancy s.
Safety of "bubble studies"

I'm looking for evidence or any supporting literature in reference to "bubble studies."  I'd never heard of bubble studies before and everyone may be doing them I just can't find any available literature. 

For those not familiar with bubble studies,they are done during both TEEs and TTEs.  The nurse mixes one ml of air into 9 ml of sterile saline (agitating the saline by forcing it between two syringes connected by a stopcock).  When the technician and/or physician is ready, the saline (containing 1 ml of bubbles) is released through the stopcock and into the patient in order to see if the champagne of bubbles crosses the ventricular septum.  It creates a pretty casade on the echo screen rather like fireflies dancing across the heart.

Anyway, the staff nurses are concerned about the practice esp. since the procedure may be repeated 3 or more times to insure an adequate echo study.  Is this a case of no-harm-no-foul or should we be concerned with this practice? 

Thanks in advance, 


nancy s. 

Kelly Smith
We do bubble studies
We do bubble studies routinely at our facility.  We have discovered that if we use bacteriostatic normal saline, we need only approx 0.2-0.4ml of air with the stopcock method.  Bacteriostatic normal saline produces a fantastic amount of bubbles.  Even before we used it, and used the 1 ml of air, we haven't had any episodes where we had concern for the patient.  With bacteriostatic, you'll never have to repeat the study, the pictures will be great. 

Kelly Smith

PICC Nurse

Boone Hospital Center

Columbia, Missouri

I am assuming that your
I am assuming that your primary concern is air embolism but this amount of air is not going to cause a problem. This is a common cardiology procedure. Venous air embolism can occur with larger quantities of air, when it is delivered rapidly and when the paitent is hypovolemic. Lynn

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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