It happens almost every shift -- I hang an IV infusion, and no matter how carefully the tubing is primed, at least one tiny bubble passes the pump's electronic air detector, and floats its way towards my patient. The patient reacts with a tense expression, visually following the tiny bubble's journey to the IV site. "Is it okay to have an air bubble in the tubing?"
I know they are thinking of the TV medical dramas of the 70s and 80s, shows like Mannix, or Quincy, in which a murderer sneaks into a hospital room and carefully injects the tiniest of bubbles into the IV tubing of the sleeping victim, who suddenly codes while the murderer, dressed in scrubs, slinks away unnoticed.
The question remains, however: How much air is too much in venous access? The answer is -- the amount that makes a patient symptomatic.
Minor cases of air embolism are common and cause minimal or no symptoms. Severe cases are characterized by hemodynamic collapse and/or acute insufficiency of certain organs, including the lungs, brain, and spinal cord.¹
For oncology nurses, the most likely causes of VAE (venous air embolism) occur in conjunction with venous access devices. In fact, 60-90 percent are caused by "fractures or detachment of catheter connections."¹ Other factors include:
Failure to occlude the needle hub and catheter while inserting or discontinuing an IV site
Self-sealing valve failure
A tract that remains after central venous catheter removal
Positioning the patient upright during central venous catheter removal
Oncology nurses use venous access devices regularly. VAE prevention includes:
Priming IV infusion tubing and needle hubs
Testing nurse inserted catheters for patency before insertion
Securing all IV and central line connectors
Instructing patients to perform a Valsalva Maneuver during central line removal
Placing patients in supine position during central venous catheter removal
Covering the removal sites of central venous catheters with an occlusive dressing
Symptoms of air embolism include:
Sense of impending doom
Change in mental status
Severe air embolism is a medical emergency. If you suspect air embolus:
Call the Rapid Response Team or Code Team
Place the patient in left decubitus position
Begin supplemental O2
Prevention is the best treatment for an air embolus. All oncology nurses should demonstrate infusion therapy competency in the patient care setting.
Have you witnessed a patient experiencing VAE? What recommendations for preventing VAE would you add? What policies have your workplace initiated?
The Oncology Nurse Community Trivia Game Michelle Bragazzi, BS, RN, 1/13/2014 6 Are you looking to test your knowledge and have a little fun at the same time? TheONC Trivia Game covers various subjects, including cancer treatments, nutrition, side effects, and ...
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