Is there a standard concerning the use of a pressure bag and IV fluids. This would be for fluid resuscitation and I/O’s. In other words, whenever a bag of IV fluid is placed under pressure (300 mmHG) should the air be removed from the bag just like it is removed from the bag when an arterial line is set up for a flush. For the art line flush we remove the air to prevent the waveform from dampening. My thoughts are for the venous fluid resuscitation or I/O we remove the air to prevent venous air embolism. There are articles describing cases of Venous emboli danger and suggests removing the air from the bag.
What I have found in questioning various ER nurses is that some nurses remove the air and some do not. The EZ I/O reps say the air should be removed but they do not teach it nor can they produce a standard or a reference.
When questioning the ER nurses, that was when I found out that they routinely do fluid resuscitation thru 20 gauge angiocaths inserted in both antecubital sites bilaterally under pressure without removing the air from either bag. If air gets in the tubing when they change bags they just aspirate the air out with a syringe. (If they see it)
There is a small amount of information in the INS SOP in the standards on Flow Control and Transfusion. There is no standard stating that air must be removed from any fluid container for any reason. Arterial infusion would be on a pump with an air-in-line detector, so no need to remove the air from the bag. I don't see how air in the bag can cause any changes to the waveform for an arterial catheter since the air is so far away from the artery. Blood and pressure bags are the primary problem when one cannot see when the container is empty to stop the fluid flow and pressure. Removal of air from all fluid bags can easily lead to contamination, adds to the time required to set it up and is only an issue when no one is paying attention to the fluid level in a bag with a pressure bag. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861