Air in Venous line on hook-up?

[silverhead]

what tricks do you have to  make the connection between the Venous line in the arm and the line from the cycler? I know I am missing something as I quite often get some small amount of air in the connection and Sharon freaks about it until I get it removed before starting the session. I am confident it will improve with time and it is only our 4th day at home since the training ended, each day has presented a new and different problem, but they have all been minor errors and good learning examples, won't make the same mistake twice I hope......
Tom

[Black]

It is almost impossible not to have a tiny bit of air because you are disconnecting and reconnecting the line.  She needs to know that those tiny bubbles are not a problem.  A few, smaller than the size of BBs, are not enough to cause a problem.  If it is several the size of an M&M, or a few inches in the line then you must stop and remove the air.

I have found that if I keep the cannulation line straight up as I remove the syringe, and Mike has kept the venous line straight up, we get the least air.  I tilt the venous line in order to make contact with the cannulation line which is still in the up position until they make contact, and then I tilt the cannulation line just enough to slide them together.

Yes, it is a learning situation but you're right, it does get easier and more routine in just a few weeks.  The first month we repeatedly thanked God for the 24-7 techs.

[skyedogrocks]

Black is correct, you are going to get some sort of air in the lines, it's impossible to be air free.

Rob's nurse had to come out ones and cannulate him, she showed me that a small amount of air is not going to bother him.  It's the big ones you have to worry about. 

It takes time and patience but you will get there.  I remember the first few weeks I pretty much freaked out each time he had dialysis.  I thought that I was killing him with air.  My biggest fear was that I would somehow touch the end of a line and infect him.  Now it's a snap to get him on and off.  I don't freak out any more. 


If you are truly afraid of the air in the venous lines try this.  Rob's nurse showed us how to do it:

Once your wife is cannulated, hook her up to the aterial.  Hold the venous line over a bucket (be careful not to touch the tip to anything) and start the process.  Let the fluid move through the tube until there is pink right before the top of the line.  Stop the machine and hook her up to venous.  Start the machine again and proceed like normal.

We have done this many times if I couldn't get all the air out of the venous lines.  It worked beautifully and no air!

Good Luck!!

[cev]

We found that keeping the lines upright helps and I squeeze the saline bag as I close the clamps on the lines.  If we have air in the venous line, other than the tiny bubbles, I move the bubbles back to the patient line and use the 10ml syringe to remove the bubbles.  It works better and neater than starting and stopping the machine

[jbeany]

There's also an odd knack to releasing the syringe at the end of the cannulation line without actually squeezing the tubing.  If you squeeze the tubing, you lose a drop or two of blood, and something has to replace the volume, which is where the tiny air bubbles come in on connections.

[Black]

This week, since we started on lot #9097708, we have had almost no air after prime.  Even when banging on the filter there's very little air.  The lines feel larger, and when I compared them to some of the lines I cut off the discarded cartridges, they look larger too.  Is it just me, or are they larger?

[silverhead]

It has been a while since I asked the question about this, what I have learned in the meantime, besides what help was offered was this, We had been doing the hookup just as the teachers and NxStage nurse had showed us and had the occasional air bubble problem, since then I now do this: originally we flushed the line with 10ml of saline, then double pumped the 3800 of heparin in the venous line, I reasoned that blood IS much thicker than saline, so reversed the order, now do the heparin mixture, then do a saline flush, it is much easier now to hold the venous lines upright and gently squeeze out the air, then make the connection, no more air problems.......