Air embolism

[calypso]

I'm still using a catheter to hook up to the machine. (Hemo). So the nurse putting me on forgets to squeeze the air out of the syringe and before i could say anything a little bit of air went in the permacath and into my bloodstream. She just shrugged it off saying you need a lot of air to cause a problem. I know that but still...makes me nervous to see that. Thoughts?

[gothiclovemonkey]

this has happened to me many times. scares the crap out of me too. Human error.... very scary stuff.

[looneytunes]

This has also happened to hubby several times at the clinic.  He says he has never felt anything amiss but it sure is a scary thought.

[Rerun]

And if you die who would know? 

                 

[Jean]

 YIKES!!!!! How much air is a "lot" of air anyways. I would be concerned about that also.

[KICKSTART]

Watch them like a hawk , remind them to check , its not worth the risk 

[Zog]

You have to have enough air to fill a ventricle in your heart (25 ml?) for it to kill you, otherwise it may go to your brain and make a tiny clot.  If you see a little bubble go in you may not remember that day with your grandpa at the ice cream parlor when you were 4.  I don't know that for sure, but air bubbles in the brain can't be good.

[Nephrologista]

You have to have enough air to fill a ventricle in your heart (25 ml?) for it to kill you, otherwise it may go to your brain and make a tiny clot.  If you see a little bubble go in you may not remember that day with your grandpa at the ice cream parlor when you were 4.  I don't know that for sure, but air bubbles in the brain can't be good.

Please remember that the air is going into the venous system.  Unless you have a hole between the two atria (a patent foramen ovale, or PFO) that air bubble will wind up in the microcapillary circulation of the lungs, where it will be reabsorbed without damage.  It can't get from the venous (right side) of the heart to the arteries that supply the brain without passing through the lungs first.  The lung circulation acts as a filter.

Small amounts of air will not cause a problem.

[calypso]

You have to have enough air to fill a ventricle in your heart (25 ml?) for it to kill you, otherwise it may go to your brain and make a tiny clot.  If you see a little bubble go in you may not remember that day with your grandpa at the ice cream parlor when you were 4.  I don't know that for sure, but air bubbles in the brain can't be good.

Please remember that the air is going into the venous system.  Unless you have a hole between the two atria (a patent foramen ovale, or PFO) that air bubble will wind up in the microcapillary circulation of the lungs, where it will be reabsorbed without damage.  It can't get from the venous (right side) of the heart to the arteries that supply the brain without passing through the lungs first.  The lung circulation acts as a filter.

Small amounts of air will not cause a problem.

Thank you Nephrologista one question though: It went into the arterial line of the catheter, does that still go the venous route and get filtered by the lungs?

[Nephrologista]

Both ports of the catheter are in the vein.  The arterial port is just named that because that port is a little higher up - the idea is you pull the blood to be cleaned from the "upstream" portion and return cleaned blood a little further "downstream".  The names treat the dialyzer as an organ - artery carries blood to the organ, veins return it.

Sometimes when a catheter isn't working well, the nurses will switch ports - pull blood through the venous side, return through the arterial.  The cleaning might be a little worse, but it's better than not having dialysis.

[Rerun]

Both ports of the catheter are in the vein.  The arterial port is just named that because that port is a little higher up - the idea is you pull the blood to be cleaned from the "upstream" portion and return cleaned blood a little further "downstream".  The names treat the dialyzer as an organ - artery carries blood to the organ, veins return it.

Sometimes when a catheter isn't working well, the nurses will switch ports - pull blood through the venous side, return through the arterial.  The cleaning might be a little worse, but it's better than not having dialysis.

Thank you.   

[Tracy]

When I first started D (May of this year) I had only done it 3 or 4 times.  They just hooked on my fistula to the machine and all the sudden the nurse yelled to a technician from across the room, stop her!  3 techs ran over to my machine and started clamping off stuff.  What I learned is that the iv bag was completely empty and they were sending a huge air bubble through my lines.  They caught it just in the nic on time and laughed about it (although nervously).  I didn't really understand what was happening, but now I do.  I check that iv bag everytime and make sure it has plenty of fluid in it.

We just have to be careful and try and catch things that they might miss I guess. 

[silverhead]

That machine should have alarmed and automatically shut down when it detected air in the lines......

[paul.karen]

I dont do HD but shouldnt they be giving every patient a brand new bag of saline?  Or whatever the IV was being used for?

So did they hook you up to the last person on the chairs old bag??

Just curious

[jbeany]

They use a bag of saline to flush the lines on the machine, pk.  Depending on how the machine cycles, problems hooking up, etc., machines may need a new bag of saline after the flushing is done, before the patient is hooked up.  Sounds like they missed that step for Tracey, or their machines don't normally use that much initially.

 If they are pulling too much, too fast and have to return fluid by adding saline, it's not uncommon to need a new bag mid-run either.

Really, it takes a really large amount of air to seriously do damage - like half an IV bag.  Still, pushing air back in is sloppy work when doing an airshot is quick and easy to do.

[Tracy]

I do know they run an iv bag through my machine before they hook me on, because the filter or something was causing me major headaches.  By running iv through machine, it (somehow) makes me not have headaches anymore.  There is only 1/2 bag left usually when I hook on.  They haven't had to replace the bag yet.  That other time when it was empty, I don't know what happened.  Incidentally, I only use one tech now.  I know his style and it may not be the best, but I KNOW it and it is consistant. 

Thanks!

[calypso]

One thing bothering me now is that the arterial line is clotting and is causing them to have to reverse the lines in order to run right. I wonder if it's related at all to the air bubble. Probably not. Guess it's time for cathflo (alteplase) but they put heparin in the lines today. Wonder if I should insist on the cathflo? My new fistula is still gonna take more than a month to be ready to use.

[Riki]

my fistula wasn't used until 2 months after it was put in.  It's normally 6 weeks, but they wanted it to develop a little more before trying it. I got the fistula in November, they started using it in February.  In March, they stopped using it for 2 weeks, because they went through a vessel and it swelled up.  After that, the fistula worked great.  I asked that my line be taken out before I went away in May, but that didn't happen.  When I was in NYC, they wanted to use the line, but I knew it wouldn't work, and I actually had to force them to use the fistula.  I was promised several times to have the line taken out after I got back, and it kept getting put off.  After a few weeks of that, and what I'm guessing was a threatening phone call from my mom, the neph finally took my line out around the first of July.  Total pain in the ass.  Keeping my fingers crossed that things go much more smoothly for you

[Bruno]

I think that air introduced introduced into the blood inadvertently or carelessly is to be avoided at all costs. That's why one of the most scariest alarms on the machine is the air in the blood warning. Having said that I understood you to say that it was during the saline injection into the arterial access...this means the air bubble went into blood moving out of the body to the machine and the nurse is right. Were we talking about air into the venous access it would be a different matter.

[carson]

just as an aside, I've been reversing my lines 7 nights/week for 3 yrs and I'm just fine.

[calypso]

just as an aside, I've been reversing my lines 7 nights/week for 3 yrs and I'm just fine.

They cleared up the permcath with alteplase (cathflo). No more having to reverse the lines. Reversing the lines causes inadequate dialysis due to recirculation. You're on 7 days a week though which might make up for that.