IV Question - Air

[bogumil]

SWIM, who has never ived, played around with a syringe. He pulled up 2ml of room temperature water. He then held the needle up, snipped at the syringe, to make the little air bubbles go away. He then pushed but found that not all the air leaves the syringe. There are small airbubbles, one in the bigger part and one in the plastic part of the needle.

SWIMs question is: What about this air? Is it dangerous when injected? Or may a small amount of air be injected? Do professionals usually get the air out completely?

[mkchll]

No airbubbles will not do you any harm. I once read somewhere you would need over 10cc's of air to risk doing any damage. So a couple of bubbles will do no harm..

[bogumil]

Ok, cool, thank you. Is that normal, that some bubbles stay in the syringe? I know, questions over questions, but SWIM wants to be sure before he might play with syringes.

[skeletontea]

Significant amounts of air can cause what is known as an air embolism. The air travels up the vein, passes through the heart, and goes into an artery. The air bubble can then block smaller arteries and prevent blood from getting to tissues that need it. As you can imagine, that can cause all sorts of trouble. But minute amounts of air are relatively harmless. Nonetheless, avoid injecting any air.

I remember a number of years ago in a hospital, an elderly nurse gave me an injection of some sort in my arm, and there was an air bubble (which appeared to be rather large) wedged betwen the top of the barrel and the plunger. I noticed the bubble as the injection was nearly complete, and was about to say something, but it was too late. I quitely asked the nurse "Did you just give me an embolism?" She replied "Oh we have to do that!" The nurse either didn't really hear what I'd said, or had no idea what an embolism was, and just pretended to know what I was talking about (either way, I lost a bit of confidence in the American health care system.)

I walked out into the waiting room, and sat there for a while before leaving, just in case any complications should arise. I didn't know how long it would take, so I waited about 15 minutes, all the while wondering if I was going to have a heart attack or a stroke. The only person to talk to was the receptionist, who would be of little help, so I just stood there in the waiting room, too frightened to do anything, waiting to see if I was going to die. After some time passed, I realized that I was fine, and slowly made my way out of the hospital (still quite shaken.)

Years later I learned that a few minute bubbles won't cause an embolism, but what she put in me still seemed pretty big.

[bogumil]

Ok I read on some boards about it. There was a similar question: Someone wanted to kow about the little bubbles of air, that travel down the infusion, when you get one. He asked if those go into the veins. The reply said that they indeed go into the veins, but that one needs a bigger amount of air to cause any harm because the small bubbles usually are eliminated by the body.
A part is distributed, another part may cause little clogs, but so small that the body can eleminate them and if a small embolism occurs in the lungs, then it usually has no effects, because the lungs have a high ability to destroy blood clogs and airbubbles. Also a small airbubble can be breathed off through the lung.
Those airbubbles, that I have seen so far at infusions, were definately bigger than the ones that form in the syringe. Still I wonder if it causes harm, when one injects small amounts of air regularly...

Another, official, site says, that the little airbubbles, that are going into the blood with a normal injection are harmless because they are decomposed in the blood. Still one shall try to remove any air from the syringe of course before iving.

They posted a link to one case there, where a woman accidently got 150ml of air with an infusion. She survived, but man ...

The thing only becomes dangerous, when the bubble gets into the arterial system. That happens with certain heart defects. Then even a relatively small bubble can do harm.

So thats maybe another reason why one should never hit an artery.

[exitwound]

Significant amounts of air can cause what is known as an air embolism. The air travels up the vein, passes through the heart, and goes into an artery. The air bubble can then block smaller arteries and prevent blood from getting to tissues that need it. As you can imagine, that can cause all sorts of trouble. But minute amounts of air are relatively harmless. Nonetheless, avoid injecting any air.

I remember a number of years ago in a hospital, an elderly nurse gave me an injection of some sort in my arm, and there was an air bubble (which appeared to be rather large) wedged betwen the top of the barrel and the plunger. I noticed the bubble as the injection was nearly complete, and was about to say something, but it was too late. I quitely asked the nurse "Did you just give me an embolism?" She replied "Oh we have to do that!" The nurse either didn't really hear what I'd said, or had no idea what an embolism was, and just pretended to know what I was talking about (either way, I lost a bit of confidence in the American health care system.)

I walked out into the waiting room, and sat there for a while before leaving, just in case any complications should arise. I didn't know how long it would take, so I waited about 15 minutes, all the while wondering if I was going to have a heart attack or a stroke. The only person to talk to was the receptionist, who would be of little help, so I just stood there in the waiting room, too frightened to do anything, waiting to see if I was going to die. After some time passed, I realized that I was fine, and slowly made my way out of the hospital (still quite shaken.)

Years later I learned that a few minute bubbles won't cause an embolism, but what she put in me still seemed pretty big.

Yeah, sadly, this is a perfect example of how little medical "professionals" know about issues of vital importance to health and safety. Sometimes I think that the entire system of medical education and licensing in this country is irretrievably broken and that people like us, well educated self-medicators, are far better off avoiding their quackery whenever possible. :mad:

[candy]

An air embolism is a life-threatening emergency, however, the risk of you developing an air embolism from injecting a small amount of air when injecting a prepared shot, is really quite low. You would have to inject yourself with a large amount of air to risk an air embolism.
In such circumstances as with an IV that has run out of fluid and air is traveling down the line, it would take a sufficient amount of air to travel into the vein to cause an air embolism. Most often in situations such as this, the IV is clamped before any air has traveled into the vein.

Unless your injecting yourself with large boluses of air, I would not worry. I do know of many who inject that leave a very small space of air in their syringe to view the flash of blood. I have not known of anyone who has had any complications from this.

While I don't encourage the injection of air, I do however encourage safe practices and tapping the syringe and expelling any air bubbles is good practice.
The symptoms of an air embolism would be respiratory distress and air hunger. Meaning you would be starving for air and taking in air would be difficult. If this happens, call 911 immediately. I imagine that if one practices safe techniques, one can avoid an emergency.

Asking questions is the first step in being safe. Air embolism is the #1 emergency for divers, also called "the bends." Treatment of an air embolism is done by hyperbaric chamber.

Be safe.

[bogumil]

Thank you Candy, I will report this to SWIM. I found a concrete number of air that may be injected (maximum until it becomes dangerous, so no air definately is the right way!).

Having been injected into a vein, the drug has to pass through the heart and then through the capillaries in the lungs before it can come back to the heart and be pumped up to your brain.

This means that air bubbles can’t get to your brain because they get stuck in the capillaries in your lungs. For air to do you any harm it has to be sufficient to cause frothing in the heart on its way through - much, much more than a 1mL syringe-full. Air bubbles can contain bacteria, so don’t ignore them and inject big bubbles; on the other hand, don’t expose the needle to the air for ages (picking up bacteria) trying to tap out tiny air bubbles that seem stuck to the side of the barrel.
http://www.exchangesupplies.org/publications/saferinjhbk/myths.html

(A cool site btw).

[shaunclo]

What Candy is talking about is what I do. I leave just a tiny, tiny amount of air in the syringe so I can see that I hit the vein right on. Just so we are all clear, it is a tiny amount or air. I believe I use the 1/2 cc insulin syringes, so the amount of air I leave in there would be no bigger than 1/2 a drop of water, if even that.

[candy]

Shaunclo.....Absolutely, exactly what I do, did! That very, very small amount of air just is not going to hurt anyone. Because the color can be so dark, especially with larger amounts mixed in a small amount of water, I leave that very small space so I can see the flash of blood that tells me I am in a vein. Works well for me and I have never had any problems.

As I said in other posts, while I don't suggest this to anyone and advocate for safety, safety, safety, I will say that a very small amount of air is not going to do any harm.

Air emboli can travel to the brain, heart, and of course the lungs.

If anyone should experience respiratory distress after injection, that is not related to say, an overdose, please seek medical attention right away. Believe me, you will know if your in distress and this is an emergency.

Anytime, anyone suspects a problem, please get medical attention right away. If you are experiencing symptoms that do not get better with rest or feel that your in distress, pick up the phone and call 911 or get help immediately. I know some fear getting into trouble, but your life or that of someone else is more important. We take a risk doing what we do and knowing what to do in an emergency is really important.

No question is dumb and we can all learn something new. Whether your experienced at this or new to this.....Don't take unnecessary risks that can be avoided.

[bogumil]

Sounds good. Thing is that SWIM doesnt have any experience with injecting. So if he would leave this bubble, knowing him, SWIM would 100% have the feeling that he has an embolie and would go to the hospital just to be sent back and told that there is nothing....

On the other hand he is very likely to miss the vein in the beginning, so a proof would be great (of that he is in the vein). He will just pull back the plunge a bit. But then he read that this can cause too much turbulence, resulting in clogs and in clogs from the blood touching the inside of the syringe too...

Sounds pretty much like beginners afraidness, huh? :D I will report what SWIM did.

[candy]

Bogumil,
I would not worry too much.
Leaving a small amount of space, just enough to view the flash of blood is not going to cause any harm or "turbulence."
If your starting out with injecting I would go for the antecubital veins, which are located in the bends of the arm or opposite the elbows. These are larger veins, more stable and hurt less. Although IV's are often started in the hands, it is done because these veins, especially with an IV, tend to offer more stability in terms of an IV.
Seeing as how your new to this form of administration, your veins should prove no problem at all.
Make sure the hub of the needle is facing up and that you are at about a 45 degree angle when injecting. Most often men have better veins and an easier time. Using a tourniquet helps as well. Once your in the vein and get a flash of blood and the blood flows easily into the syringe when pulling back, your in the vein. Pushing on the plunger with gentle pressure and your done. If you push on the plunger and you see the skin start to rise or swell, you have missed the hit. Or if you inject and feel pressure, try pulling back on the needle just slightly until you see another flash of blood, and continue to inject. Sometimes even when your in the vein, the needle can be up against the wall of the vein. This may happen when you don't get a good blood return, but know you are in the vein. Sometimes, just pulling back just slightly, without pulling the needle out or turning the needle slightly will give you a flash of blood or the blood return and you can proceed to inject.

If you do miss a shot and inject into the surrounding tissues, this is called infiltration and while it can be painful and unsightly, it is not really dangerous. Applying a warm compress for 15 mins. a few times a day will help the tissues absorb the fluid faster and decrease the risk of a problem developing. Abscesses develop sometimes from an infiltration because the fluid sits under the skin in the tissues and becomes a breading ground for bacteria. So, put on some heat and it should do the trick. If you do get an infiltration, you will want to use the areas above the infiltration for injection. Try to avoid areas below the area if you should miss and cause an infiltration.

Just some suggestions to help. There is an information handbook posted in another forum, "The Right Hit," I believe it is called. Where I used to work, we handed out a small handbook called, "Getting off Right." It goes over some of what I did here.

If you have never injected, be careful. A test shot may be a good idea. Injecting is different than smoking it or snorting it, so doing a small shot may be a good idea.

Be well

[bogumil]

Thank you for the reply!

SWIM will do like you said. He is careful so he decited to use 1/3 of his snorted dose for a test shot and to iv this very slow.