Air or gas stuck in an IV tube can lead to serious complications for patients, especially patients with cancer who are at increased risk for embolisms. Oncology nurses are often the first to respond to infusion pump alarms indicating that air is stuck in the tube and also the ones to correct potential problems. Yet the number of alarms related to air in lines can lead to alarm fatigue and safety concerns when nurses become desensitized or overloaded with alarms related to air in the tubes. Patients frequently lose sleep and become disturbed by the alerts.
A group of nurses recently developed and distributed a survey to oncology nurses asking them about their experiences dealing with air in IV tubes. Seth Eisenburg, ADN, OCN®, TCTCN™, and Nancy L. Trick, RN, CRNI®, VA-BC, published their findings in the Clinical Journal of Oncology Nursing. Results showed that 97.2% of respondents saw air in lines causing problems in their clinical practice.
Nurses managed air in lines using several strategies: flicking tubing (84.1%), opening the IV tubing or aspirating with a syringe (64.6% with nonhazardous infusions and 71.8% with hazardous infusions), and returning the bag to the pharmacy (11.9%). When asked what their biggest concerns were about air in lines, nurses’ top concerns included pump alarms (93.5%), delayed treatment (58.3%), extended infusion time (69.0%), patient safety (53.8%), and workflow disruption (82.5%). Nurses also noted how air in lines contributed to wasted time and medication.
These results are alarming for several reasons. First, the authors note that little formal research has examined how air in lines affects nursing care and patient outcomes, despite it being a concern almost universally among oncology nurses. Second, several of the ways nurses noted they dealt with air in lines were contrary to guidelines, exposing patients and nurses to safety risks. During chemotherapy infusions, opening the IV administration set and aspirating air are against most hospital policies and Oncology Nursing Society guidelines.
The researchers’ findings point to ways nurses can lead efforts to improve patient safety and outcomes related to IV infusions. Prevention of air in lines through air-eliminating filters, back-check valves, and closed air traps may be appropriate, and the Infusion Nurses Society offers guidance. Being able to identify the cause of air bubbles in the lines can help determine whether an alarm is a nuisance or truly indicates a potential hazard. Where the bubbles originate, the presence of outgassing (when medications create tiny bubbles, especially during infusion), and specific pump designs could help predict potential causes and help nurses quickly determine the most appropriate remedy.
This study helps oncology nurses see a routine part of their cancer care as something potentially addressable through research and collaboration. The authors’ call to action to address the lack of clinical studies on the extent and impact of air in lines should be addressed by our community, both for protecting patient safety and for reducing the workplace alarm fatigue that so often plagues oncology nurse well-being.