A Prospective Observational Study of Air Burden in Intravenous Tubing: Factors that Increase Patient Exposure

Background/Aims: The purpose of this investigation was to identify causes and triggers of air entrainment related to intravenous (IV) access in a setting of clinical, operative or interventional procedure. Methods: An observational prospective trial was conducted in operating room settings across multiple study sites. A total of 120 surgical patients undergoing a variety of interventional and surgical procedures were included, representing multiple patient populations, case types and anesthesia setups. The ClearLine IV, a device that detects and removes air from IV tubing, was inserted into the IV circuit. Clinicians followed standard protocols. Blood warmers were used at the practitioner’s discretion. IV fluid was administered at a constant flow rate or through a bolus given over 30-60 seconds per standard of care. The volume and duration of fluid administration was recorded, along with the frequency, duration and amount of air captured by ClearLine IV. Results: Data confirmed a 52% probability of having air in the IV tubing, 79% when using a fluid warmer or bolus, and for every 10 mL of blood products administered, the risk increased by 0.5%. The baseline probability of dense air (defined as greater than 1000 μL per L of fluid) increased from 0% to 20% with the inclusion of a syringe setup, and up to 50% with a warmer or bolus. Conclusion: Air entrainment occurs in the presence of an IV in the hospital setting, and air burden, the amount of air captured, is increased by use of a fluid warmer, administration of medication by bolus, delivery of blood products, and inclusion of IV syringe setups. CLInICaL STuDy SuMMaRy