Air Burden Created by Common Clinical Interventions
Hospitals are familiar with the rare and often fatal cases of air embolism. These cases can be catastrophic and often lead to significant morbidity and mortality as well as increased expenses for the hospital. These are the cases that can hit the evening news and lead to litigation.
But Air Burden is something altogether more common and more insidious. There are innumerable times that air enters a patient’s venous system through their IVs but it is not recorded, simply because the patient did not have bad enough side effects or those side effects such as shortness of breath, chest pain, memory loss, lightheadedness, and decreased level consciousness were attributed to something else.
Air embolism has been named the #2 Hospital Acquired Condition (HAC) by the Center for Medicare & Medicaid Services and instances of air entering intravenous lines have recently shown to be predictable and systematic*. It is not only the accidental incidents of improperly de-airing a fluid bag or failing to fully prime the patient line that creates air in IV tubing, but air presents simply as a result of common medical interventions. The likelihood of these air in line events are directly correlated with the use of certain common medical interventions such as the use of fluid warmers, bolus injections, and the administration of blood products and certain medications. Patients experience these common medical interventions everyday, exposing them to the risk of having air masses – foreign bodies – enter their venous system. As patients undergo various common hospital treatments they are unaware of the increased risk of air entering their system. For the majority of cases, if the amount of air is small enough to bypass the limited precautions and standard of care, i.e. visual inspection or an infusion pump alarm, this foreign body may go undetected completely. Air burden is difficult to diagnose and treatment options are limited.
There has long been a bias in the medical community that the body can “tolerate” small amounts of air and that the lungs will “filter it out.” However there is now a growing body of evidence that even small amounts of air can cause significant damage to the blood vessels and organs. This research shows that every time air is allowed to enter a patient’s circulation, harm can be caused. This is Air Burden, chronic amounts of air entering the venous system and causing harm to the patient. Air is foreign to our vasculature and the body responds to it as it would any other foreign mass. As soon as an invading air mass enters the vasculature it is coated by platelets, white blood cells and other proteins as they travel through our bloodstream. These air masses can be hundreds or thousands of microns larger than the capillaries they are trying to pass through. While they travel, they can damage or degrade delicate lining of our blood vessels (called endothelial glycocalyx and its underlying endothelial cells) resulting in endothelial cell edema, inflammation, localized platelet and white cell activation and even blockages in pulmonary capillary vessels.
With the newly FDA cleared ClearLine MD no patient should be subject to the risk of fatal air embolisms or the Air Burden caused by today’s common medical interventions. Prevention is the best treatment as there is not enough evidence to prove exactly how much air is enough to cause fatal damage but there is growing evidence showing that any amount of air causes damage. The onus should not be on the patient’s anatomy to reabsorb or manage foreign air masses, but on the medical system to prevent air from entering patient’s vasculature.
ClearLine MD is the only FDA cleared and CE certified product that automatically detects and continuously removes air from IV lines. This patient safety device protects patients from preventable iatrogenic air embolisms and Air Burden. ClearLine IV is a strong line of defense for patients, especially those at increased risk of air embolism or undergoing clinical interventions where the risk for Air Burden is higher.
*A Prospective Observational Study of Air Burden in Intravenous Tubing: Factors that Increase Patient Risk