Opioids Air bubble IV death

[Pickledlemons]

^^I just don't feel like that is very good harm reduction advice. Injectng air should be avoided whether its enough to kill you or not, IMO.

 

[Coolwhip]

Isn't the whole point of harm reduction looking at actual risk and consequences to make rational, logical conclusions? You think you shouldn't do something because it seems intuitively wrong, and want to block out the reality of the situation? Ok, whatever, you go with that. Leaving a tiny bit of room in the barrel so your blood registers without having to move the syringe or pull on the plunger is a well known and widely used harm reduction technique. For one, people in this thread aren't even using the correct unit measurements. 1 syringe = 1ml = 100 units. I'm talking about a couple units but earlier in the thread 10 to 20 units was tossed around, I can't see any reason to have that much air in your shot, but as far as consequences go 20 units would be .2 ml, people need to understand just how greatly far off this is from even beginning to constitute a danger, you are talking about 10's of ml of air instantly infused into the bloodstream, literally hundreds of times greater. As I said, IV lines infuse volumes of air magnitudes of order greater than a few units in your shot into thousands of patients on an hourly basis, without consequence.

If leaving a unit or two of room in your shot means you don't miss, then DO IT. Missed shots really can kill you, or lead to severe outcomes such as amputation. But go ahead, worry about your hollywood created scenarios and myths and ignore the dangers that actually exist.

https://thenursepath.blog/2016/12/1...w-about-air-bubbles-in-your-patients-iv-line/

Pay special attention to the beginning of this page, and this quote from later.

I really wouldn’t worry too much about those individual small bubbles.

These precautions are taken to ensure the IV isn't pumping 10's of ml of air into the patient, even then the chances of repercussions are very small. It's OK to flat out ignore multiple bubbles some of which are probably approaching half a ml or more, even though they can be fatal or cause severe consequences? lol, ok

 

[tacodude]

I honestly looked this up during my issues with suicidal ideation.... It's not easy even if it's possible. Still I don't recommend injecting air. I may have injected 5-10 units on occasion forgetting to push the air out before getting into a vein and not realizing too when registering, but it's not a good idea

 

[Scrofula]

Sure, Mr. Whip, don't worry about them. It really is long odds you'll be hurt. But for fucks' sake why would you do it on purpose.

Anyway, if you need proof that it's possible to be grievously injured or killed from this, unrelated to syringe IV of drugs, but in a hospital IV during catheterization or surgery, just search pubmed for "venous air embolism". I'll admit, finding a case study of death explicitly due to accidental air during user-IV is tough to find in that pile, or at least takes more than five minutes.

I got distracted by other case studies:

In the fourteen cases of central embolism of needle fragments following intravenous drug use, needles embolized to the right heart in six patients (43%), to the lungs in seven patients (50%) and to both right heart and lung in one patient (7%). In cases of pulmonary embolism, the right lung was affected in seven patients (88%) with only one case of left lung involvement. Followup ranged from nil to three years. Needle emboli were found at autopsy in one case and were not contributory to the cause of death. Of the seven cases of needle embolization to the heart, three (43%) resulted in complications requiring intervention: two patients developed pericarditis, and one developed consequent endocarditis with multiple septic emboli. Of the eight cases of pulmonary needle embolism, there were no documented complications or ongoing symptomology.

Of the published cases of centrally embolized foreign bodies, most have been iatrogenic complications of vascular access, intravascular monitoring, or diagnostic device usage (12); needle embolism from intravenous drug use would seem to be comparatively infrequent. However, due to lack of physician awareness of this entity, its inconspicuity on imaging, and its routine absence of symptoms, the true incidence of IVDU-related central needle embolism may be underestimated.​

So why do I bring up needles? For one, if a needle can travel from your leg veins and lodge in your lungs, a tiny bubble can.

Plus, as with the above, the true incidence is unknown. If you only have intense pain in your chest for a while that eventually goes away, you're an IV drug user without insurance, no one checks, no one tells you, you never know you had a resolving embolism. If they find you dead somewhere, do you think they check for that sort of thing?

And, look, all but a couple people were sort-of fine! Nobody died! So it's safe, right? You'd totally break a needle off into your veins so you don't miss your shot.

source

 

[Coolwhip]

I've given a perfectly valid reason why you would want to leave a couple units of air in your rig. And I get the argument you are making and understand why you would make it, but even those case studies usually involved multiple co morbidities, extreme circumstances, and hundreds of times greater volume of air than what we are talking about.

You aren't wrong about checking for this in IV drug users, but if IV lines used under normal conditions were giving people symptomatic embolisms at any rate, let alone killing people, I think we would know about it by now.

But I don't even know why you are brining up solid objects traveling through the blood stream. Straw man argument I guess? It's totally unrelated.

The fact of the matter is you are never going to hurt yourself by leaving a bit of air in your shot, and there is a valid reason to want to. It's not even long odds, its no odds, its an idea based on how we think the human body works, that falls apart upon further inspection, it has never happened, there isn't even a way to try to calculate such odds. Meanwhile the odds of complications from a missed shot are relatively high.

And I am quitting this thread, nothing more to say, I've answered the OPs question and feel confident in my defense of my statements, if anyone wants to believe air bubbles in their shot are going to hurt them, go ahead. I'm not in the habit of combating obvious myths and superstitions, especially not ones that can easily be resolved with a quick google search.

 

[Scrofula]

Oh, don't go dude, I had to include the needle thing, found it hours before the last several posts.

And the site has to say, "never" is not the right answer. Close to never, sure.

 

[tacodude]

I'll also add I use 29-30 guage needles so that probably affects how big the air bubbles can be if they get through. I'm guessing the risk is higher with a larger needle

 

[Limpet_Chicken]

With regards to having space to pull back and register, I HAVE to pull back to register if I can find a vein. But I don't need to leave air in the rig either. I just use a 5ml barrel incompletely filled, unless the drug needs that sort of volume of saturated solution to do its job, like morphine (for me)

Just fill it, airless to whatever level, including if needs be, a little extra water to take up some space, then just do so, and push up until one JUST sees, when looking right down the needle like the barrel of a gun, the liquid take up space in the tip. For the uber-niggardly around us, its still in the needle, and any air that would be injected would be deadspace in the needle just at the tip, nanoliters or picoliters. Not going to kill someone at that volume.

 

[Captain.Heroin]

You may die from the tiniest bubble. Even though it's rare (only rare through injection, not rare for other procedures), it happens.

It does not have to lodge in your brain to kill you.

It does not have to pass into an artery to kill you.

I was always under the impression it required a large amount of air.

 

[Scrofula]

The more air the worse you'll be. "Large" is kind of relative anyway.

 

[Jekyl Anhydride]

I was always under the impression it required a large amount of air.

And you are under the correct impression. Fractions of a cc aren't going to kill you, is it an easily avoidable practice ? Of course. I'm going on the OP's question which seemed to point specifically to IV drug use.
If this were pertaining to the placement of a centeral line or sub-clavian, This would sound a little different.

The lethal dose for humans has been theorized to be 3-5 ml/kg and it is estimated that 300-500 ml of gas introduced at a rate of 100 ml/sec is a fatal dose for humans.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665124/


IV'ing gas as a form of recklessness will only gain one points for the Darwin award.

 

[Scrofula]

"Futile" over 50mL doesn't mean "Perfectly good idea" for 49.9 and below, though (what source?).

TB ClearER, time number 4, you can die from an air embolism that's microscopic in size. Those ARE NOT associated, as far as any one knows, with citizens shooting their own drugs from syringe.

FUCK YES you can die from air bubbles in your IV catheterization in the hospital.

Look, everyone in this thread is in agreement that risk of injury from an accidental bubble injection is very remote. I have to make clear, cause I'm also stuck in that "role" FWIW, and because I know that eleventybillion to one is still greater than zero, and knowing the number of casualties from air embolisms is very big, and some of those are venous air embolisms, that it's is not nice to tell people they should go ahead and shoot air in their veins intentionally, to save a tenth of a ul in drug being lost to the atmosphere.

 

[tacodude]

I actually think scroff makes sense. In hospitals they use 22-23 guage needles, which can probably create a larger size bubble when it passes through vs a smaller guage like 27+ IV drug users use. That's probably why air embolisms are more common in the hospital setting

 

[Chris42393]

I work in the medical field, you can inject A LOT of air into your veins (at least 10cc+) and you will be fine. I dont suggest doing it for fun, but the air bubbles will break up in your blood stream. You'll be good!

 

[Ketamania]

I work in the medical field, you can inject A LOT of air into your veins (at least 10cc+) and you will be fine. I dont suggest doing it for fun, but the air bubbles will break up in your blood stream. You'll be good!

I have some experience with taking care of a PICC (peripherally inserted central catheter), and I have a question.

I have been told numerous times that any large bubble that gets injected could have serious repercussions - a SMALL amount!

Why is this? I would assume it would have to be because of the location the PICC line empties out into right (near the heart/in the heart)?

 

[Jekyl Anhydride]

PICC lines dump straight into the S. Vena Cava, which I imagine reduces transit time, a chance to homogenize an air bubble into the blood through turbulence and also dilution of intersecting vessels that meet up as the air bubble travels up from an arm or wrist/hand. You're dumping your air bubble right into the carburetor throat so to speak.

In my experience flushing with saline and Locking with Heparin is crucial as a little/ large speck of air could clot blood in the PICC between uses, which is also no bueno.

 

[LesFleursDuMal]

Ive got a PICC line in my right arm at the moment. Huh, what are the odds?

 

[Jekyl Anhydride]

You lucky dog with an easy access capped luer-lok Y site . Although hope you fare well since you need one at the moment. Warm up the antibiotic syringes as I'm sure you've found out it's weird having that cold feeling in side your arm/ clavicle.

 

[Coolwhip]

Tacodude, it doesn't have anything to do with the size of the bubble, but the amount of air, and it needs to be infused pretty much instantly, even a large "bubble" is going to be broken up into smaller ones in the blood stream as the blood will be flowing around the point of injection at all times. Even things that warn about this talk about the "accumulation" of micro-bubbles. A barrel attached to a syringe just can not hold enough air to hurt you. And maybe 49.9 mL of air isn't safe, although they say chances even that much isn't going to kill you, maybe just possibly 5ml of air INSTANTLY infused could kill someone with multiple co-morbidities and bad luck, but no expert or researcher of the topic says less than 1mL of air infused as part of an injection is possibly going to hurt you. No one. Let alone a few bubbles or a tiny bit of room in a 1ml syringe, which would amount to at MOST 10 units, so you are talking about .01-.1mL of air.

Honestly, I think people on the other side of this are lucky that this is such a widespread myth and intuitively believable. Otherwise they would be seriously damaging their credibility right now. Talking about air bubbles in your shot hurting you is akin to saying be careful how big a glass you use, because if you drink too much water it will kill you.

This edit is actually in reference to the post below mine, as I don't want to bump this thread again. But within the link you will see that "the percent of injected venous air retrieved (73% +/- 13% and 65% +/- 21%, mean value +/- SD, respectively)" in reference to 5ml/kg of air injected directly into the jugular(much, much more dangerous) leaving around ~1.5ml/kg of air on average sometimes much more, which would be 120ml/80kg, and they were still able to resuscitate most of the dogs. Outside the use of a central catheter, venous air embolism just isn't a major concern and even then you are talking about 10x the amount of air than can even fit in a barrel, thousands of times more air than the bubbles in a shot.

 

[Jekyl Anhydride]

If you do happen to add 5ml/Kg (300ml for small adult) of gas to a vein over 30 seconds, at least there's a catheter that can retrieve some of it and maybe give you a shot.

Modification of a new catheter for air retrieval and resuscitation from lethal venous air embolism. https://www.ncbi.nlm.nih.gov/pubmed/1632537