Two ways for changing IV administration set. 

Contexts in source publication

Context 1

... the time that nurse anesthetist changed the IV set in the recent case, the volume of fl uid used in the 1,000 mL bag was 300-400 ml and we found that a maximum of 240-300 mL Table 2 -Volume of air entry into an infusion bag after changing the administration set. of air can enter into a PP bag at the same conditions while in a PVC bag this amount decreases to 120-130 mL. The amount of air remaining in the bag in this recent case was 55 mL and the volume of drip chamber and tubing was 15 ml. Thus, the estimated volume of air embolism was 170-230 mL. In literature, plastic bottles have been responsible for the risk of VAE 4,5 . One of the reasons to use self-collapsible IV fl uid bags instead of conventional glass or plastic bottles is to take precaution against air embolism. Air embolism is out of the question when collapsible bags are used as a closed infusion system. To our knowledge, this is the second case report on venous air embolism related to the use of collapsible IV fl uid bags, where the estimated volume of air entry and the bag's material were not mentioned in that case 6 . There is risk for impairment of this closed system when IV administration set is disconnected from the outlet. Self-sealing outlets become safe guards to prevent air em- bolism and contamination. When the administration set has to be changed, the outlet of the bag may be clamped with a forceps to prevent air entry (Figure ...

Context 2

... the patient and the fetus were stable upon arrival in the operating room. We monitored ECG, non-invasive blood pressure and SpO 2 , and administered oxygen 5 L.min -1 via facemask, inserted another 18G intravenous canula to the antecubital vein for rapid volume expansion and performed spinal anesthesia with the patient in the sitting position. We placed a 25-gauge spinal needle atraumatically in the fi rst attempt to the subarachnoid area at L3-L4 level and injected 2.5 mL of hyperbaric bupivacaine 0.5% without incident. At this point the patient had received a total of 600 mL of crystalloid solution through both catheters. The patient was positioned in supine and the surgery began at the 10 th minute of spinal anesthesia. Five minutes later, the patient had nausea while her arterial pressure tended to decrease slightly (Table 1). We administered ephedrine 5 mg twice and accelerated IV fl uid administration by squeezing the IV fl uid bag with a pneumatic pressure infuser. A healthy male infant was delivered with an APGAR score 9. We administered IV oxytocin 10 IU. Blood loss was approximately 400 mL and 1,100 mL of fl uid had been administered up to this point. Between the 25 th and 30 th minutes of spinal anesthesia, the patient had suddenly become agitated and confused with SpO 2 levels 84-80%. We administered ephedrine 10 mg, midazolam 2 mg IV and began performing manual mask ventilation with 100% oxygen. The pulse of radial artery was palpable, both lungs were easily expanded with low airway resistance, but the SpO 2 level was decreasing and EtCO 2 was 12 mm Hg. At this time, the anesthesiologist recognized the IV administration set (both drip chamber and tubing) full of air and clamped immediately. There was also some amount of air in the IV bag (measured as 55 mL after the case) with no fl uid remaining. We administered propofol 100 mg and rocuronium 20 mg and performed urgent endotracheal intu- bation, but the EtCO 2 level did not change and SpO 2 values decreased. Circulatory collapse developed in minutes and was treated with noradrenaline, atropine, adrenaline and volume expansion with a colloid solution (Table 1). After we restored hemodynamic condition, we inserted an arterial cannula and placed a central venous catheter to the left internal jugular vein (the attempt at the right internal jugular vein failed). Repeated attempts to aspirate the air from the central venous catheter had failed. The fi rst arterial blood gases analysis revealed pH: 7.27, pCO 2 : 43 mm Hg, pO 2 : 111 mm Hg, HCO 3 : 19 mmol.L -1 , BE: -7 mmol.L -1 , lactate: 3 mmol.L -1 . Before extubation pH was 7.38 and lactate level decreased to 2 mmol.L -1 . The patient was extubated 50 minutes after surgery. The patient regained consciousness with no neurologic defi cits and was transferred to the pos- toperative care unit. After the case, a conversation with the nurse anesthetist cleared the story: when positioning the patient for spinal anesthesia, the IV administration set detached from the IV line and soiled unintentionally. When changing the set, she had turned the IV bag upside down (as in Figure 1-A) and some air entered into it. Using a pneumatic pressure infuser for rapid volume administration caused ...