Air in IV Lines: A Growing Concern for Oncology Nurses and Patient Safety
Air or gas trapped within intravenous (IV) tubing is an alarming issue that can lead to serious complications, particularly for patients undergoing cancer treatment who are at increased risk for venous air embolisms.1 Oncology nurses are often the first to respond to infusion pump alarms indicating air in the line and are responsible for correcting the problem. Although, the frequency of these alarms can lead to alarm fatigue, potentially compromising patient safety as nurses turn into desensitized or overwhelmed.1 These alerts can also disrupt patient rest.
Prevalence and Management of Air in IV Lines
A recent survey distributed to oncology nurses revealed the widespread nature of this problem. Published in the Clinical Journal of Oncology Nursing, the findings showed that 97.2% of respondents encountered issues caused by air in IV lines during their clinical practice.1
Nurses employ various strategies to manage air in lines, including:
- Flicking the tubing (84.1%)
- Opening the IV tubing or aspirating with a syringe (64.6% for non-hazardous infusions, 71.8% for hazardous infusions)
- Returning the IV bag to the pharmacy (11.9%)
Concerns and Risks Associated with Air in IV Lines
The survey highlighted several key concerns among nurses regarding air in IV lines:
- Pump alarms (93.5%)
- Delayed treatment (58.3%)
- Extended infusion time (69.0%)
- Patient safety (53.8%)
- Workflow disruption (82.5%)
Nurses also reported that air in lines contribute to wasted time and medication.
Guideline Discrepancies and Best Practices
The study revealed that some of the methods nurses used to address air in lines contradict established guidelines, potentially exposing patients and themselves to safety risks. For example, opening the IV administration set and aspirating air during chemotherapy infusions goes against most hospital policies and recommendations from the Oncology Nursing Society.1
The Infusion Nurses Society provides guidance on preventing air in lines through the employ of air-eliminating filters, back-check valves, and closed air traps.1 Identifying the cause of air bubbles – whether from the medication itself (outgassing) or the pump design – is crucial for determining the appropriate response.
The Role of Research and Collaboration
This research underscores the need for further investigation into the extent and impact of air in IV lines on both patient safety and nurse well-being. Addressing this routine aspect of cancer care through research and collaboration can lead to improved outcomes and reduced alarm fatigue for oncology nurses.1
Implantable Port Management and Improved Competence
Recent projects, such as one conducted in Taiwan and published in 2025, have focused on improving nurses’ management of implantable venous ports (IVPs) to reduce complications like occlusion or infection.4 The study utilized the JBI Evidence Implementation Framework and video training to enhance nurses’ skills and compliance with best practices. Before the intervention, only 18.8% of nurses passed an objective structured clinical examination (OSCE) assessing their IVP care skills. After implementation, compliance with all audit criteria reached 100%.4
Nurse practitioners play a vital role in developing evidence-based care protocols and addressing barriers to effective IVP care.4
Key Takeaways
- Air in IV lines is a common problem in oncology nursing, affecting nearly all respondents in a recent survey.
- Current management practices don’t always align with established guidelines, potentially compromising patient safety.
- Further research is needed to understand the full impact of air in IV lines and to develop effective prevention strategies.
- Targeted training and evidence-based protocols can significantly improve nurses’ competence in managing IVPs and reducing complications.