Massive air in arterial

I posted this to the nxstage users facebook and also want to ask all of you. Twice this week I’ve had massive air sucked into the arterial line forcing me to end treatment. Thursday it happened a few seconds after starting treatment. Last night I had 2 hours left. There were inches of air at a time entering the arterial from my site. My needle looked fine. I didn’t feel anything sucking against the wall but it must have been. I’ve had needles against the wall before but never such massive amount of air. My platelets are very low right now from chemo - 20 on Friday and 16 yesterday. I wonder if that is a factor.

Has anyone ever experienced this before? I can’t figure out where all that air is coming from with my needle in place.

Wendy R.

Wendy, the air CAN’T come from your needle once it’s in your access–that’s not possible. There’s no air in your vessels. :slight_smile: There could be a problem with the connection between the needle and the tubing, though. Or, from the saline infusion line, if it’s not clamped (do NxStage machines have these? Standard ones do). Air can get into a dialyzer that’s being primed, too but that would go into the venous return, not the arterial…

That looks like either the arterial was clamped with the blood pump going, or the saline emptied. I’ve done both … um more than once.

The previous photo is right after I stopped the machine and disconnected. This happened 5 hours into my run. I watched the air coming from the arterial access into the lines - gobs of it. I will show a picture of where the air enters the lines at my arterial access (my skin looks aweful!). I wonder if it is the tubing connection to the needle wings. That was my first thought on Thursday and then again this morning. The saline was not emptied plus I watched the air enter the line from my access. I just can’t explain it. If it’s the tubing connection to the needle, someone better take a look at this. What if it was the tubing connection to the venous? No alarms would sound and blood would be lost with possible dire consequences.

So there is the possibility that air is somehow entering the line but the more likely cause is that the line is blocked and the machine is continuing to pump which causes a vacuum and it looks just like that. You can see this during the initial set up, after the cycler goes through the prime and you’re in 23. If you press the red clamp together the cycler will suck the line creating voids in the saline that appear just like the blood in the photo.

Just based on the picture and your description I think the needle is clotted. If that is the case it isn’t that air has entered the system it is that voids in the circuit have developed because the pump was drawing against either a clamp or a clot.

After treatment is over and you’ve stopped bleeding have you examined the needle? I would expect to see a clot of blood in the end of the needle. How are your sticks going? When I am first flushing the needle line after cannulating I hold the line up to my floor lamp so as I am flushing the needle I am looking for dark spots - clots - traveling in the needle line and am likely to see these after I have any trouble putting in my buttonhole. For me it is most likely to happen on the arterial stick.

Bill, after I cannulate I bleed the lines by twisting the cap on the end of the lines. When do you ‘flush’ the lines after cannulating? Are you using a saline syringe after you bleed the lines? When you do see clots during your inspection, what do you do to resolve the issue? Pull the blood into syringes and discard? I think it’s a good idea for me to inspect the line before hooking up. My cannulations are very slow but have been that way for a long time. Maybe I am ‘coring’ the track a bit - I could see that happening. Still doesn’t explain why it would happen hours into a run. I don’t clot at all right now because platelets are so very low (15-20). Thank you for your input.

holly crap, that looks scarry… at least it’s heading away from access not into the v… Only thing i can think is… Is your luer lock tight on your A line? Does the sucking start above the connection part of the line, not right at the cannulation part?

oops…sorry, i dont know how i missed all the other posts :confused:

The only time I have seen something like this is if the saline T connection is slightly loose where it connects into the Arterial line. The pump will start sucking air in the line…
I would send the cartridge and lines back to NxStage for them to study for any type of cracks in the tubing. If it is happening near your access, then there may be a small crack in the bloodlines/needle as well.

///MM

The air appears at the needle access. I think Bill might be right. Somehow I think the needle is against the wall. Why I don’t feel it is anybody’s guess. Why it doesn’t stop sucking air when I move it a bit I don’t understand either.