Air may enter the externalized line if it becomes disconnected while unclamped.  With inspiration, the thoracic pressure decreases compared to atmospheric pressure.  Air travels into the line from an area of high to low pressure, thus causing an air embolism.  Prevention is key to avoid this life-threatening complication.

Prevention:

• Never leave the needle or IV tubing open to air
• In the case of accidental disconnection or severing of the tubing, immediately clamp the tubing or remove needle
• Use a primed access needle attached to a short capped and clamped extension set when externalizing the port
• Clamp the capped extension tubing when changing the administration set, collecting blood or flushing
• Use luer-lock devices and tape all connections to prevent accidental disconnection
• Rotate the extension tubing clamp site to minimize the risk of severing the tubing

Intervention:

• If air enters the system, clamp the extension tubing or attach a 10cc syringe to the open needle and aspirate any air.  Put the patient left lateral Trendelenburg to trap air in the right ventricle