Intravenous (IV) tubing priming is a necessary procedure that must be completed before an IV line is connected to a patient for an infusion. Priming refers to filling the entire length of the administration set with the prescribed intravenous solution. This action displaces all the air within the tubing and replaces it with fluid. Successfully priming the line ensures that the infusion fluid, and not air, will be delivered once the setup begins. This information is intended strictly for educational purposes and does not substitute for formal medical training or professional healthcare guidance.
Preparation and Safety Checklist
Establishing a clean environment and gathering the correct supplies are necessary initial steps. You will need the IV fluid bag, the new primary IV administration set, non-sterile gloves, and an alcohol swab. Before beginning, perform hand hygiene thoroughly, and then put on non-sterile gloves to maintain an aseptic technique throughout the setup.
The main safety concern addressed by priming is the prevention of an air embolism, a potentially serious complication that occurs when air enters the patient’s circulatory system. Air within the tubing can enter the bloodstream and form a blockage, disrupting blood flow to vital organs. Fatalities have been reported with volumes as small as 10 milliliters (mL). Priming the line fully is the most effective way to eliminate this risk by ensuring the entire pathway from the bag to the patient is filled with fluid.
The IV fluid bag must be inspected to confirm the correct solution and concentration, and to check for clarity, expiration date, and any signs of cloudiness or precipitates. The IV tubing should also be inspected for any damage or defects. The roller clamp must be located and moved near the drip chamber, then closed completely to prevent fluid flow before the line is spiked.
The Step-by-Step Priming Procedure
The priming process starts with the fluid bag and the administration set. First, remove the protective cover from the IV bag’s access port, taking care not to contaminate the exposed opening. Then, remove the protective cap from the spike at the top of the administration set, ensuring the spike itself remains sterile.
The spike is inserted into the bag’s access port using a firm, twisting motion until it is fully seated. Once spiked, the bag should be hung on an IV pole to allow gravity to assist with the fluid flow. The next step is to fill the drip chamber by gently squeezing it until it is approximately one-third to one-half full of fluid. Filling the chamber to this level helps prevent air from being pulled down into the tubing during the infusion.
With the drip chamber filled and the distal end of the tubing held over a sink or waste receptacle, slowly open the roller clamp to begin the flow of fluid. Allowing the fluid to flow slowly helps control the process and reduces the chances of creating new air bubbles. As the fluid moves down the line, check the entire length of the tubing for any trapped air bubbles, particularly at access ports or Y-sites.
Special attention should be paid to accessory ports and backcheck valves, which should be inverted or gently tapped as the fluid passes through them. This action encourages any air trapped in the side ports to be displaced. The flow is maintained until a steady stream of fluid exits the distal connector, confirming that the entire line is completely flushed of air. After the line is confirmed to be air-free, the roller clamp must be closed securely to maintain the fluid inside and keep the end of the line sterile until connection.
Common Issues and Troubleshooting
During the priming process, several common issues may arise that require quick corrective action. One frequent problem is the presence of small, persistent air bubbles in the main tubing segment. Holding the tubing taut, gently flick the line with a finger at the site of the bubble encourages the air to move upward toward the drip chamber.
If a bubble is too large or stubborn to move by flicking, other techniques can be used. If a bubble is near an access port, gently tapping the port while inverting it can help dislodge the air. If a large bubble is near the distal end, slowly opening the roller clamp to let a small amount of fluid flush the bubble out may be necessary before re-clamping the line.
Another common issue is an incorrectly filled drip chamber, either over-filled or under-filled. If the drip chamber is over-filled, the fluid level makes it difficult to monitor the flow rate. To correct this, temporarily invert the IV bag and gently squeeze the drip chamber to force some fluid back into the bag. Re-hang the bag and check that the chamber is now about half full. If the chamber is under-filled, simply squeeze it again until the fluid reaches the proper level.
Some IV sets are designed specifically for use with infusion pumps, often having specialized pump segments that must be correctly loaded into the pump mechanism. The priming procedure is completed before the tubing is inserted into the pump. The final check for air bubbles is performed before the pump is programmed to begin the infusion.