Is It Normal To Have Bubbles In Your Urine – When was the last time you or someone close to you was lying in a hospital bed with an IV line attached to your arm and an IV bag hanging from an IV pole next to you?
Maybe when the fluid bag started to empty, a healthcare professional came into the room to hang up another life-saving fluid bag, or maybe just attach a smaller medicine bag to put you in an IV line. While she/he changed bags and adjusted the IVs to the IV line, you sat quietly and thought deeply about when you would be out of the hospital or what you were going to do that day. But out of the corner of your eye you noticed a large air bubble slowly moving along the IV line towards your arm. You reported the cupping alarm to the doctor and were told “nothing to worry about, because a little air never hurt anyone.” This explanation is usually followed by another brief explanation of how it takes a huge amount of air to hurt you and that there is nothing to worry about these little pieces of air.
Is It Normal To Have Bubbles In Your Urine
Unfortunately, this scenario is repeated thousands of times by healthcare professionals who still consider venous air bubbles to be insignificant and then spend their careers ignoring the small amounts of air bubbles that enter the venous circulation through the intravenous line. In fact, it is nearly impossible to estimate the number of times air bubbles enter a patient’s bloodstream through intravenous lines in any healthcare setting. These bubbles are often referred to as iatrogenic air (coming from the activities of the medical unit). No harm is ever intended, assumed, or even imagined, but is often just part of the clinician’s training, their routine practice of maintaining an intravenous infusion, and their confusion and misinformation about the dangers of air bubbles entering the venous circulation.
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The reality is… small amounts of air bubbles entering the bloodstream can have negative consequences and can be harmful. Interestingly, there is absolutely no reason for any amount of air or air bubbles to pass through a patient’s IV line. Any clinical protocol for setting up and maintaining an intravenous line emphasizes the importance of ensuring that all air has been purged from the line before it is connected to the patient’s circuit. All air bubbles are foreign to our circulation, and most can be easily removed from the IV line before entering the patient’s circulation. But more importantly, air bubbles can potentially cause harm and are not in the patient’s best interest… let me explain why.
First, regardless of the size of the bubble or its point of entry into our arterial or venous blood, bubbles or particles entering our bloodstream are foreign to our circulation and our physiology. For this reason, when the bubble enters the bloodstream, it is immediately attacked and treated like any other foreign substance that penetrates our body’s natural defenses. The bubbles are immediately coated with platelets, white blood cells and other proteins as they move towards the right side of the heart. As they pass through the venous and pulmonary circulation, they can damage or degrade the delicate lining of blood vessels (called endothelial glycocalyx and endothelial cells), causing local swelling of endothelial cells, inflammation, local activation of platelets and white blood cells, and even blockages in the small capillaries in the lungs, blood vessels, as well as a solid or fatty embolus. The latter has been shown to cause pulmonary edema and a very low platelet count (thrombocytopenia). It is assumed that over time the vesicles will gradually dissolve in the blood, but not before damaging this endothelial layer of the glycocalyx as they slide through the microcirculation.
The normal size of our capillaries (microvasculature) is 4 to 9 micrometers in diameter, but bubbles trying to pass through these capillaries can be hundreds or thousands of micrometers larger. If the bubbles enter the arterial blood that goes to the brain, they can cause neurocognitive dysfunction (memory loss, emotional disturbance, etc.) or stroke.
At birth, we are all born with a hole in the atrium wall of our heart that separates the right and left sides of our heart. This opening is called the foramen ovale, and it normally closes with our first breaths after birth, sending venous blood to the lungs and arterial blood to the brain and the rest of the body. Some defects in the foramen ovale do not close at birth and are later called patent foramen ovale (PFO), which can often be detected by auscultation, detection of heart murmurs and subsequent radiological follow-up. This PFO is still estimated to occur in about 10% to 35% of adults (or about 1 in 5-6 people) and has been reported as an important risk factor for stroke, cerebrovascular accidents, and transient ischemic attacks (TIA). Some people know they have PFO, but most adults don’t until a doctor discovers it. People generally function well and go through life with PFO until they are diagnosed during a routine exam or develop symptoms.
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Even in the absence of a PFO, microbubbles have the potential to travel from the venous circulation to the left side of the heart through existing shunts in the lungs called intrapulmonary arteriovenous anastomoses (IPAVA), which are simply small blood vessels that do not come into contact with the air sacs in our lungs and therefore allowing venous blood (and blockages) to pass directly to the left side of the heart. These IPAVA shunts are known to occur in approximately 30% of adults at rest, and their number may increase in all adults during exercise. Even a very small percentage of people (about 30/100.00) have small openings in the chambers of their heart wall (sometimes referred to as patent holes) that allow limited blood flow between the right and left sides of the heart, but may not cause problems for the individual persons.
Bubbles that enter the veins and travel to the heart’s right atrium are called venous air embolism (VAE), regardless of the size of the bubbles. VAEs have the potential to enter the left side of the heart and arterial circulation through PFOs or those with patent IPAVA shunts. When air bubbles pass from the right side of the heart to the left side of the heart, it is referred to as a paradoxical air embolism (PAE). PAE can then be pumped to the brain as the heart ejects blood from the left ventricle through the aortic valve.
The problem for healthcare professionals is that the vast majority of patients they care for ever show signs or warning signs that they may have a PFO or any degree of IPAVA leakage.
To determine the presence of a right-to-left shunt (especially a PFO), some cardiology clinics perform a test called a “bubble test.” This is a test where a fixed amount of saline (usually 9.0 ml) is mixed with a fixed amount of air (usually 1.0 ml) and shaken in syringes to produce a large number of small microbubbles. This microbubble solution is then injected into a vein while ultrasound is used to see if any of the microbubbles enter the left side of the heart through a hole in the heart wall (PFO). In theory, if there is a PFO, paradoxical air will be detected on the left side of the heart. However, in the absence of PFO, all microemboli should remain on the right side of the heart. heart and passes through the lungs, and venous blood is theoretically supposed to be removed through the alveoli. However, using ultrasound machines placed on both sides of the brain, researchers have discovered that cerebrovascular complications such as seizures (TIA) and stroke can occur in patients who have paradoxical air on the left side of the heart due to PFO or IPAVA shunts.
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An intraoperative study of 21 adult neurosurgical patients for the occurrence of PAE associated with venous air bubbles showed that all patients in the study had air bubbles on the right side of the heart. But more importantly, 3 of these 21 patients (14.3%) had air bubbles that had passed through the atria and lodged in the left side of the heart as a paradoxical air embolism… the right side of the heart was diffuse.
Going back to the statement that it takes a lot of air to hurt you, you wonder how much air it actually takes to create a sudden, life-threatening problem after air has entered your bloodstream. It was
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