Definition
Administering bolus medications also known as IV push involves delivering a concentrated dose of medication directly into the bloodstream over a short period (usually seconds to minutes). It’s a high stake, high impact procedure used when rapid therapeutic effects are needed, such as in emergencies or for medications with immediate action.
Introducing a single dose of concentrated medication directly into the systemic circulation. An IV bolus may be given as follow;
- Directly into a vein.
- Into an existing IV line through an injection port.
- Through a saline or heparin lock.
A saline lock consists of an indwelling needle or catheter attached to a plastic tube with a sealed injection port on the end.
Purposes
- Used in emergencies with critically unstable patient.
- To achieve immediate and maximum effect of a medication.
Disadvantages
- There is no time to correct in case of medication errors.
- Direct irritation to the lining of blood vessels.
Articles
- Clean gloves.
IV Push (Existing Line)
- Medication in ampoule or vial.
- Syringe (3-5 ml.).
- Sterile needle (optional).
- Alcohol swab.
- Wristwatch.
- Medication administration record.
IV Push (Intravenous Lock)
- Medication in vial or ampoule.
- Syringe (2-5 mL).
- Vial of heparin flush solution (1 mL = 100 units or 1 mL = 10 units) depending on agency policy or vial of normal saline.
- Sterile needles.
- Alcohol swab.
- Medication administration record.
Procedure
| Nursing action | Rationale | |
| 1. | Before procedure Check physician’s order for name of medication, dosage and route of administration. | Ensures safety and accuracy in medication administration. |
| 2. | Collect information necessary to administer drug safely including action, purpose, side effects, normal dose, time of onset, time of peak action, and nursing implications. | Allows nurse to give drug safely and to monitor patient’s response to therapy. |
| 3. | If drug is to be given through existing IV line, determine type of additive in IV solution, if any. | IV medication may not be compatible with additives. |
| 4. | Assess condition of needle insertion site for signs of infiltration or phlebitis. | Drugs should not be administered if site is edematous or inflamed. |
| 5. | Check patient’s history of drug allergies. | IV bolus delivers drugs rapidly. Allergic reaction could prove fatal. |
| 6. | Assemble supplies in medication room. | Ensures sterile preparation of medication. |
| 7. | During procedure Wash hands and don gloves. | Reduces transmission of infection. |
| 8. | Prepare medication from vial or ampoule. | |
| 9. | Check patient’s identification by asking name and compare with medication card. | Ensures that drug is administered to the correct patient. |
| 10. | IV push (existing line): a. Explain procedure to patient and encourage patient to report symptoms of discomfort at IV site. | Informs patient of planned therapies. |
| b. Select injection port of IV tubing closest to patient. Whenever possible, injection port should be a three-way port or other needleless device. | ||
| c. Connect syringe to iv line; In needleless system, remove cap of needleless injection port. Clean port with antiseptic solution. Insert standard tip of syringe containing prepared medication. in needle system, select port indicating site for needle insertion. Clean port with antiseptic swab. Insert a small gauge needle of syringe containing drug through center of port. | Cleaning of port before insertion prevents introduction of microorganisms. Inserting a small gauge needle of syringe containing drug through center of port prevents damage to port diaphragm. | |
| d. Occlude the intravenous line by pinching tubbing just above the injection port. Pull back gently on the syringe’s plunger to aspirate for a blood return. | Ensures that medication is being delivered in the bloodstream. | |
| e. After noting blood return, inject medication slowly over several minutes. | Rapid injection of an IV drug can be fatal. | |
| f. Observe IV site during injection for sudden swelling. | Determines development of infiltration into tissues surrounding vein. | |
| g. Release tubing after injecting medication, withdraw syringe, and recheck the fluid infusion rate. | Injection of a bolus may alter the rate of fluid infusion. Rapid fluid Infusion can cause circulatory fluid overload. | |
| 11. | Flush the three-way port in cases where medication is administered through a three-way port in which fluids are not flowing. a.Heparin flush method: Prepare a syringe with 1 mt heparin flush solution. Flush the iv line. | Flush solution keeps intravenous line patent after drug is administered. |
| b. saline flush method: Prepare syringe with 2 ml of normal saline. Flush the IV line. | Normal saline has been found to be effective in keeping intravenous lock patent. | |
| 12. | After procedure Dispose of uncapped needles and syringe in proper container. The needle into needle cutter and syringe (piston and barrel in red color container or receptacle with bleach as per agency policy). | Prevents accidental needle sticks. |
| 13. | Remove gloves and wash hands. | Reduces transmission of microorganisms. |
| 14. | Observe patient closely for adverse reactions during administration and for several minutes thereafter. | IV medications act rapidly. |
| 15. | Record drug, dose, route and time on medication forms. | Timely documentation prevents medication errors. |
| 16. | Report any adverse reactions to nurse in-charge or physician. | Adverse reactions to bolus may necessitate emergency measures. |
Special Considerations
- Some IV medications can only be pushed safely when the patient is being continuously monitored for dysrhythmias, blood pressure changes or other adverse effects. So, check the instructions before administering medication.
- At times, a saline or heparin lock will not yield a blood return even though the lock is patent. If IV medication is incompatible with IV fluids, stop the IV fluids, clamp the IV-line, flush with 10 mL of normal saline, the iv bolus over the appropriate amount of time.
- Flush with another 10 ml of normal saline at the same rate as the medication was administered and then restart the iv fluids at the prescribed rate.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
Connect with “Nurses Lab Editorial Team”
I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.
