Lab 4: IV Bolus

Question 1

what is an IV bolus

Answer 1

• the intro of a concentrated dose of a med directly into the patient’s systemic circulation

Question 2

what is the advantage of IV bolus

Answer 2

• requires only small amt of fluid to admin med = good if on restricted fluids

Question 3

what is a con to IV bolus

Answer 3

• most dangerous method for med admin
• no time to correct an error
• may cause direct irritation to lining of blood vessels

Question 4

what should you do before administering a bolus

Answer 4

• confirm placement of IV line by obtaining blood return

Question 5

what does the inability to obtain a blood return indicate

Answer 5

• needle or catheter is in patients tissues or resting against vein wall

Question 6

when should you never give an IV bolus

Answer 6

• if insertion site is puffy edematous, if IV fluid cannot flow at proper rate

Question 7

what can accidental injection of IV bolus into tissue around a vein cause (3)

Answer 7

• pain
• sloughing of tissues
• abscesses

Question 8

how do you determine the rate of admin of an IV bolus

Answer 8

• amt of med/min

Question 9

if you make an error during IV admin, what should you do and why?

Answer 9

• report immediately to minimize harm

Question 10

what should you do before and after admin of IV med? why?

Answer 10

• flush
• before = verify IV placement
• after = ensures right dose & time

Question 11

what are indications for IV push (4)

Answer 11

• emergencies –> fast acting
• if limited IV access
• if multiple meds to infuse
• for meds for pt comfort (nausea, pain)

Question 12

what makes giving a med IV push more critical than other secondary infusion methods (3)

Answer 12

• med acts quickly = adverse effects
• no time to correct errors
• irritating to veins

Question 13

what is order range

Answer 13

• the range indicated on the PDM

ex. morphine dose 2.5-5 mg

Question 14

describe the difference between diluted and nondiluted

Answer 14

• if PDM says undiluted you can still dilute (if dose is v small) –> best practice if to avoid diluting if PDM says not to
• if PDM says diluted, you must dilute it

Question 15

why is it best practice to not dilute a drug that says undiluted in PDM (3)

Answer 15

• potential for errors
• risk for contamination
• drug stability when diluted

Question 16

what is volume of diluent

Answer 16

• what the PDM specifies to dilute the med w

ex. dilute w 4mL NS + 1mL med = total 5 cc

Question 17

what is range of time to admin

Answer 17

ex. over 4 min

Question 18

what determines what size of syringe used in IV bolus

Answer 18

• how much you decide to dilute

Question 19

what is the amt of time that you pause?

Answer 19

• ???

Question 20

what are the 2 methods for IV push

Answer 20

1. via a saline lock (no primary fluid infusing)

2. via a port thru an infusing line

Question 21

when administering an IV bolus thru a port thru an infusing line, what port should you choose

Answer 21

• port closest to the pt

Question 22

what is the “push med and pause” method

Answer 22

ex. if need to give 5mL over 5 min
- give 1 mL, wait full minute
- after full minute, give next, etc.

Question 23

what are the steps for administernig IV bolus thru an infusing IV

Answer 23

• check rights (1st check)
• review pt info (allergies, pain, assessment)
• read PDM
• draw up med
• check rights (2nd check) & double check if required

at bedside:

• assess IV site, pt education, VS, assessment
• check rights (3rd check)
• kink tubing above injection site
• clean port
• administer bolus as per PDM
• release kinked tubing
• repeat until entire med given
• attach 3cc NS syringe & flush w 3cc @ same rate as bolus
• monitor pt

Question 24

what are the steps of IV bolus admin via saline lock

Answer 24

• check rights
• review pt info
• read PDM
• draw up med (check rights, 2nd check)
• assess IV site, NS flush / aspirate blood return
• check rights (3rd ceck)
• pt edu, assessment, VS prn
• admin bolus per PDM
• flush w 3cc NS (.5 cc @ same rate as bolus, flush remainder to saline lock)
• monitor pt

Question 25

what do you do if the IV med is not compatible w IV solution

Answer 25

• stop IV fluid
• clamp line
• flush line w 10 ccNS
• give IV bolus
• flush with 10cc NS @ same rate as bolus
• restart IV infusion

Answer 26

• check PDM first
• if no guidelines, dilute in 5-10 mL NS
  (ensures med doesnt collect in dead spaces (injection ports, etc.) and helps w timing of push

Question 27

what do you do if the primary rate is running fast (ex. 200 mL/hr)

Answer 27

• the bolus med will travel thru your line faster when you unkink –> possibly faster than PDM states is safe
• stop primary infusion
• give med through port (as per PDM)
• flush slow w 3 ccNS post-med
• then unkink and restart primary

Question 28

what do u do if the pt has an adverse reaction to an IV bolus (6)

Answer 28

• stop med & IV
• do not flush line
• report to MD
• chart incident & add allergy if needed
• benadryl
• monitor VS

Question 29

if a med is going to take >5min to push, what do you do

Answer 29

• best to make a minibag

Question 30

read skills 33-7 for thorough steps on med admin via IV bolus

Answer 30

…