Lab 4: IV Bolus Flashcards
what is an IV bolus
- the intro of a concentrated dose of a med directly into the patient’s systemic circulation
what is the advantage of IV bolus
- requires only small amt of fluid to admin med = good if on restricted fluids
what is a con to IV bolus
- most dangerous method for med admin
- no time to correct an error
- may cause direct irritation to lining of blood vessels
what should you do before administering a bolus
- confirm placement of IV line by obtaining blood return
what does the inability to obtain a blood return indicate
- needle or catheter is in patients tissues or resting against vein wall
when should you never give an IV bolus
- if insertion site is puffy edematous, if IV fluid cannot flow at proper rate
what can accidental injection of IV bolus into tissue around a vein cause (3)
- pain
- sloughing of tissues
- abscesses
how do you determine the rate of admin of an IV bolus
- amt of med/min
if you make an error during IV admin, what should you do and why?
- report immediately to minimize harm
what should you do before and after admin of IV med? why?
- flush
- before = verify IV placement
- after = ensures right dose & time
what are indications for IV push (4)
- emergencies –> fast acting
- if limited IV access
- if multiple meds to infuse
- for meds for pt comfort (nausea, pain)
what makes giving a med IV push more critical than other secondary infusion methods (3)
- med acts quickly = adverse effects
- no time to correct errors
- irritating to veins
what is order range
- the range indicated on the PDM
ex. morphine dose 2.5-5 mg
describe the difference between diluted and nondiluted
- 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
why is it best practice to not dilute a drug that says undiluted in PDM (3)
- potential for errors
- risk for contamination
- drug stability when diluted
what is volume of diluent
- what the PDM specifies to dilute the med w
ex. dilute w 4mL NS + 1mL med = total 5 cc
what is range of time to admin
ex. over 4 min
what determines what size of syringe used in IV bolus
- how much you decide to dilute
what is the amt of time that you pause?
- ???
what are the 2 methods for IV push
- via a saline lock (no primary fluid infusing)
2. via a port thru an infusing line
when administering an IV bolus thru a port thru an infusing line, what port should you choose
- port closest to the pt
what is the “push med and pause” method
ex. if need to give 5mL over 5 min
- give 1 mL, wait full minute
- after full minute, give next, etc.
what are the steps for administernig IV bolus thru an infusing IV
- 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
what are the steps of IV bolus admin via saline lock
- 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
what do you do if the IV med is not compatible w IV solution
- stop IV fluid
- clamp line
- flush line w 10 ccNS
- give IV bolus
- flush with 10cc NS @ same rate as bolus
- restart IV infusion
- 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
what do you do if the primary rate is running fast (ex. 200 mL/hr)
- 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
what do u do if the pt has an adverse reaction to an IV bolus (6)
- stop med & IV
- do not flush line
- report to MD
- chart incident & add allergy if needed
- benadryl
- monitor VS
if a med is going to take >5min to push, what do you do
- best to make a minibag
read skills 33-7 for thorough steps on med admin via IV bolus
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