Skill 36

Intravenous Medications

Intravenous Bolus

An intravenous (IV) bolus introduces a concentrated dose of a medication directly into a vein by way of an existing IV access. An IV bolus, or “push,” usually requires small volumes of fluid, which is an advantage for patients who are at risk for fluid overload. The IV bolus is a dangerous method for administering medications because it allows no time for correction of errors. Therefore, be very careful in calculating the correct amount of the medication for administration. In addition, a bolus may cause direct irritation to the lining of blood vessels; thus always confirm placement of the IV catheter or needle. Accidental injection of some medications into tissues surrounding a vein can cause pain, sloughing of tissues, and abscesses.

The Institute for Safe Medication Practices (2011) has identified the following four strategies to reduce harm from rapid IV push medications:

▪ Make sure that the information regarding rate of administration of IV push medication is readily available.

▪ Use less-concentrated solutions whenever possible.

▪ Avoid using terms such as IV push, IVP, or IV bolus in orders with medications that should be administered over 1 minute or longer. Use more descriptive terms such as IV over 5 minutes.

▪ Consider alternatives such as a syringe pump to administer a medication that has a high risk for adverse effects. If this is not an alternative to IV push, have pharmacy dilute the medication and administer in a piggyback.

Verify the rate of administration of IV push medication using institutional guidelines or a medication reference manual.

Delegation Considerations

The skill of administering intravenous medications by IV bolus cannot be delegated to nursing assistive personnel (NAP). The nurse directs the NAP about: