IV Bolus Injection
The IV bolus injection method allows rapid drug administration. It can be used in an emergency to provide an immediate drug effect. It can also be used to administer drugs that can’t be given IM, to achieve peak drug levels in the bloodstream, and to deliver drugs that can’t be diluted, such as diazepam, digoxin, and phenytoin. The term bolus usually refers to the concentration or amount of a drug. IV push is a technique for rapid IV injection.
Bolus doses of medication may be injected directly through an existing venous access device or through an implanted port. The medication administered by these methods usually takes effect rapidly, so the patient must be monitored for an adverse reaction, such as cardiac arrhythmia and anaphylaxis. IV bolus injections are contraindicated when rapid drug administration could cause life-threatening complications. The safe rate of injection is specified by the drug’s manufacturer.
Equipment
Patient’s medication record ▪ patient’s medical records ▪ gloves ▪ antiseptic pads (alcohol, tincture of iodine, or chlorhexidine-based) ▪ prescribed medication ▪ prefilled-syringe containing preservative-free normal saline solution ▪ syringe and needleless adapter ▪ diluent, if needed ▪ Optional: second syringe (and needless adapter) filled with preservative-free normal saline solution.
A useful dosage form is the ready injectable. (See Using a ready injectable, page 420.)
Implementation
Avoid distractions and interruptions when preparing and administering medications to prevent medication administration errors.1
Verify the order on the patient’s medication record by checking it against the doctor’s order in his medical record.2
Compare the medication label to the doctor’s order to verify the correct medication, indication, dose, route, and time of administration.2
Check the expiration date; return the medication to the pharmacy if it’s expired.2
Check the patient’s medical record for an allergy or other contraindication to the prescribed medication. If an allergy or other contraindication is present, don’t administer the medication and notify the doctor.2
Visually inspect the medication for discoloration or any other loss of integrity. Don’t administer the medication if its integrity is compromised.
Check the compatibility of the medication with the IV solution and any medicated infusions that are infusing.
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