Intravenous Medication Administration
Administering Medications by Intravenous Bolus
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Take the Review Test:
Safety
- Monitor patients closely for adverse reactions during and shortly after giving an IV bolus, since this method allows medication to act quickly and leaves no time to correct errors.
- Double-check all calculations. Use a medication reference to review the rate of administration for all IV push medications. Normal saline (0.9%) flush following the IV medication must be administered at the same rate as the medication. Use a less concentrated solution whenever possible.
- Avoid using terms in orders such as “IV push” and “IV bolus” to describe medications that should be administered over 1 minute or longer. Use more descriptive language, such as, “Give IV over 5 minutes.”
- Some direct IV medications may be given only if the patient is being continuously monitored for dysrhythmias or blood pressure changes.
- IV push medications carry an increased risk of infiltration and phlebitis, especially if a highly concentrated medication is delivered, a small peripheral vein is used, or the medication is administered by means of a short venous access device.
- To avoid extravasation, confirm placement of the IV catheter or needle. Avoid small veins and veins on the back of the hand if possible.
- Never prepare high-alert medications (e.g., heparin, dopamine, dobutamine, nitroglycerin, potassium, antibiotics, or magnesium) on a patient care unit.
- Use standardized concentrations for all infusion medications.
Equipment
(Roll cursor over items to see labels)
Watch with second hand
Clean gloves
Clear, occlusive dressing
Tape
Antiseptic swabs
Medication in vial or ampule
Safety syringe
Three prefilled NS flushes in 10 mL syringes
Saline lock with J loop
PrintableDelegation
The skill of administering medications by IV bolus may not be delegated to nursing assistive personnel (NAP). Be sure to inform NAP of the following:
- Explain the potential actions and side effects of the medications and when to report their occurrence to the nurse.
- Request that NAP report any patient complaints of moisture or discomfort around the insertion site.
- Instruct NAP to obtain any required vital signs and report them to you.
Preparation
- Check the accuracy and completeness of each MAR or computer printout against the prescriber’s written medication order. Confirm the patient’s name, medication name and dosage, route of administration, and time of administration. Clarify incomplete or unclear orders with the health care provider. Note if the patient has allergies.
- Review medication’s action, purpose, side effects, normal dose, time of peak action, how slowly to give the medication, and nursing implications, such as the need to dilute the medication or administer it through a filter.
- If you give medication through an IV line with continuous infusion, determine the compatibility of the medication with the running IV fluids and with any additives in the IV solution.
- Assess the condition of the IV insertion site for signs of infiltration or phlebitis.
- Assess the patency of the patient’s existing IV line or saline lock.
Follow-up
- Observe the patient closely for adverse reactions during administration and for several minutes thereafter. Report any adverse effects to the health care provider.
- Observe the IV site during injection for sudden swelling and for 48 hours afterward.
- Assess the patient’s status after giving the medication to evaluate its effectiveness.
Documentation
- Record the time of administration, dose and concentration of the medication, site location, and infusion time on the MAR immediately after administration, not before. Include your initials or signature.
- Document the location and appearance of the IV site before and after medication.
- Report any adverse reactions to the health care provider. Patient response sometimes indicates the need for additional medical therapy.
- Record any special monitoring if required with IV bolus medication.
Review Questions
1. Which statement might a nurse make to nursing assistive personnel (NAP) when caring for a patient prescribed an intravenous (IV) bolus of analgesic medication?
“Assess the IV site frequently for signs of inflammation.”
“Let me know immediately if the patient complains of pain at the insertion site.”- “Make sure the patient knows what results to expect from the medication.”
- “Observe the IV site for sudden swelling when the IV bolus is administered.”
INCORRECT. Patient assessment may not be delegated to NAP.
CORRECT. This is an instruction the nurse might give, because the task of reporting a patient complaint may be delegated to NAP.
INCORRECT. Patient education may not be delegated to NAP.
INCORRECT. No aspect of patient assessment or medication administration may be delegated to NAP.
2. Which patient safety issue is specific to administration of medication by IV bolus?
- Determining that the medication is compatible with the IV solution
- Checking for patient allergies before giving the medication
- Identifying the patient using two identifiers
- Checking the medication against the medication administration record (MAR) three times
CORRECT. Medication that is incompatible with the running IV solution could form a precipitate and endanger the patient’s health.
INCORRECT. The necessity of checking for patient allergies is applicable to all routes of medication administration.
INCORRECT. The necessity of properly identifying the patient before administering a medication is applicable to all routes of administration.
INCORRECT. The necessity of checking the medication against the MAR three times is applicable to all routes of medication administration.
3. What is the most important action the nurse can take to protect the patient when administering a narcotic analgesic by IV bolus?
- Injecting the medication at the prescribed rate
- Observing the insertion site after giving the medication
- Instructing the patient about side effects to report to the nurse
- Using an alcohol swab to wipe the insertion port on the primary tubing
CORRECT. Injecting the medication at the prescribed rate is the most important action the nurse can take to protect the patient when administering a narcotic analgesic by IV bolus, since injecting the medication faster than recommended may result in injury or death.
INCORRECT. Although observing the insertion site after giving the medication is appropriate, injecting the medication at the recommended rate is of greater concern.
INCORRECT. Although it is important for the patient to understand potential side effects, injecting the medication at the recommended rate is of greater concern.
INCORRECT. Use of an alcohol swab is important, but it is not the first priority in keeping a patient safe during IV bolus administration. Injecting the medication at the recommended rate is of greater concern.
4. How can the nurse best minimize the patient’s risk for infection when administering an IV bolus of an analgesic?
- Use the injection port closest to the patient.
- Assess the IV insertion site for signs of infiltration.
- Follow aseptic technique during the entire process.
- Instruct the patient to report any adverse medication reactions.
INCORRECT. Although the nurse should use the closest injection port, aseptic technique is critical to reducing the risk for infection.
INCORRECT. It is important to assess the insertion site for infiltration, but aseptic technique is the principal way to prevent infection when administering an IV bolus.
CORRECT. Using aseptic technique minimizes the patient’s risk for infection.
INCORRECT. Patients should be instructed to report adverse reactions, but doing so will not reduce the risk for infection.
5. If the nurse does not see blood return when aspirating the saline lock in preparation for an IV bolus medication, what is the next step?
- Attempt to aspirate the site again.
- Prepare to access another IV site.
- Assess the saline lock site for signs of phlebitis.
- Assess the site for swelling or coolness while flushing the saline lock with normal saline.
INCORRECT. There is little chance that a second attempt to aspirate will provide blood return.
INCORRECT. Finding a new site may not be necessary.
INCORRECT. Lack of blood return does not indicate phlebitis.
CORRECT. Blood return may be absent with a smaller-gauge catheter. Infusing normal saline while checking for infiltration ensures that the catheter tip is both patent and in the vein.
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