Download I.V. bolus injection

I.V. bolus injection
The I.V. 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 I.M., 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. I.V. push is a technique for rapid
I.V. injection. Bolus doses of medication may be injected directly into a vein, through an
existing I.V. line, or through an implanted vascular access port (VAP). 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. I.V. bolus
injections are contraindicated when rapid drug administration could cause life-threatening
complications. For certain drugs, the safe rate of injection is specified by the
manufacturer. Some facilities permit only specially trained nurses (such as emergency
department, critical care, and chemotherapy nurses) to give bolus injections.
EQUIPMENTPatient’s medication record and chart gloves prescribed medication 20G
needle and syringe diluent, if needed tourniquet povidone-iodine or alcohol sponge sterile
2" × 2" gauze pad adhesive bandage tape optional: winged-tip needle with catheter and
second syringe (and needle) filled with normal saline solution; noncoring needle if used
with a VAP; heparin flush solution. Winged-tip needles are often used for this purpose
because they can be quickly and easily inserted. They’re ideal for repeated drug
administration, as in weekly or monthly chemotherapy. Another useful dosage form is the
ready injectable. (See Using a ready injectable.) EQUIPMENTUSING A READY
INJECTABLE A commercially premeasured medication packaged with a syringe and
needle, the ready injectable allows for rapid drug administration in an emergency.
Usually, preparing a ready injectable takes only 15 to 20 seconds. Other advantages
include the reduced risk of breaking sterile technique during administration and the easy
identification of medication and dose. When using a commercially prefilled syringe, be
sure to give the precise dose prescribed. For example, if a 50 mg/ml cartridge is supplied
but the patient’s prescribed dose is 25 mg, you must administer only 0.5 ml — half of the
volume contained in the cartridge. Be alert for potential medication errors whenever
dispensing medications in premeasured dosage forms. PREPARATION OF
EQUIPMENTVerify the order on the patient’s medication record by checking it against
the doctor’s order. Know the actions, adverse effects, and administration rate of the
medication to be injected. Draw up the prescribed medication in the syringe and dilute it
if necessary. IMPLEMENTATIONConfirm the patient’s identity, wash your hands, put
on gloves, and explain the procedure. Giving direct injections Select the largest vein
suitable for an injection. The larger the vein, the more diluted the drug will become,
minimizing vascular irritation. Apply a tourniquet above the injection site to distend the
vein. Clean the injection site with an alcohol or a povidone-iodine sponge, working
outward from the puncture site in a circular motion to prevent recontamination with skin
bacteria. If you’re using the drug syringe’s needle, insert it into the vein at a 30-degree
angle with the bevel up. The bevel should reach 1/4" (0.6 cm) into the vein. If you’re
using a winged-tip needle, insert the needle (bevel up), tape the butterfly wings in place
when you see blood return in the tubing, and attach the syringe containing the medication.
Pull back on the syringe plunger and check for blood backflow, which indicates that the
needle is in the vein. Remove the tourniquet and inject the drug at the appropriate rate.
Pull back slightly on the syringe plunger and check for blood backflow again. If blood
appears, this indicates that the needle remained in place and all the injected medication
entered the vein. Flush the line with the normal saline solution from the second syringe to
ensure delivery of all the medication. Withdraw the needle and apply pressure to the
injection site with the sterile gauze pad for at least 3 minutes to prevent hematoma
formation. Apply the adhesive bandage to the site after bleeding has stopped. Giving
injections through an existing I.V. line Check the compatibility of the drug with the I.V.
solution. Close the flow clamp, wipe the injection port with an alcohol sponge, and inject
the medication as you would a direct injection. (Some I.V. lines have a secondary
injection port or a T-connector; others have a latex cap at the end of the I.V. tubing where
the needle is attached.) Open the flow clamp and readjust the flow rate. If the drug isn’t
compatible with the I.V. solution, flush the line with normal saline solution before and
after the injection. (For additional information, see the section on intermittent infusion
devices.) Giving a bolus injection through a VAP Wash your hands, put on gloves, and
clean the injection site with an alcohol or povidone-iodine sponge, starting at the center
of the port and working outward in a circular motion over a 4" to 5" (10- to 12.7-cm)
diameter. Do this three times. Palpate the area over the port to locate the port septum.
Anchor the port between your thumb and the first two fingers of your nondominant hand.
Then, using your dominant hand, insert the needle into the appropriate area of the device
and deliver the injection. (See the section on vascular access device maintenance.)
SPECIAL CONSIDERATIONSBecause drugs administered by I.V. bolus or push
injections are delivered directly into the circulatory system and can produce an immediate
effect, an acute allergic reaction or anaphylaxis can develop rapidly. If signs of
anaphylaxis (dyspnea, cyanosis, seizures, and increasing respiratory distress) occur, notify
the doctor immediately and begin emergency procedures, as necessary. Also watch for
signs of extravasation, redness, or swelling. If extravasation occurs, stop the injection,
estimate the amount of infiltration, and notify the doctor. If you’re giving diazepam or
chlordiazepoxide hydrochloride through a winged-tip needle or I.V. line, flush with
bacteriostatic water instead of normal saline solution to prevent drug precipitation
resulting from incompatibility. COMPLICATIONSExcessively rapid drug
administration may cause adverse effects, depending on the medication administered.
DOCUMENTATIONRecord the amount and type of drug administered, time of
injection, appearance of the site, duration of administration, and patient’s tolerance of the
procedure. Also note the drug’s effect and any adverse reactions.