An intravenous push, often called an IV bolus, is a method of rapidly delivering a concentrated dose of medication directly into the patient’s bloodstream using a syringe. This technique bypasses the digestive system and continuous intravenous infusions, allowing the drug to reach therapeutic levels almost immediately. This rapid delivery is useful in emergency situations, such as administering pain medication or agents during cardiac events, where a swift onset of action is desired. Because the medication immediately enters the central circulation, this procedure carries an elevated risk of adverse reactions and requires a licensed professional trained in the precise administration technique.
Essential Pre-Administration Steps
Before administration, the healthcare provider must strictly adhere to patient safety protocols, beginning with the verification of the medication order. A thorough check of the physician’s order is mandatory, ensuring the drug name, dose, route, and time align with the patient’s current needs. This verification also involves confirming the patient’s identity using at least two unique identifiers and asking about known drug allergies to prevent hypersensitivity reactions.
The medication requires close inspection, including checking the expiration date and visually assessing the drug for any discoloration or particulate matter. A drug reference guide must be consulted to confirm the medication is approved for IV push administration, determine the correct dosage, and check the need for dilution or reconstitution. Dilution is often necessary to reduce the drug’s concentration, which helps minimize vein irritation and allows for a slower, safer push rate.
Checking the compatibility of the medication with any primary intravenous fluids or other drugs running through the same access line is a safety measure. Incompatible substances can precipitate, forming crystals that pose a risk of embolism and blocking the catheter.
All necessary supplies, including the medication syringe, two pre-filled saline flushes, alcohol pads, and gloves, must be gathered using strict hand hygiene and aseptic technique. Finally, the IV access site must be assessed for complications like infiltration, phlebitis, or infection, ensuring the catheter is patent and safe for use.
Executing the IV Bolus Administration
Administration begins with preparing the injection port, often called “scrubbing the hub,” by vigorously cleaning the needleless connector with an antiseptic wipe for at least 15 seconds. Allowing the port to air-dry completely is crucial for the antiseptic to effectively reduce the microbial load. The first saline flush is then connected to assess the patency of the intravenous line, ensuring the solution flows freely without resistance or causing the patient pain or swelling.
If a continuous primary infusion is running, the line must be momentarily paused or clamped above the injection port to prevent the drug from being pushed backward. Once patency is confirmed, the medication syringe is attached, and administration is timed precisely according to drug-specific recommendations. The rate of injection is a regulated factor, often measured in seconds per milliliter, and is determined by the drug’s potential for rapid systemic effects like hypotension or bradycardia.
The medication must be administered using a slow, steady push that is manually timed, with many drugs requiring administration over at least one to five minutes to mitigate the risk of “speed shock.” During administration, the professional must continuously observe the patient for immediate signs of adverse reactions, such as flushing, dizziness, changes in heart rhythm, or sudden pain. For drugs requiring a long push time, a “push-pause” technique may be employed, injecting the drug in small increments with brief pauses to ensure a consistent, slow rate and allow for ongoing assessment.
Post-Procedure Monitoring and Documentation
After the entire dose has been injected at the controlled rate, the syringe is removed, and the injection port is cleaned again. A second saline flush is immediately administered, typically using the same controlled rate as the medication push, to ensure the full dose is cleared from the catheter and delivered into the bloodstream. This final flush also prevents interaction between the administered drug and subsequent medications or fluids.
If a continuous primary infusion was paused, it must be promptly restarted at the prescribed rate following the final flush. The patient’s immediate response is assessed, including a post-administration set of vital signs and a subjective assessment of symptoms like pain level or nausea. The intravenous site is also closely inspected for localized complications, including swelling, redness, or pain, which could indicate infiltration or phlebitis.
Accurate and complete documentation is a mandatory legal and clinical requirement, which must be performed immediately after the procedure. The charting includes the exact name and dose of the medication administered, the date, time, route, and the specific injection site used. The patient’s response, whether positive (e.g., pain relief) or negative (e.g., adverse reaction), must also be recorded to provide a full clinical record of the procedure and the outcome.