IV Bolus

[mariok]

Giving an IV Bolus of NS with a pump, pt has a 20 gauge and is physically able to tolerate fluids well. What do you set the rate at? What do you set the volume to be infused at if it is a 1 L bag?

[Cat365]

JKL33 said:

I think it's kinda funny how many say a bolus is 999 ml/hr.

It wasn't THAT long ago that regular IV pumps could max out at 1999 ml/hr. So guess what everyone said "bolus" meant, back then?

Moral: You really should know what the provider means by "bolus."

A relatively large volume of fluid or dose of a drug or test substance given intravenously and rapidly to hasten or magnify a response; in radiology, rapid injection of a large dose of contrast medium to increase opacification of blood vessels.

I don't think the definition changes per provider. It's the speed and amount that change.

[JKL33]

Cat365 said:

A relatively large volume of fluid or dose of a drug or test substance given intravenously and rapidly to hasten or magnify a response; in radiology, rapid injection of a large dose of contrast medium to increase opacification of blood vessels.

I don't think the definition changes per provider. It's the speed and amount that change.

I sense an attempt at sarcasm.

Since this is possibly one of the most nonsensical things I've ever read here, I'll simply say "duly noted."

[Mavrick, BSN, RN]

mariok said:

Giving an IV Bolus of NS with a pump, pt has a 20 gauge and is physically able to tolerate fluids well. What do you set the rate at? What do you set the volume to be infused at if it is a 1 L bag?

You MUST have a volume with this order. Technically you should also have the rate also ordered such as 1 liter over an hour and you can calculate the rate.

A lot of times though the rate is situation dependent. WHY is the pt getting the bolus? Heart condition? Vein condition? Gravity or pump or pressure bag?

Interesting question, though.

[dmarsh69]

100cc/hr

[mariok]

Pt was getting the Bolus due to hypotension

[gemmi999]

Hypotension could be a lot of things. If the pressure is 89/65, that's very different from a pressure of 40/20, etc. Are they on a medication that can cause the hypotension--for example, Levaquin? In that case I would slow down the rate of the antibiotic before checking with the MD about a fluid bolus.

Typically I just hang fluid bolus' to gravity but there have been cases where I start a pt's fluid bolus, take the pt. from the ED to the floor, and the floor RN is upset b/c the bolus isn't on a pump and then wants to restart the bolus with the tubing she has already primmed, etc.

So, yes, situation dependent. Also, zebra and horses dependent. I work in an ER with a *bunch* of SNFs around. When I get pt's who are hypotensive from the field, I first think of Sepsis. I did a day at a facility without any SNFs around, and when I got a hypotensive pt, the provider's first thought wasn't Sepsis but rather something benign. And fluid bolus' ordered in both situations were different b/c of the rational behind the bolus. Sepsis? 30mL/kg wide open FAST; the other pt? 250mL bolus over 1 hr.

So, the point, check with the provider if you're unsure of the cause of the hypotension. The cause should dictate the rate, if it's emergent vs just slightly hypotensive (is the pt's sleeping, etc, did you just give Ativan or another med that alters BP).

This feels very rambly to me, hope it helps.

[Ruby Vee, BSN]

mariok said:

Giving an IV Bolus of NS with a pump, pt has a 20 gauge and is physically able to tolerate fluids well. What do you set the rate at? What do you set the volume to be infused at if it is a 1 L bag?

Are you in an ICU, a stepdown or the floor? Is the patient an infant, child, or adult? Is the adult a strong, athletic man or a frail little old lady on the verge of CHF? Why are they getting the bolus?

In my SICU, I usually just run them in without a pump (and make sure I'm in the room to watch). Otherwise, 999cc/hour and 999 volume.

[Mavrick, BSN, RN]

dmarsh69 said:

100cc/hr

Not a bolus rate for any normal adult. Is this a typo? 1000ml/hr would be more like it.

[HalfBoiled, BSN, RN]

Given that you said "bolus", it would be 999ml/hr.

[PeakRN]

Depends on health history and indication. For example when we bolus for sepsis our goal time is less than 30 minutes for almost every patient (unless we are bolusing based on fluid response from hemodynamic monitoring), so the rate is is a function of how fast their fluids will go through their angios with a pressure bag at 300 mmHg. These are also patients who we know may become fluid overloaded and would rather bipap/tube them than have them decompensate because we didn't adequately bolus their fluids.

On pediatric patients we give their bolus over an hour (excluding sepsis, trauma, et cetera), so their rate is whatever their volume is over an hour.

Most of our boluses (dehydrated gastro, hung over, et cetera) are given wide open with one meter of elevation, so for a 20 guage that would be about 50-60 mL/minute.

[ICU56]

For ICU its at least a liter and its 999 ml/Hr. I don't really care to ask much more than that from the provider about boluses because I don't really need to, I know what to do and what my intensivists want or if its for sepsis or dehydration I have protocols for the unit. Hypotension should be corrected, we are protective of MAP and if the patient is less than 60 and symptomatic it is an emergency, if the patient isn't readily fluid responsive after the first liter or two depending on circumstances than I'm getting a vasopressor.

[CKPM2RN, ASN, EMT-P]

peripateticRN said:

Totally this

Although when I was in the ED and asked for that that detail I was scoffed at and told something to the effect of "a bolus is a bolus - you run the prescribed amount as fast as it'll go".. so I'm going to say its situation and department dependant!

In emergency situations both in hospital and pre-hospital a typical "bolus" is 250cc's wide open. Make sure you watch it or it will be 500cc's or more before you know it. A 20 gauge in a good vein will flow a lot faster than you think.