IV Bolus not so simple
- 0Sep 21, '03 by ohbetToday Dr. ordered a patient to receive a Bolus of 500cc of NS. The IV was running 75cc/hr via IV pump.
A nurse tried to run the IV bolus, thru the pump,because all she had was IV pump tubing,but she turned the pump off and hoped it would flow by gravity thru the pump with the pump turned off but for some reason the NSwould not flow by gravity thru the turned of IV pump. All we had on the floor was IV tubing to be used in a pump,no regular tubing to be used simply by gravity.
I went home before I found out how they ran the Bolus but I wanted to ask,can you run a Bolus by an IV pump?,and if so,how fast would it go in? I think they were talking about running by the pump at 300cc per hr.,but I dont know why they chose that rate.
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- 0Sep 21, '03 by GldngrlIt depends on how fast you need to infuse the bolus, what kind of access you have, your pt's condition and their ability to tolerate a rapid bolus. Normally, I set my pump volume at its highest infusion rate "999" and set the volume to be infused at 500 or whatever was ordered, but this is going thru a central line in postop abd. surg. patients that are hypotensive d/t hypovolemia and can handle the fld. Sometimes if you have a smaller gauge peripheral access, the pump is going to beep off if you try running fld thru that fast or you'll blow your access so you need to run it slower. We also have a hospital policy that we can't run anything off pump. MMB
- 0Sep 21, '03 by bellehillI usually get a 500cc bag (or whatever is ordered), set it up as a piggyback as fast as the patient can tolerate. Setting it as a piggyback with allow the fluid to switch back to the original setting without beeping and bugging everyone.
Most pumps clamp off when the tubing is in the loading chamber. Perhaps this is why the NS wouldn't flow by gravity?
- 0Sep 21, '03 by dianah Senior ModeratorIn the same way we're not to use TKO or KVO anymore (a rate must be specified in the MD orders), I would think the term "bolus" is too general/vague. I would extract from the ordering MD the rate of the infusion (based on, as others have noted above, pt's ability to handle rapid influx of fluid) as well as the amount. It just seems safest to me, unless there is a P and P set up, approved by the MDs (which, IMO, is still subject to the pt's condition).
- 0Sep 22, '03 by grneyes676Most pump tubing can be ran just as gravity...just dont put it in the machine. It depens on what pumps you use, but there is some sort of clamp that is on the tubing part that would go into the machine, you use that just as if it were a roller clamp.
I prefer to run my boluses by gravity if it is a PIV, that way the run at there own rate, not with to much pressure, less chance of blowing your IV!!