Bolus

Your protocols for a hep bolus should tell you how fast to run it. It isn't much fluid, so I push it and then hang the drip.

As far as the NS 1L bolus, in theory, this is as fast as you can run it. Now,..in reality. How big is your IV? Why are we giving the bolus? How big is your pt? What kind of hx does your pt have? If I'm sharing a 30yr old, 85kg, otherwise healthy male a bolus because he's been vomiting for three days and is dehydrated, And I have at least an 18g, I will set the pump as high as it will go,.ours have a bolus setting that I believe is 800ml/hr. I'm in ER and wouldn't use a pump; I can usually dump 1000ml in 30 minutes with a good 18g. Of course, I can cut that to about 5 min with a pressure bag.

I hope that answers some of your questions.

Where I work, we run a fluid bolus via pump @ 999 ml/hr. That's the highest rate for the pumps we use. If you have maintenance fluids ordered after the bolus, I piggyback the bolus, with the bag of maintenance fluids hanging as the primary to pick up when the bolus is complete.

As for heparin bolus, your facility should have a policy/procedure for heparin infusion. I want to say I've seen a bolus over 10 minutes followed by a weight-based drip, and this would also depend on physician preference.

And there are no stupid questions -- I've been told that the most dangerous nurse is the one who doesn't ask questions.

My preceptor gave me the best advice - "know what you don't know, and know who you can ask"

I hope this helps; interested to see how many other ways there are to bolus a pt.

I just started a new job after not being on the floor for a while...

The order read 1 Liter NS bolus @ 125 cc/hr. I asked a couple of people because I thought bolus meant wide open. Evidently, in this case, it just meant 1 liter now. 

We usually get an order for how much the bolus is for and how long to run it over. So if we order 1 liter over 30 minutes, our pumps will only go at 999 ml/hr, so we'll sometimes hang 2 500 ml bags on two separate pump channels at 999 ml/hr each and y them together to get the 1998 ml/hr rate.

You MUST ensure that the order includes the duration of the bolus.

Ex. 500 ml bolus of NS over 1 hr.

It is always a good idea to get it clarified by the physician in case there are underlying conditions that may contradict the bolus running in too fast.

The term bolus doesn't have anything to do with the amount of time the infusion is administered.

It has to do with volumes and doses and means giving a specified amount above and beyond, or in addition to, the current amount.

For example:

Bolus 25 ml of 25% Albumin over 30 mins for CVP.

999 on a pump. If exsanguination is an issue, sometimes you can get fluid in faster with a gravity feed and a pressure bag.

Thank you all for replying; it has clarified my confusion.

Aloha.