1. 1.When a MD writes an order, say bolus 1 liter of NS....that means wide open right? The problem is our IVF are on a do I take the tube off the pump and let it run wide open by gravity? and if I do that the fluid sometimes does not run very fast. If I bolus with a pump how much do I set the pump for?
    2. If a MD writes a order to bolus heparin at X do I do that?

    These may seem like bone head questions...if so...then so be it.
    Thank you all for your help....this site is a great resource.
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    About garciadiego

    Joined: Feb '06; Posts: 204; Likes: 29
    from HI , US


  3. by   BrnEyedGirl
    Your protocols for a hep bolus should tell you how fast to run it. It isn't a large amount of actual fluid so I always 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 in. Now, 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 giving a 30yr old, 85kg, otherwise healthy male a bolus because he's been vomitting for 3 days and is dehydrated,..AND I have at least an 18g, I would 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 I wouldn't use a pump,..I can usually dump 1000ml in 30 min with a good 18g,..of course with a pressure bag I can cut that to about 5 min.

    Hope that answers some of your question.
  4. by   nurse2b_bakey
    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 policy/procedure for heparin infusion. i wanna say i've seen bolus over 10 minutes followed by a weight based drip. 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"

    hope this helps, interested to see how many other ways there are to bolus a pt.
  5. by   Gititgirl7
    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.
  6. by   blondy2061h
    We usually get an order for how much the bolus is for and how long to run it over. So if we get an order for 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 999ml/hr each and y them together to get 1998 ml/hr rate.
  7. by   ladybugdivarn
    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.
  8. by   Daytonite
    A bolus could mean anything to anybody. That's an irresponsibly written order. I wouldn't do anything without calling the doctor to get a specific infusion rate.
  9. by   RazorbackRN
    The term bolus doesn't have anything to do with the amount of time over which 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 < 6. May repeat x 1.
  10. by   mpccrn
    999 on a pump. if exanguination is an issue sometimes you can get fluid in faster with a gravity feed and a pressure bag
  11. by   garciadiego
    Thank you all for replying, it has clarified my confusion.