IV Bolus Question

Published

I am an RN student, finishing in two months!!! The other day at clinical, the doctor ordered a 500cc NS Bolus. Now, I've never been taught anything else than to run the bolus through a pump as fast as possible. However, the nurse with me that day said that that was incorrect. She told me that the entire purpose of a bolus is to quickly make a change in the patient, and if we were to run it through a pump, it wouldn't be as effective. Her method was to raise the IV pole up as high as it would possibly go and run that bolus in wide open, carefully watching for any patient reactions. This was news to me. Does everyone do this or is this a preference of my nurse that day?

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Specializes in Nephrology, Cardiology, ER, ICU.

In the ER - we ran it in as fast as it would go. I'll be honest though - that if I could stay in the room with the pt I would do the gravity method. However, if I was at all concerned about fluid overload, then I used a pump. If I was really concerned about fluid overload, I only used a 500cc bag of fluid so that I was absolutely sure that no more than the 500cc infused. Then...if I needed more fluid, I had another bag ready.

BTW - even if ran in 500cc as fast as an IV pump could run (999cc/hour), it would take 30 minutes for the 500cc to run in. By gravity, you can get 500cc in much, much faster.

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Specializes in Adult and Pediatric Vascular Access, Paramedic.

You can run a bolus through a pump or by gravity, depends on personal preverence, and the situation. Pumps can be set at fast rates which would deliver bolus fairly quickly; however please keep reading:

When a doctor orders a "bolus" of fluid the healthcare provider must use judgement in deciding how fast this bolus should be delivered. It is one thing if the patient is young and healthy and an adult, but for the really old (and any patient with renal disease and/or heart disease) or for the really young, a fast bolus could put them in fluid overload! So what I am saying is not all boluses shoudl be delivered quickley and by gravity, there are situations when a fluid bolus shoud be delivered over at least an hour and on a pump.

Swtooth

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You can run a bolus through a pump or by gravity, depends on personal preverence, and the situation. Pumps can be set at fast rates which would deliver bolus fairly quickly; however please keep reading:

When a doctor orders a "bolus" of fluid the healthcare provider must use judgement in deciding how fast this bolus should be delivered. It is one thing if the patient is young and healthy and an adult, but for the really old (and any patient with renal disease and/or heart disease) or for the really young, a fast bolus could put them in fluid overload! So what I am saying is not all boluses shoudl be delivered quickley and by gravity, there are situations when a fluid bolus shoud be delivered over at least an hour and on a pump.

Swtooth

Thank you for clarifying this. It made me wonder when this nurse had told me that ALL boluses should be given via gravity. I had thought the same thing about renal disorders and heart problems, but I just needed some extra opinions. Thanks a bunch!!

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