IV Bolus

peripateticRN, BSN, RN · Jan 15, 2018

I generally would check how long the doc wants it run over - sometimes they say bolus but want it over a longer period of time - 2-3 hours. But generally speaking we would set the pump at 999 (and it infuses in an hour).

kaylee. · Jan 15, 2018

It depends on the condition of the patient. If they are unstable with an emergent event, bp in the 60s you might give 500/hr or even wide open. If they are chf this is taken into consideration but it may be that the benefit of fluid recsusitation in the moment outweighs the risk of overload.

Now lets say they are not as unstable but bp 70s - 80s but they need the bolus which can be given slower. The default in epic when you type "fluid bolus" puts the rate at 200/hr.

This is fine alot of the time. So it really depends on the unique situation. Dont hesitate to ask your charge or rrt what a good rate would be.

brownbook · Jan 15, 2018

I would go back to the doctor and tell them to write how much fluid to bolus and over how many minutes or hours.

As others have said, it can be a liter at the highest rate your pumps go, or 250 militers over 30 minutes.

It requires a Dr. order, not a guess by the nurse.

peripateticRN, BSN, RN · Jan 15, 2018

brownbook said:
I would go back to the doctor and tell them to write how much fluid to bolus and over how many minutes or hours.
As others have said, it can be a liter at the highest rate your pumps go, or 250 militers over 30 minutes.
It requires a Dr. order, not a guess by the nurse.

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!

JKL33 · Jan 15, 2018

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?

Is this a school question? This information doesn't tell you how much of a fluid bolus is actually ordered - which, putting aside the rate issue for a minute, you must know how much of a bolus is ordered (AKA the volume). If the ordered volume is the 1-L bag you have on hand, then that answers your question about how to set the volume.

I agree with others as far as the rate. There should be nursing policies or specific protocols that note exactly what is meant by "bolus." For example, sepsis protocols involve a 30 ml/kg "fluid challenge"/bolus over 30 minutes - - realize that for a 200-lb pt (90.9 kg) that is almost 3 liters of fluid (2,727 ml)...over 30 minutes.

Cat365 · Jan 15, 2018

Our department would run it at 999 because that's as fast as our pumps will go. If lactic is high or blood pressure is low we would grab a pressure bag to get it in faster.

Its generally understood in our department that a bolus runs over an hour. So whatever is ordered, barring any odd labs or vitals, will run over an hour. A 250 bolus goes in st 250, a 500 goes in at 500, and a liter at 999, because that's the pumps limit.

Cat365 · Jan 15, 2018

kaylee. said:
It depends on the condition of the patient. If they are unstable with an emergent event, bp in the 60s you might give 500/hr or even wide open. If they are chf this is taken into consideration but it may be that the benefit of fluid recsusitation in the moment outweighs the risk of overload.
Now lets say they are not as unstable but bp 70s - 80s but they need the bolus which can be given slower. The default in epic when you type "fluid bolus" puts the rate at 200/hr.
This is fine alot of the time. So it really depends on the unique situation. Dont hesitate to ask your charge or rrt what a good rate would be.

We have epic and our default is 999 so this is facility/department dependent.

candacern59217 · Jan 15, 2018

Find out your facility's policy. We run it at 999 unless there's a reason the patient can't tolerate it, like CHF/respiratory issues

akulahawkRN, ADN, RN, EMT-P · Jan 15, 2018

I work in the ED and for us, when a provider orders a fluid bolus, we run it wide open, whatever the volume is. If I need the fluid to infuse as fast as it'll go, I do two things: increase the height of the water column and/or grab a pressure infuser bag (or two). Remember that even a 22g will flow around 2100 mL/Hr if needed and a 20g will flow around 4L/Hr if needed. Normally I won't use anything bigger than an 18g because the flow rate is around 6L/hr. That being said, a 16g flows around 13L/HR and a 14g can go as high as around 19L/hr. I can count one hand the number of times I have used a catheter bigger than an 18g. I'm certainly not afraid to go big, but if I don't need a huge flow rate, there's no need to cause that kind of discomfort.

If I need some more fine control over the infused fluids, I'll put the fluids on a pump and set it for "999" because that's the max per channel. More fluids over that hour means more primary lines and more channels set at "999" with one of them set to stop "early" because it's only doing a partial bag. Most of the time I just do boluses via gravity as it's faster and I can run a single channel for the last partial bag to complete the bolus.

AnnieOaklyRN, BSN, RN, EMT-P · Jan 15, 2018

Generally a bolus is run at 999/hour on the pump and we do not know how much fluid is to be given bolus, so we cannot tell you how much volume to infuse.

Annie

JKL33 · Jan 15, 2018

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."