Intravenous (IV) Bolus Medication: Administration Through an Intermittent Continuous Infusion Line (Nursing)

00:00 Let's take a look at the skill Administration of an IV Push Through a Continuous Infusing Line.

00:11 Let's see what we're going to need. You're going to need the appropriate syringe for the amount of medication you're going to give and something to pierce the vial to draw that.

00:20 You're going to need your alcohol swabs to clean, the IV medication itself that's ordered, and also saline flushes. Let's take a moment and discuss compatibility of medications. Now, this is a really important topic because this affects patient's safety. So, anytime you go to give an IV push or IV bolus medications through a continuous line, you want to ensure that those 2 medications play nice together. So one way that we can do this is sometimes in an electronic medical record there is a resource in there for you and you can check medication compatibility to make sure you can mix the 2 together. Now, if you don't have electronic medical record, don't forget about drug guides and a really great resource for you as well as your pharmacist at your facility. So before we start, we want to remember that we've got to draw up the medication per the physician's order. So this is typically going to be done in the medication room so we can check the order against the medication dispense system. We want to make sure we're using sterile technique to draw up that medication. Now again, if you need a little refresher on drawing up medication, remember this is a separate skill.

01:31 Once we've done that, we're going to trace the medication tubing from the patient to the point of origin. Now, what I mean by this is sometimes your patient has several different IV infusing lines so whatever you're going to give the medication through, you need to make sure you're doing it to the appropriate tubing. Then we're going to close the flow clamp on the continuous infusion and scrub the needleless injection port with alcohol or antiseptic for at least 5 seconds and allow that to dry. Once we've scrubbed the hub, we're going to attach a normal saline flush and inject that slowly. Once we've done that, we're going to be able to dispose of that normal saline flush. Then we're going to scrub the hub again with antiseptic or alcohol for at least 5 seconds and allow that to fully dry. We can now attach our medication syringe and then we can inject the medication as prescribed. Now once we've done that and injected the med, we can detach the medication syringe and dispose of that appropriately. Now let's scrub the hub again with the antiseptic or an alcohol pad for at least 5 seconds and allow to fully dry. Now we want to attach our normal saline flush syringe and slowly inject the saline to flush that medication in. Once we flushed it, we're going to attach the normal saline flush, dispose of that in the appropriate disposable bin, and then we're going to open the flow clamp to continue the infusion. Let's take a live look on how we administer an IV bolus or IV push medication through a continuous infusion line.

03:14 Now anytime you hear the term continuous infusion line, you may also hear the nurses call it primary line or primary fluids. Now, all this means it's fluids that are running constantly through the patient's IV. So once we get started, we want to go ahead and draw up our medication into our syringe in the medication room. So this is usually where you're going to draw up your medications. Now it's important to label this appropriately according to agency protocol before you take it to the patient's bedside. Now, anytime you're talking about drawing up meds and giving a bolus or a push, it's usually a cinnamal of ordered medication.

03:56 And this could be, for example, nausea medicine like Zofran. Now that I've drawn up my medication, I've labeled it and I'm here at my bedside. I can take a look and trace all of my lines and make sure I look at my IV site. Now it's important here to assess. Now because we've had fluids going, hopefully this is working wonderfully but you want to double check that before we put anything else in there that there are no signs of infection, leaking, pain, redness, or streaking around the site. Now, once we've decided that this looks good, this is a great time to go ahead and pause or silence your pump. Now, once you've done this, we want to close the flow of that continuous infusion. So it's a great idea that you can just do this close as to where you're going to give the meds via the roller clamp. So when I close this, I'm going to take this and I'm going to just push this down and then it's going to pinch off your tubing and close off that flow for you. So once this is closed off, here's another tip.

05:01 Just keep in mind in regard to your equipment that there's a lot of different ports on a primary line. So there's one up here, there could be additional one in the middle, but you always want to give your IV push medications in the port here closest to your patient.

05:19 Now the reason why we do this, as you can imagine, if you give the medicine way up here for example it's going to take much longer to get to your patient. So again, when you administer IV push, pick the port that's closest to your patient. Alright, so now that we're ready to go don't forget of course to scrub your hub, I'm going to take my alcohol pad, make sure you've got plenty, and we're going to scrub this vigorously. Now it's important here that we scrub this and then we want to allow it to fully dry. Now while that's drying, notice that I'm holding on to this so it doesn't get contaminated in the patient's bed or on the bedside table. Then I'm going to grab my normal saline flush. I'm going to open this up, take off my top. Now, here's the thing to know about a normal saline flush. This end is sterile, so I don’t want to lay it down on the table, I don't want to touch it with my hands, I want to make sure I stay away from the top of this. Now, here's a great little tip to prime an IV flush. These are packed under a little bit of pressure so if I push on this this may geyser up to the ceiling. So it's a great idea to take the plunger and just pull down and just kind of release and break that pressure and then take the plunger and push it up. This is going to prime out the top. Now once we've done this, we're ready to attach our normal saline flush. So it's important here to make sure that you clamp this off so when we give medications it's going to go in to the patient. So now I'm going to go ahead and attach my flush and remember you're going to push in and then we're going to screw this on and then we're going to slowly inject. So, here's just a kind of a consideration for you. Because we've had continuous fluids going all the time, sometimes you may see nurses skip this step.

07:17 Because as you can imagine there's been lots of fluids going and so we know it's been flushing and we've assessed the site. So if we choose to flush it, now we can go ahead and detach our flush, and then dispose of this appropriately. Now we're going to go ahead and scrub that port again. And again make sure you don't drop this, it doesn't touch the patient or the linen so we keep this clean. Now, we're going to take our alcohol pad and we're going to scrub our port again. Important here to be vigorous with this and of course allow it to fully dry. Now that we've done this, we want to go ahead and get our medication and attach our syringe. So again, be careful about not contaminating this and then I'm going to push this in, screw it on, and before I inject at some point make sure you pinch this off so the medication again will go in to the patient. So here is something to consider before I push this in. Every medication is a little bit different so it's important you follow your agency policy and check your medication guide. Some medications, let's say Lasix for example or otherwise known as furosemide which is a diuretic, if you push away too fast sometimes it can cause damage to the ear. So make sure you check your specific medication. So once I've attached my syringe, I want to inject per my protocol or per my drug guide. Now once we infuse this, I can let go and I can detach. Now, once I've detached this and I throw my medication in to the appropriate bin, it's important here as well to scrub the hub again. I'm going to take my alcohol pad, and I'm going to scrub this vigorously, and of course don't forget to allow this to air dry. Now, once we've done this if the nurse chooses to we're going to flush this again.

09:24 So, I'm going to go ahead and pull back on this plunger again, break that seal, and then prime it to the top. So now that I've primed this and I've already scrubbed, I'm going to attach my normal saline again and again maintaining sterility of the syringes, I'm going to pinch this off and again slowly inject my saline. So remember anytime you flush, just as a reminder, if you're giving certain medications that have to be pushed kind of slow or at a certain rate make sure you do the same with your flush. So once I flushed this, I can detach my normal saline flush, dispose of it appropriately, then we can open up our flow to the clamp, open up our clamp, and then restart our pump. Thanks for watching.