Intravenous (IV) Bolus Medication: Administration Through an Intermittent Vascular Access Device (Nursing)

00:00 Once we've verified our order, checked our IV patency, and made sure those medications are appropriate for our patient, we're going to look at how to give an IV bolus medication or otherwise known as an IV push. That's what you're going to hear most often. We're going to take a look how you give this through an intermittent vascular access device. Okay, that's a mouthful. Really we're going to show you how to give an IV push medication through a patient's IV. So first of all, we need to make sure we have the syringe whatever we're going to give the patient. So we need a something also to pierce the vial so we can draw up that medication. We need alcohol swabs to clean the site, we also need our medication itself.

00:47 And make sure when you're looking at the med is it expired? If so, we don't want to use it.

00:52 Is it a weird color, any discoloration or cloudiness? We do not want to use that med on our patient. Also, is it the right med? Then we need to make sure we bring saline syringes to the room so we can flush before and after the medication. When we go to give our medication, first of all we need to draw up our medication using sterile technique. Now, when we do this, we are going to draw up our medication that's to be given to the patient in a medication room, not the patient's room. So the reason why we do this is we will draw up the appropriate medication and check that against the med dispensing system. Now, if you need a little refresher on drawing up medication, you can see this is a separate skill. So once we've drawn up our medication in the med room, we're going to take and go to our patient's room and at the bedside itself. So once we do that, we're going to look at the IV catheter from the patient to where it's inserted. So we need to check that. Then we want to make sure we release the blue catheter lock or whatever color it may be, but there is a little law that keeps in fluid from going in so we need to unlock that. Now, don't forget you're going to hear all the time to scrub the hub. You're going to hear this a lot throughout nursing school, there are posters, it's really important to help reduce infection in a patient's IV. So you got to remember as a nursing student anything that's inserted in a patient or that we put in, we definitely can cause infection. So scrubbing the hub is a great way to do that. So make sure we scrub that hub for at least 5 seconds and allow it to dry. Then we're going to attach our normal saline flush and slowly inject the saline. So, this is really important to flush first because now we can check for patency here. So let's say we go to flush that saline syringe and it doesn't want to flush, we can troubleshoot at this point. Now that we flushed our saline, we can detach the normal saline flush and dispose that in the appropriate bin. Now we're going to scrub the needleless port with antiseptic or an alcohol wipe for at least 5 seconds and allow this to fully dry. Now we can attach our medication syringe and then we can inject the medication as prescribed. Once we have given that medicine, we can detach the medication syringe and dispose of that. Next, we need to scrub the needleless injection port with our alcohol for at least 5 seconds again and allow that to dry as well. Now we can attach our normal saline flush and slowly inject the saline. Once that's finished, we can detach the normal saline flush and dispose that in the appropriate disposal bin. And now once that's flushed, we can lock the catheter if needed, that blue little lock, this is a good time to make sure that's sealed. Now let's take a live look at how we give an IV push medication. You may also hear it referred to as IV bolus medication as well. So here we've got our set up with our medication, we've got plenty of alcohol pads to scrub the hub, and of course our normal saline syringes for flushing. So we're going to take a look to this skill.

04:10 So before we get started, let's talk about the medication. So just make sure you follow your agency policy, but I've drawn up the medication into my syringe in the medication room.

04:22 So if I do this, make sure that you label appropriately per your agency's protocol before you bring it to your patient's bedside where we are now. And again, make sure you follow this closely because depending on the med, it's going to the pan on where you draw this up, what the label looks like, and how you administer that medication. So now that we've done this, we want to make sure we trace our IV catheter from our patient to the point of origin.

04:50 So once we do this, it's a good idea at this time to go ahead and assess the site. Now, if I come into my patient's room before I go give my medication, I want to take a look around the insertion site. Do we see any redness; any streaking; any signs of infection such as any weird leakage, drainage, anything that looks painful and warm? If we see any of these signs, we want to stop and not use this IV catheter. Now once we've assessed our site and it looks good here, don't forget and we do this a lot, make sure you want to go ahead and release the lock on here. So a lot of the times you will see a little slider clamp like this that has it pinched and all you've got to do is move that up so it's nice and unlocked for you. So now that we've done this and we've had our medication drawn up in our room and we've labeled it according to our agency policy, we want to go ahead and at this time go ahead and scrub our hub. And then we're going to get ready to attach our saline. Always a good idea to bring plenty of alcohol pads with you because you may need them. So now I've got my alcohol pad and I want to scrub thoroughly. And it's important here when we scrub the hub that you do this in a very vigorous manner and you also allow it to fully dry. So once I've scrubbed it, I want to be careful not to lay this back down so we don't contaminate it as well. So I've scrubbed my hub, now I want to go ahead and get my normal saline syringe ready. So, this we know are sterile because they're in a package. I'm going to go ahead and take off my cap. Now here's a little tip for you. If I push this plunger, you may see this geyser up to the ceiling and you don't want to shoot your patient or the ceiling. It's packed under a little bit of pressure so a little tip I like to give nursing students, if you pull this plunger down it will kind of release some of that pressure and you can kind of feel that when you do. Then you want to push it back up and prime it all the way to the top then you see this saline dripping out bubbling out from the top so now we know that we are primed, which is great and we're ready to go. So now once we do this, one thing I want you to remember, it's really important that we maintain sterility on anything that we attach to our clean IV port. So what I mean by that is I don't want to touch with my hands or lay this down on the table, anything that we attach to our clean scrub port. So now that I've got this primed, I can go ahead and attach here. So when you do this, it feels a little odd, but you've got this end and you're going to push end to end, kind of push down and screw on. So once I've attached my normal saline flush, I want to slowly inject the saline. So, as you remember, we released the clamp so when I flush one key thing I want you to know. As I'm flushing, this is a port of assessment of the site, because at any point now if I slowly flush and I see at this site that the patient says "Oh men that's really painful" if it starts leaking around the site or it starts kind of swelling up around the site, that is a problem and that is not a working IV and we want to stop. So, this is why it's a great idea to flush first, make sure that your IV is working before we put any medications in it. So now that I've went ahead and I flushed thoroughly and again when we're talking about peripheral IVs, you can do anything from like 3 ml of saline just to make sure we flush all the way through that line. So once we've done this, we can detach our normal saline flush and dispose of this in the appropriate disposal bin. So now that I flushed, I want to go ahead and scrub my hub again, again why it's great to have plenty of alcohol pads. And as you notice I'm not setting down my hub, my needleless port either. So I'm going to scrub this again very vigorously and again make sure once I've done this you allow it to dry. And we're going to allow this to dry and at this point if you remember don't forget about your medication rights because we've done this as we've entered the room at the patient's bedside. I'm going to go ahead and take my medications and then now that I've allowed this to scrub and allowed it to air dry I can go ahead and attach my medication now. Same thing, we're going to kind of push in and twist and then we're going to slowly inject our medications. So here is a really important point to note. If you're going to give something IV push such as Lasix for example, which is furosemide and it's a diuretic, the problem with that particular med for example if you push this way too fast this can cause damage to the patient's ear. Now every medication is a little bit different so you want to be very sure that you check the medication guide when you're giving IV push medications about how fast you can inject. So once I've inject my medications, after I've done that, I can now go ahead and dispose of it and detach it and then throw it in the disposable bin as well. So now that we've injected that medication, now one thing you want to keep in mind of course we've injected it but we have all this line. So I want to scrub my hub again, again making sure we maintain cleanliness of the port, I'm going to scrub very vigorously, make sure you allow it to dry then I've got to flush again because as you can imagine we've got a little bit of that IV loop and we want to make sure the med actually gets to the patient.

10:43 So then I'm going to get my normal saline flush again, take off the cap and if you remember so we don't geyser the ceiling, pull down the plunger, and release that pressure. Then make sure to prime it again, see a couple little blood there, and then again make sure you maintain sterility of this so we don't touch the table or anything and contaminate the top of this.

11:10 So now that we've done this, we want to go ahead and attach our normal saline again, we're going to push and we're going to twist and then we're going to slowly inject. So here's another point to know. Do you remember when we talked about how fast you inject a medication? So, if we did really careful education and made sure we looked up that medication and administered at a certain rate, if I go behind and flush it really fast, well that kind of negates that issue. So make sure when you flush the second time you're doing it approximately the same speed or the same time as your medication. So once I've injected this and I slowly injected my saline then I want to go ahead and attach my normal saline flush, I can dispose of this appropriately, and then don't forget to make sure you lock back your catheter. Thanks for watching.