IV Medications (Bolus)

Things Required:

• IMR
• Medications (usually powdered form)
• Diluent (eg. H₂O for injection)
• Normal Saline
• 2 Syringes
• 2 Needles
• Gloves
• Alcohol swabs
• Gauze
• Kidney dish

Always check the items you take for expiry date and clarity (if applicable).

1.  Check whether the order for that medication is a first dose for that patient. If it is the first dose, doctors are to administer them. Verify order and patient's need for this procedure.

2. Perform hand rub.

3. Withdraw an appropriate amount of diluent eg. 10ml (depends on what medications you are giving and the hospital policy/ guidelines) into a syringe. Ensure that there is no bubbles.

4. Swab the top of the medication bottle with an alcohol swab. Attach the needle to the syringe and inject the diluent into the medication. Dissolve the medication well by rolling the medication bottle in your palms, rather than shaking, which would introduce bubbles.

5. Withdraw the dissolved medication into the syringe and throw the needle into a sharp box.

6. Depending on hospital policy, withdraw 6-10ml of normal saline into another syringe. Place the IMR, syringes, alcohol swabs, gauze and gloves into the kidney dish before approaching patient.

7. Approach and identify patient with 2 patient identifiers again: patient’s name and IC by asking patient and verifying it with his wrist tag. Ensure that patient is not allergic to the medication by checking it with the IMR and by asking patient. Prepare the environment where necessary.

8. Wear gloves. Stop and detach any IV lines connected to the patient and swab the patient's IV plug with an alcohol swab. Place a gauze underneath it.

9. Occlude the vein just above the plug to prevent blood from flowing out when you disconnect the stopper. Connect the syringe containing normal saline to the plug. Attempt to withdraw any blood clots near the plug. If only blood is withdrawn, "flush" the plug to check for its patency by pushing 3-5ml of normal saline into it. If there is any blood clots withdrawn, great resistance when pushing the normal saline in or if patient complains of pain and tenderness around the plug, stop the procedure and report it.

10. If there is no blood clots, little resistance and no pain, slowly inject the whole medications in at a constant rate.

11. "Flush" with the remaining normal saline.

12. Swab the plug again before reattaching any IV lines back.

13. Inform patient that the procedure is complete and ask him to report if he is feeling uncomfortable/ malaise or if there is pain at the plug site. Ensure patient’s safety and comfort levels and that the call bell is within reach before leaving.

14. Document the procedure in the IMR. Check for any adverse reactions/ patient's response to the medications and document in the relevant notes.

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