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Giving IV medications: bolus and intermittent infusion

  • Procedure

Given intravenously, a drug acts within minutes; so compatibility, the patency of the line and the rate of administration are checked.

Updated

What it is

The intravenous (IV) route delivers the drug straight into the blood: the effect is almost immediate and a drug given IV push cannot be retrieved. It is used as a bolus or IV push (the syringe is pushed through the port closest to the patient at the rate the drug reference gives) or as an intermittent infusion (a small bag run over a set time, as a «secondary» or «piggyback» on the primary line). Before giving it, check the rights, compatibility with the running fluids, and that the cannula is patent and free of phlebitis or infiltration.

Indications

  • A rapid effect is needed.
  • The drug would be poorly absorbed by other routes (the IV route bypasses first-pass metabolism).
  • A patient who cannot take medications by mouth.

Contraindications and precautions

  • Cannula with signs of phlebitis or infiltration, or that does not flush freely: do not use it until assessed; never force a flush.
  • Incompatibility with the solution or another drug in the same line.
  • Known allergy to the drug.
  • Reduced liver or kidney function or heart problems: higher risk with a fast bolus; keep strictly to the rate.

Equipment

  • Prepared, labelled medication and medical order.
  • Prefilled saline flush syringes.
  • Alcohol swabs to disinfect the port.
  • Secondary tubing and an infusion pump for intermittent infusion.
  • Clean gloves and a watch with a second hand.

Step by step (and why)

  1. Apply the rights and check the administration rate in a drug guide or with pharmacy — a bolus that is too fast can be toxic.
  2. Check compatibility with the running solution — an incompatible mixture can form a precipitate in the line.
  3. Assess the cannula site for pain, warmth, redness or swelling — a damaged vein is not used.
  4. Scrub the port and let it dry — prevents catheter-related bloodstream infection.
  5. Flush with saline and check for blood return — confirms the cannula is patent; never force it.
  6. Bolus: clamp the line above, give through the port closest to the patient and time it with a second hand — keeps to the safe rate.
  7. Infusion: hang the secondary higher, open the clamp and programme the pump — the secondary runs first at the right rate.
  8. Flush at the end at the same rate as the drug and watch the patient — completes the dose and catches early reactions.
  9. Document drug, time, rate and response — allows monitoring and prevents duplicate doses.

Complications

  • Phlebitis and infiltration; extravasation of drugs that damage tissue, with a risk of necrosis.
  • Allergic or infusion reaction.
  • Speed shock from giving the drug too fast.
  • Catheter-related infection.
  • Fluid overload (new oedema, changes in lung sounds, higher oxygen needs).

Next step: when to call for help

  • Pain, swelling or coolness at the site: stop the infusion and report; do not keep using that vein.
  • Chest tightness, irregular pulse, flushing or headache during a bolus: stop, keep the line for emergency access and report at once.
  • If extravasation is suspected: stop the infusion, follow the institutional protocol and report at once — early treatment can prevent necrosis.
  • Doubts about the rate or compatibility: ask the pharmacist before giving the drug.

Test yourself

Think of the answer, then tap the question to see it.

Why is an IV bolus given through the port closest to the patient?

So the drug enters the vein through the shortest stretch of tubing and the timed rate reaches the patient.

Where is the secondary bag hung in an intermittent infusion?

Higher than the primary, so it runs first; then the primary runs again.

What does the nurse do if the cannula site is cool and swollen?

Stops the infusion because infiltration is suspected, does not use that vein and reports.

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Connections

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Nursing Advanced Skills (Open RN), 2.2 Basic Concepts of IV Push Medication (Open RN, Chippewa Valley Technical College (LibreTexts), 2024); Nursing Advanced Skills (Open RN), 2.5 Checklist: Administer IV Push Medications (Open RN, Chippewa Valley Technical College (LibreTexts), 2024); Nursing Skills (Open RN), 23.2 IV Therapy Basics (Open RN, Chippewa Valley Technical College (LibreTexts), 2022); Preventing Unsafe Injection Practices (Centers for Disease Control and Prevention (CDC), 2024).

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