Monitor patients closely for adverse reactions during and shortly after giving an IV bolus, since this method allows medication to act quickly and leaves no time to correct errors.  Double-check all calculations. Use a medication reference to review the rate of administration for all IV push medications. Normal saline (0.9%) flush following the IV medication must be administered at the same rate as the medication. Use a less concentrated solution whenever possible.  IV push medications carry an increased risk of infiltration and phlebitis, especially if a highly concentrated medication is delivered, a small peripheral vein is used, or the medication is administered by means of a short venous access device.  Never prepare high-alert medications (e.g., heparin, dopamine, dobutamine, nitroglycerin, potassium, antibiotics, or magnesium) on a patient care unit.  Take steps to eliminate interruptions and distractions during medication preparation. OVERVIEW An IV bolus is one method of medication administration currently practiced on patient care units. It introduces a concentrated dose of a medication directly into a vein by way of an existing IV access. An IV bolus or “push” usually requires small volumes of fluid, which is an advantage for patients who are at risk for fluid overload. Administering medications by IV bolus is common in emergencies when you need to deliver a fast-acting medication quickly. Because these medications act quickly, it is essential that you monitor patients closely for adverse reactions. Agencies have policies and procedures that identify the medications that nurses are allowed to administer by IV push and other IV routes. These policies are based on the medication, compatibility and availability of staff, and type of monitoring equipment available. There are advantages and disadvantages to administering IV push medications. Medications should be diluted or compounded in the pharmacy before dispensing and only when recommended by the manufacturer and approved by the organization’s practice.1 Some organizations will allow medication compounding in a specific area of practice. If dilution or reconstitution of an IV push medication becomes necessary outside of the pharmacy, the nurse should perform these tasks immediately before medication administration in a clean, uncluttered, and functionally separate location.1 The nurse should use organization-approved, readily-available drug information resources, and sterile equipment and supplies to dilute or reconstitute IV push medications.1 The IV bolus is a dangerous method to administer medications because it allows no time to correct errors. Administering an IV push medication incorrectly or too quickly can cause death. Therefore be very careful in calculating the correct amount of the medication to give. In addition, a bolus may cause direct irritation to the lining of blood vessels; thus always confirm placement of the IV catheter or needle. Never give an IV bolus if the insertion site appears edematous or reddened or if the IV fluids do not flow at the ordered rate. Accidental injection of some medications into tissues surrounding a vein can cause pain, sloughing of tissues, and abscesses.2 The nurse administering an IV bolus of medication should be trained and competent at managing anaphylaxis. Verify the rate of administration of IV push medication using agency guidelines or a medication reference manual. The Institute for Safe Medication Practices has identified the following strategies to reduce harm from IV push medications:1  Provide IV push medications in a ready-to-administer form whenever feasible.  Disinfect medication vials prior to preparation of parenteral medications.  Disinfect access ports including needleless connectors prior to the administration of IV push medications.  Withdraw sterile IV push medications from glass ampules using a blunt filter needle or filter straw.  Consider alternatives such as a syringe pump to administer medication that has a high risk for adverse effects. If this is not an alternative to IV push, have pharmacy dilute the medication and administer in a piggyback.  Do NOT dilute IV push medications, including those available in prefilled syringes, unless recommended by the manufacturer or the organization’s practice, or supported by literature.  If dilution or reconstitution of an IV push medication becomes necessary outside of the pharmacy sterile compounding area, perform in a clean, designated location using organization-approved, readily available drug information resources.  IV push medications should be administered at the rate recommended by the manufacturer or the organization’s practice, or supported by literature.  Following IV push drug administration, the volume of the subsequent IV flush must be appropriate to ensure that the entire drug dose has been infused.  Avoid using terms in orders such as IV push, IVP, or IV bolus with medications that should be administered over 1 minute or longer. Use more descriptive terms such as IV over 5 minutes. Review the amount of medication that a patient will receive each minute, the recommended concentration, and rate of administration. For example, if a patient is to receive 6 mL of a medication over 3 minutes, give 2 mL of the IV bolus medication every minute. Understand the purpose of the medication and any potential adverse reactions related to the rate and route of administration. To ensure safe practices with IV medication administration, use the mnemonic CATS PRRR: C, compatibilities; A, allergies; T, tubing correct; S, site checked; P, pump safety checked; R, right rate; R, release clamps; R, return and reevaluate the patient. Tubing or catheter should be traced from the patient to the point of origin before connecting or reconnecting any device or infusion.3 Tubing should be labeled at the connection site closest to the patient and at the connection site closest to the source when there are different access sites or several bags.3 Labeling reduces the chance of misconnection, especially in circumstances where multiple IV lines or devices are in use. Connections should not be forced, and equipment should only be used for its intended purpose.3 Forced connections or workarounds could indicate that the connection should not be made. If the patient informs you of a concern regarding the accuracy of one of their medications, do not give the medication. Investigate the patient’s concern, notify the practitioner, and verify the order. SUPPLIES Click here for a list of supplies. EDUCATION  Provide education that is developmentally and culturally appropriate and consider the patient’s desire for knowledge, readiness to learn, and overall neurologic and psychosocial state.  Teach patient and/or significant other that effects of IV push medications occur rapidly. Explain reasons for giving medication slowly and teach signs of adverse effects.  Encourage questions and answer them as they arise. ASSESSMENT AND PREPARATION  Check the accuracy and completeness of each MAR or computer printout against the prescriber’s written medication order. Confirm the patient’s name, medication name and dosage, route of administration, and time of administration. Clarify incomplete or unclear orders with the health care provider. Note if the patient has allergies.