What should the nurse do before administering an I.V. bolus?
A physician orders an I.V. bolus injection of diltiazem hydrochloride (Cardizem) for a client with uncontrolled atrial fibrillation.
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A. Gently aspirate the I.V. catheter to check for a blood return. B. Insert a second I.V. line into the opposite ARM. C. Warm the I.V. medication to room temperature. D. Place a tourniquet on the ARM in which she will administer the injection.
Previous answers have indicated that the correct protocol would be to gently aspirate the IV to check for a blood return. In this case, a blood return on the IV could certainly mean that the patient had high blood pressure and needed this medication. If someone has atrial fibrillation, they have a rapid heartbeat that is often irregular. This causes poor blood flow.
No blood return on the IV could mean that there’s a low blood pressure or something else is wrong, and in this case, the nurse should not give the Cardizem because it could worsen the situation. Regardless, blood return on an IV is typical and means everything is in working order. It’s good to have a blood return on an IV, if somewhat disturbing if you’ve never had it happen before.
Nurses give many injections. Did you know that not all injections are to be given the same way? IV stands for the fact that the injection is given into the vein. From Latin, a “bolus” injection is administering a certain amount of medication in a specific time. Now the diltiazem hydrochloride injection contains a calcium ion influx inhibitor.
This is given for atrial fibrillation. It is a white to cream powder. Diltiazem hydrochloride injections are clear, sterile, nonpyrogenic, colorless solution. It’s pH range is from 3.7 to 4.1.If a nurse is asked to administer an I.V. bolus injection of this drug, she should gently aspirate the I.V. catheter to check for a blood return. This injection slows down AV nodal conduction time. It also prolongs AV nodal refractoriness.