How do I appropriately use the push-pull technique to deliver a bolus to a pediatric patient?
Push-pull Technique
Hook up 3 way stopcock to IV tubing and attach syringe to 3rd port.
Turn off to patient, draw fluid from bag.
Turn off to bag, push bolus into patient with steady pressure.
Repeat 2-3 until full amount of bolus given.
Use
To deliver adequate fluid resuscitation in a timely fashion to pediatric patients (superior to gravity)
Similar flow rates as pressure bag, but with higher accuracy of volume
For difficult IVs, you are able to feel resistance when giving the bolus and recognize a blown vein earlier
Contamination Concern!?
A study showed that with repeated use, the contents inside the syringe may become contaminated (see fluorescein study below)
Gross!!! This implies we may unwittingly introduce bacteria into systemic circulation....
Tips for Improvement
Use syringe that is larger than the amount of the individual pushes (e.g. use a 60ml syringe to give 30ml at a time or a 20ml syringe to give 10ml at a time)
Consider wearing sterile gloves and maintain aseptic technique
Avoid touching the "ribs" (see below)
