Simultaneous Electrolyte Administration

[sarahc331]

Good Morning!

I want to preface my topic with the following: I am a relatively new traveler, just had my first day of orientation at my second travel assignment but have been a nurse for 9 years. Admittedly, 8.5 years of my experience is in one facility (a Level I trauma ICU) so my experience is fairly limited in terms of facility protocols.

Anyway, I just heard for the first time this morning that you should NEVER administer two electrolyte supplements (such as KCl & Mg) simultaneously, even if it's thru two separate lines. Now I do not like to take orders like these at face value...I question everything I don't understand so that I can make sense of it. And that's what I did...I questioned the nurse orienting me, of course it came across badly as though I was discounting their policies. She couldn't provide me any rationale so I did as she said but then went to pharmacy who confirmed my knowledge (or lack there of) that this would be an issue. He didn't seem to have any idea the nurses followed this "policy". So then I went to the nurse educator who essentially said this was policy and I was to follow it regardless, even though she wasn't able to show me any such policy or even knew if one existed. It's just "the way we do it". The charge nurse told me, "It would be like writing a policy to 'not jump off the roof'...you just know not to do it." Well apparently that isn't true since I've never heard it in my 9 years of nursing. Just to be clear, this is also a level I trauma ICU so they are both similar facilities and are both held in high regards.

So, my question to you...what's your knowledge & experience with this and if it's something you've always "known to be true", what's the rationale?

Thanks in advance for helping me understand since the facility could not.

[Esme12, ASN, BSN, RN]

Welcome to AN! The largest online nursing community!

Well......my advice is as the traveler.....do it as they do it unless it is against the standards of care. They obviously have had a problem and have decided that this is they way they wish it to be done. If you want a peaceful contract I'd go with the flow.

As a traveler you will find idiosyncrasies to each and every place you are contracted to work. They have been developed over time and have become integrated to the doctrine of the unit......and these "policies" are sacred. They can be given at the same time even on the same lines on their own pumps....this unit has decided that this isn't done.

Sometimes it's because something bad happened usually it's a physician preference so they just keep it that way....you aren't going to change them so just play along. I worked at a CVICU once that secured their PA lines in the craziest, most difficult way I have ever seen...it made NO Logical sense what so ever......but if didn't hurt the patient I secured them as they told me to. You are "the traveler" and some nurses feel... not to be trusted. You are temporary. The outsider. Some nurses make the adjustment some don't like always being the outsider.

You will find these "sacred doctrines" every where you go and they cannot be changed easily.....especially not by "the traveler".....if they don't "harm" the patient I say let it go.

Good Luck!

[Bec7074]

Here are my thoughts (although to be clear I fully disagree with this facility).

1. It cannot be an IV compatability issue since we all know Mg and KCl are compatiible. Hell, they're both in TPN. And this facility says 2 separate lines is not ok even.

2. Therefore, I believe the issue has to be with the effect of administering 1 electrolyte has on the other electrolytes. For example, have you ever heard that if you have a low Mg, your K will never come up? It has to do with the electrical charge across the cell. Calcium and Phos have an adverse relationship. Administration of one will typically make the other go down. Phos binders may help calcium to come up, etc. However, if this is their rationale, they should be asking you to check electrolytes in between IV administrations.

3. I have never had a problem with treating electrolytes at one time and have never heard of such a thing. What if they patient has many critical values? Let's just watch their K of 2.6 while we treat their Mag of 0.8 for 4 hours. And what about if they patient has K constantly infusing through IV fluids?? Doesn't make too much sense....

[umcRN, BSN, RN]

Interesting. I work peds and we actually dilute our Mag in our K!

But like others have said, you are the traveller and must abide to the protocols inf which ever facility you are in.

I am really hoping to travel one day and think I may have a hard time with "biting my tongue" but will do it to get the travel experience I desire, so long as no harm is coming to my patients

[BelgianRN]

The only issue that we keep having with our new people is simple chemistry problems. Like you can't infuse potassiumphosphate and magnesiumsulphate together since it forms the insoluble magnesiumphosphate and things like sodiumbicarbonate and calciumchloride. It's easily overlooked when someone (esp. inexperienced residents) wants to supplement several electrolytes and is inexperienced with the solubility of different salts.

[nrsang97, BSN, RN]

I have put magnesuim in potassium before. Other than that I have always ran everything seperate.

[sarahc331]

Just to clarify, I was intending to run the supplements thru two separate IVs, so it wasn't just a compatibility issue.

[Esme12, ASN, BSN, RN]

Just to clarify, I was intending to run the supplements thru two separate IVs, so it wasn't just a compatibility issue.

It can and has been done but if that is not the way they do it.....you need to follow thier routine. Your presence amongst them is temporary......if they have certain "routines" then follow the routines...your contract will end and you are out of there......don't make it any harder on yourself than necessary.

[sarahc331]

I understand that I am temporary and fully intend on doing it the way they ask but still would like to know the rationale. I just don't understand doing something for no reason, particularly if it just delays patient care, as this does. How often do you have someone with a low K, Mg & Phos? All the time! Why delay supplementation of one of those electrolytes without a good reason? Especially since they aren't even able to tell me the reason they do it other than "we just do". That's not a good enough reason to do anything, in my book.

[Esme12, ASN, BSN, RN]

I know what you are saying...but what difference does it make? I mean really make?

This is your first assignment. Giving them separately is not detrimental and is the standard in some facilities....just because they say so. You are the temporary employee...you are viewed different, an outsider. You will be labeled as uncooperative and difficult to work with and your agency will stop booking you good assignments or stop booking you altogether.......is the need to "be right" worth it to you?

I have been a nurse a long time......tread lightly when you are the traveler. If it isn't dangerous or blatantly against the standards of care....just do it their way...you aren't going to change them. If something happens when you aren't doing it their way you are in deep water....if you make too many waves you will find your self with a canceled contract and no where to go.

PS...... as a traveler you need to be sure you have malpractice insurance.

I wish you the best.