Calcium Gluconate

  1. 0 Question, over what period of time do you give an amp of calcium gluconate to someone who is not coding? Had to give this to a pt with hyperkalemia last night and all the resources I read just said to push slowly, but didn't give me any period of time... I gave it over 4-5 minutes, but my pt still had a drop in hr, bp, became flushed, and said her heart felt like it was going to jump out of her chest, which makes me think I should have given it slower?

    Just want to get some other insight! Thanks
  2. Visit  SweetMelissaRN profile page

    About SweetMelissaRN

    Joined Feb '13; Posts: 134; Likes: 141.

    13 Comments so far...

  3. Visit  turnforthenurseRN profile page
    0
    My drug guide says to be given slowly at a rate of 1.5mL/min with a small needle into a large vein. Ideally, this should be given through a central line because it is a vesicant. It may also be given as an intermittent infusion not exceeding 200mg/min or by continuous infusion.

    I have never given calcium gluconate to a non-coding patient...only calcium chloride.
  4. Visit  Jory profile page
    0
    I have received calcium gluconate because of an imbalance issues I had due to a health problem. The nurse didn't dilute it enough and I had to stop her mid-administration because it was INCREDIBLY painful. I don't remember experiencing any symptoms afterwards, but then again, I didn't have cardiac issues.
  5. Visit  rnrandik profile page
    1
    We give this often in the ER for hyper K+. I put mine on a syringe pump and it will run over 10 mins or so. This works well for me!
    turnforthenurseRN likes this.
  6. Visit  LalaJJB profile page
    0
    I put it in a 250mL bag, and ran it WO....this guy did not have CHF...if they did, you can put it in a 100mL bag and run it over 10 min.
  7. Visit  LalaJJB profile page
    0
    and if you dont feel comfortable mixing it, have pharmacy do it.
  8. Visit  ChristineN profile page
    0
    They don't even stock calcium gluconate in our ER pyxis because it is on drug shortage. Pharmacy sends it up in a 100ml bag which they recommend giving over 5 min, normally I just hang it to gravity.
  9. Visit  Sassy5d profile page
    0
    Good question! I've only come across this once. I asked the doc who said 'just push it'. I knew in my gut 'just push it' was a bad idea.
    I mixed it and was going to hang it and they were actually being transferred out, so the transfer team said they would give it.
    Meds like those get me nervous, for exactly like was described here.. Plus the high rate of hemolysis and the real potential danger that is present.
    When in doubt, I ask 3 different nurses and see what they say, in addition to the drug reference.
  10. Visit  Esme12 profile page
    0
    Calcium Gluconate is given IV slowly...usually as a IVPB like MGSO4/K+ and is given in TPN. If given in a code it's given over 2-5 min for documented hyperkalemia, hypocalcemia, or hypermagnesemia and calcium channel overdose.....5-10 mins or greater watch EKG and vitals Medscape: Medscape Access medscape requires registration but is a great resource!

    CALCIUM GLUCONATE -* Intravenous (IV) Dilution
    http://drkamaldeep.files.wordpress.com/2011/11/iv.pdf

    Calcium Chloride is an drug that used to be apart of ACLS protocol.......it can still be given in a code IF it is given at all.
  11. Visit  SweetMelissaRN profile page
    0
    Quote from Sassy5d
    Good question! I've only come across this once. I asked the doc who said 'just push it'. I knew in my gut 'just push it' was a bad idea.
    I mixed it and was going to hang it and they were actually being transferred out, so the transfer team said they would give it.
    Meds like those get me nervous, for exactly like was described here.. Plus the high rate of hemolysis and the real potential danger that is present.
    When in doubt, I ask 3 different nurses and see what they say, in addition to the drug reference.
    Lmao, my ER doc told me the EXACT same thing! I just looked at him and was like "here, you push it and risk your license!" Lol
  12. Visit  SweetMelissaRN profile page
    1
    Thank you everyone for the input! I will definitely remember this for future practice!
    brian likes this.
  13. Visit  A.Brook profile page
    0
    In my reading from our online pharmacy system it says minimum 5 minutes, but patients still tend to have slight reactions like you said. These patients tend to be the renal folks who can live another 5-10 minutes with their K of 7 (because that's what it is once a week) while you push it through a 20/22 because they have absolutely no veins left....Even though they are only 25.

    (This is my jaded experience)
  14. Visit  Sandman2855 profile page
    0
    The first time I gave this medication, it was for a non-coding hyperkalemic patient. I asked a colleague if there was anything special I needed to know about the administration of these medications (also giving sodium bicarb, insulin, dextrose). She said "nope, just push em". Immediately after pushing my meds, the patient started freaking out and saying she she felt "funny" and had shortness of breath. Her vitals were stable and her rhythm were fine, but I wont "just push" these meds again. Seeing this thread, I am guessing it was the calcium gluconate.

    Side note: An ED doc explained to me the difference between calcium chloride and calcium gluconate. He said you give calcium chloride to a coding patient because it is more effective but is a stronger vesicant and coding patients dont care. Calcium gluconate hurts less but needs to make a liver pass before becoming activated, which means it is less effective in coding patients with their... questionable... circulatory status..


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