Hanging IV Potassium
- 0Oct 24, '05 by MrsMinorWhat is the normal procedure you use when hanging KCL? Meaning, when you admin it how is it diluted??
I had to hang 2 bags of 20 meq KCL diluted with 100cc saline each--one after the other--this is premixed by the pharmacy & sometimes they'll add lidocaine to it since it can be very irritating to the veins.
Is this how most of you hang potassium or do you usually dilute it more? This seems to be the norm on my floor, but one nurse passing thru was very surprised it wasn't diluted more. Your feedback appreciated!
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- 0Oct 24, '05 by NotReady4PrimeTime Senior ModeratorI work in a primarily cardiac surgical PICU and we often run KCl 1mmol/mL infusions centrally to correct critical hypokalemia. We usually start at 1 mmol/hr (depending of course on how low it starts out), and check the serum K+ hourly, increasing or decreasing the infusion as indicated. We often have as much as 80 mmol/L in our maintenance as well, because our kiddies are so fluid restricted that they are hardly getting any maintenance on top of their other infusions. KCl is compatible with a lot of drugs, but three very important incompatibilities exist: amphotericin B cholesteryl sulfate complex, diazepam and phenytoin.
- 0Oct 24, '05 by MrsMinorSo, I'm not hanging this wrong then?? Thanks to all who replied.
I had a pt who needed a new IV site prior to hanging the potassium.
The IV nurse (who is not a staff/floor nurse on my particular floor, but part of an IV team for the hospital), got extremely upset with me.
She called down the hall to me after she changed the IV site & asked if I was planning to hang the potassium that I had ready & waiting to go. (I thought it odd that she was asking my plans with my pt to begin with!)
Anyhow, she instructed me how I should NOT be hanging it the way it was (the 20meq c 100cc saline pre-mixed) & that I needed to have it diluted more & it was NOT OKAY to hang it up.
I was taken back by this....BTW, I'm still on orientation & I had already checked my IV infusion book, and had talked to BOTH my preceptor AND charge nurse once I received the order to initiate the med.
When I walked back into my pts room he stated "what are you trying to do, kill me??" I had no idea what he was talking about until he continued...."that IV nurse said that you should not be hanging that the way it is & that you need to hang a couple ringers with it, it will be harmful to my arm, etc. etc."
I then proceeded to tell him my plans, what to expect/any SE that he may notice (burn/sting....) & that I would start slow & stop the med stat if needed, etc.
He then asked me if he was my guinea pig.....!! After I talked to him & answered any questions/concerns he was okay & he ended up not having any problems with the med.
I was very upset how this nurse talked at me the way she did--in a very disapproving tone, but most of all how she undermined my competency as a nurse & made my patient question my nursing care!! I felt placed in a very awkward situation with my patient. My preceptor had to go in to talk to
him as well.
My patient told me later how "that nurse has come by twice more to stick her head in here & shake her head." How frustrating!! If she had such an issue with this, she should have asked to speak with me in private--but NOT at me from down the hallway....OR TO MY PATIENT!!!!
I was truly hoping to hear that others hang potassium similarly!! Thanks again & sorry so long!!
- 0Oct 24, '05 by 20yearsandcountingHi, I'm an ICU and ER nurse and do IV team per diem...That IV nurse was out of line to say anything to the pt , if she had a problem she should have spoken directly to you in private (the professional thing to do) and in a helpful manner.However it is within the realm of the IV team nurses duties (rights?) to offer advice and instruction on infusion therapy and practices. But she handled herself poorly. It is a lot of hospitals policy/protocol to infuse 10meq kcl in 100cc peripherally and 20meq kcl in 100cc should go centrally only because it is very irritating to the small peripheral veins. Pt's can and do get severe burning which some describe as painful and redness/phlebitis at the site which renders that site useless and then it must be changed. I have given 20meq in 100cc peripherally when it is piggybacked into other IV fluid so that is further diluted and less caustic and I've even given it peripherally (In the ER or ICU when in a pinch and without central access)with lido 1-2cc in the bag and 1cc injected into the heplock to help with the pain.Most people have the pain and redness, though I have seen a few,very few, come out unscathed. Hope this helps.Last edit by 20yearsandcounting on Oct 25, '05
- 0Oct 24, '05 by TweetyOur pharmacy mixes KCL in large volumes if it's a peripheral site. They will call the nurse and ask if it's peripheral and if there's any contraindication to large volumes. I forget what they put 20 meq's in, but they put 40 meqs in 500 cc bags.
Central lines get mixes in volumes of 100 cc or 250.
I would be like the nurse passing through, very suprised it's not diluted more. `Last edit by Tweety on Oct 24, '05
- 0Oct 24, '05 by 20yearsandcountingA lot of ICU's and ER's too ( I was a traveling nurse for several years in several states and several hosps), have 10meq's in 100cc and 20meq's in 100cc. Even our Med/Surg floors use 10meq's in 100cc to replete k+ levels of 3.5 and under. There are liter bags of say... D5.45 with 20meq's etc. but those are typical IVF bags for pt's needing a little extra K+ that does not need to be replaced/corrected quickly.Last edit by 20yearsandcounting on Oct 25, '05