[Sharon]

As a nurse doing pediatric disaster care in the field for over 10 years (or maybe) we never did a pre-infusion EKG regardless if it was infectious vs trauma prior to administering KCL IV. Since all of the cases we had were demonstrating cardiac irregularities due to hypokalaemia, dehydration, or trauma. As someone pointed out previously, the response time required to save the life of a child is so tiny that any change pre-presentation to pre-infusions was only academic.

Renal function was the key. We did q 10 minute output checks and q 20 min K levels until spontaneous voiding of adequate amounts urine, the amount was determine by calculation GFR. Given everything else had been stabilized, at 45 to 60 minutes if evidence of GFR had not return, assumption of acute renal failure and appropriate treatment plan took over.

In children it is so much easier to resuscitate a heart and leave other major organs dead because of the attention to the heart. I have had the unfortunate experience to see multiple children, who were cared for by providers who focused only on the possibility of maintaining a stable cardiac rhythm and did not pay attention to the brain, lungs or kidneys resulting in the death of those organs.

So I vote for output.

[gwenith]

Originally posted by pediRNCHAM
First - No RN's add KCL to IVs. All KCL additives are done by the pharmacy (You'll get a Type 1 citation from JCAHO if you've got KCl on your units!!!). As far as clinical assessment of the pedi patient before having IVF w/KCl, patient needs to have voided before hanging the K. Renal function needs to be validated before using KCl additives

Sorry doesn't apply here - we add the K!! and everything else if it comes to that - we just plain do not have enough pharmacists to do the additives.

[janfrn]

Originally posted by gwenith
Sorry doesn't apply here - we add the K!! and everything else if it comes to that - we just plain do not have enough pharmacists to do the additives.

Ditto for us here in cosmopolitan, high-income Edmonton too. We mix all our infusions, reconstitute all our antibiotics and even mix up our dialysate and replacement fluids for patients on CVVH. We have a clinical pharmacist who does rounds on weekdays, but our cutting-edge, state-of-the-art quaternary care Centre of Excellence does not have an in-house pharmacist after 2300 hours any day of the week. The facility I came here from (tertiary care centre in a "have-not" province) had satellite pharmacies in all critical care areas, each manned around the clock by a critical care pharmacist. I don't get it.

[jnette]

Originally posted by Sharon
As a nurse doing pediatric disaster care in the field for over 10 years (or maybe) we never did a pre-infusion EKG regardless if it was infectious vs trauma prior to administering KCL IV. Since all of the cases we had were demonstrating cardiac irregularities due to hypokalaemia, dehydration, or trauma. As someone pointed out previously, the response time required to save the life of a child is so tiny that any change pre-presentation to pre-infusions was only academic.

Renal function was the key. We did q 10 minute output checks and q 20 min K levels until spontaneous voiding of adequate amounts urine, the amount was determine by calculation GFR. Given everything else had been stabilized, at 45 to 60 minutes if evidence of GFR had not return, assumption of acute renal failure and appropriate treatment plan took over.

In children it is so much easier to resuscitate a heart and leave other major organs dead because of the attention to the heart. I have had the unfortunate experience to see multiple children, who were cared for by providers who focused only on the possibility of maintaining a stable cardiac rhythm and did not pay attention to the brain, lungs or kidneys resulting in the death of those organs.

So I vote for output.

DITTO !!!
(to the vote part... not the experience part !) But I must so totally agree with her on this.

Gee... where IS the OP with the anwer to this one ???

[vemiliob]

As far away from the question we get, we’re missing the question.
It would be nice if wiseRN makes clear if the question came just as an NCLEX type question or as personal one?

I’ve seen it as an NCLEX question. If that is the case one should know that one must choose the best option the computer is offering, not what one finds in ones daily-reality to be the best.

However if it is a personal question probably no one will ever perform an EKG before adding KCl to Ivs.

By the way, it doesn’t apply here as well, we had everything that comes. Pharmacists? My goodness! Except in big hospitals they don’t exist (Nurses and administrative assistants replace them). Even though RNs prepare everything.

[Brownms46]

Originally posted by pediRNCHAM
First - No RN's add KCL to IVs. All KCL additives are done by the pharmacy (You'll get a Type 1 citation from JCAHO if you've got KCl on your units!!!). As far as clinical assessment of the pedi patient before having IVF w/KCl, patient needs to have voided before hanging the K. Renal function needs to be validated before using KCl additives

Sorry this isn't true in a lot of places, and I as an LPN have added KCL to IVFs.

[uk_nurse]

Originally posted by Brownms46
Sorry this isn't true in a lot of places, and I as an LPN have added KCL to IVFs.

In my hospital in the uk we already have bags of fluid made up with either 10mmols or 20mmols of kcl added. I do work in paeds. So i dont know if only paeds do this or adult trained nurses do to. It does make things easier tho.

[Sharon]

10 to 15 years ago I was asked to compose questions about practical situations that I observed new residents repeatedly screwing up for U.S. physician board certification exams. I composed a very similar question for the about 15 years ago. Guess what the correct answer for the medicine board exam was?

[jnette]

Originally posted by Sharon
10 to 15 years ago I was asked to compose questions about practical situations that I observed new residents repeatedly screwing up for U.S. physician board certification exams. I composed a very similar question for the about 15 years ago. Guess what the correct answer for the medicine board exam was?

Pray, DO TELL !!!


Sure would like to get to the bottom of this one !!!

[pediRNCHAM]

It's fascinating to learn about the what is customary practice in other countries. Joint Commission and sentinel events at several hospitals in the US involving problems with RNs adding K+ to IV's has resulted in it being removed from stock on nursing units in both the large NYC hospital where I know work and the much smaller community hospital where I previously worked. It is not a matter of adequate pharmacy coverage, it's a matter of retaining your accreditation and licensure. This has all occurred in the northeast US in the past four years. So this is a fairly recent change in practice. But getting back to the Pedi question: the answer is "pee" before KCl.