[URO-RN]

Just wondering .... can we get a "sticky" for this thread?. It's a very good one.

Jo-

[zacarias]

Originally Posted by begalli

. Second, 40 meq per bag was waaaaay too much in one bag no matter what the length of time it was to be given. By all standards I've ever seen, I don't think there should ever be more than 20 meq in 250 mls minimum for peripheral administration. 40 in 500 would maybe be acceptable but then you get into fluid status issues. Just a little bit of lido added to a bag does the trick.
That's a great link and a great lesson for all of us.

I agree that potassium should be given PO whenever possible. I will say that 40mEq in 250 ccs is VERY common even in renowned medical centers with top researchers. Fluid status may or may not be that large of an issue. In a 250 cc bag of 40mEq, we'd set it for 62ccs/hr or so and most people can take that.

[stbernardclub]

Nope....i Have Never Worked Anywhere That Added Anything But 250cc To Dilute It. Its Not A Medication That Can Run All Day! If A Patient Needs Iv K, Its Needs Given In A Timely Manner. I Would Never Put Ice On Arm Unless A Iv Was Pulled. Go For Another Vein.

[begalli]

Originally Posted by zacarias

...even in renowned medical centers... In a 250 cc bag of 40mEq, we'd set it for 62ccs/hr or so and most people can take that.

In a peripheral IV?

The hospital I work is considered "world renowned." The only concentration of KCL we have for peripheral IV admin is 10 meq/100 ml to be given over an hour's time minimum.

500 ml of fluid to replace electrolytes IS an issue for 99% of our patients (CTICU). The amount of fluid used for electrolyte replacement is minimized...mag sulfate comes 8 or 16 meq/25 ml; calcium chloride or gluconate comes 1 gm/25 ml. We use these whether the patient has a central or peripheral line. And it's true....usually if a patient needs potassium...they need it now, not 2-3-4 hours from now.

The only lyte we replace over several hours is phosphorus and it comes in 250 ml. We rarely replace phos and I don't recall the concentration, but I think we run it over 4 or 6 hours.

For our central lines we give K in bags of either 10 or 20 meq/50ml and we run it over 30 minutes. The most I remember givng in a relatively short period of time was 160 meq total in about 4 hours.

Not saying what's right or wrong. It's pretty obvious things are done differently in different places.

This really IS an interesting thread!!

[gwenith]

I would not have an issue with lignocaine being given on a monitored patient but I have to re-iterate to use extreme caution with an unmonitored patient.

[geekgolightly]

just today i gave 40mEq in 200mL x2 into a subclavian. why is this considered to be a bad idea for those who say that one should never give that much K+ in that little fluid?

we ran it in 100mL bags (20mEq in each) at two hours for each bag.

brief hx: pt was in for UTI, a couple days ago she was prepped with golitely for a colonoscopy which is a possible reason for her critical K+ (2.7). she has no problem tolerating fluids.

[gwenith]

Subclavian is a huge vein whose own flow through will dilute the K+ even further - very different from a teeny vein at the back of the hand.

Actually we don't use piggybacks here we add the K+ directly to the bags ourselves or add it to the burette.

[NRSKarenRN]

US guidelines:
Vanderbuit policy...this is how I was taught and practiced:

http://vumcpolicies.mc.vanderbilt.edu/E-Manual/Hpolicy.nsf/AllDocs/204559611F29D08C86256D4E007EF361




Australia guidlines
http://www.safetyandquality.org/arti...lertfinal1.pdf

http://www.safetyandquality.org/arti...oyalhobart.pdf

Great Britan:
Implementing an IV potassium policy


Potassium: An Element of Life Contact Hour


Avoiding the Pitfalls of IV Therapy
http://nsweb.nursingspectrum.com/ce/ce94.htm

Diminishing the risks of iv potassium chloride.


Extravasation of Vasoconstrictive or Caustic Agent Protocol
http://www.resourcenurse.com/RN/refcenter/extravasation


Error stories!
Potassium Chloride for Injection Concentrate Errors Table
http://www.usp.org/patientSafety/briefsArticlesReports/qualityReview/qr561996-10-01d.html



Quizz: Potassium Balance and Imbalances

[stevierae]

Originally Posted by gwenith

Subclavian is a huge vein whose own flow through will dilute the K+ even further - very different from a teeny vein at the back of the hand.

Actually we don't use piggybacks here we add the K+ directly to the bags ourselves or add it to the burette.

That's what I was wondering about--I don't think I have EVER seen KCl in a piggyback, and have been wondering if this is a new trend on med-surg and/or ICU.

Seems like every patient that comes to the operating room has a 1L bag of RL that ALREADY has (that is, the manufacturer supplied it that way; just as they do pre-Heparinized NS for art lines) 20 or 40 MEQ of KCl added. Presumably, it is set to run over 8 hours, or perhaps KVO. We always d'c it, because running KCl druing induction of general anesthesia can cause dysrhthmias.

It's been a long time since I saw a bag of IV fluid with the orange additive sticker, indicating a nurse or pharmacist had to add KCl--and I have NEVER seen KCL in less than a 1L bag. Then again, I don't work med-surg or ICU, and maybe they do this in patients we don't see in the OR--that is, medical patients.

I wonder why people ever got out of the habit of adding meds to a Buretrol, andyway, and using piggybacks? When I was in the Navy, we added everything to the Buretrol--just opened the primary--that is, the only--IV, filled it with 50 or 100 or solution, then added the med directly to the Buretrol at whatever rate we wanted. Then, when it infused, you would open the IV to flush it, and then readjust the drip rate to whatever you wanted the primary to run at. I remember getting my Heparin this way when I was hospitalized with DVT.

I could see whay you'd need a piggyback with Vanco or Flagyl--you want the extra volume that might not fit in a Buretrol (i.e., 250 or 500 cc) and you'd want to run it over an hour--but, as long as a med isn't incompatible with your primary IV, I never could understand why a piggyback (secondary bag) became preferable to a Buretrol. Sure would save time, money, and space in landfills!

[?burntout]

If I have a patient that is getting IV K+ and they complain of burning, I will decrease the pressure setting on the pump and wait about 5-10 minutes to see if that helps: if not, I usually will restart the IV in another site.