Advice giving Kayexalate enemas

[nursej22, MSN, RN]

Had a pt. with a K+ of 6.5 the other night, r/t respiratory acidosis. MD had me give 2 amps bicarb, mg of Bumex, and wanted me to give a Kayexalate enema. Well, I started with the bicarb and bumex knowing they would work quickest and had to wait for the Kayexalate to come up from pharmacy.

I had only ever seen prepackaged Kayexalate enemas and was a little taken aback when they sent me 2 bottles of the po solution. So I consulted with the stat RN about how to give because I knew it wasn't going in through a regular enema bucket. She advised that it be given po, doc said fine po but he wanted it given pr as well.

So I call ICU again, because per doc, "they give it all the time." I ended up using a 60 cc catheter syringe and the biggest red rubber catheter I had,( an 18Fr.) and cut the tip off. It was still kind of a mess, drawing it up and injecting it, and my poor pt had trouble retaining it because of the Bumex. But she was able to retain most it for about 30 minutes.

In hind sight, I'm not sure if the po and pr solution were equivilent, should I have added more diluent, or tried to insert a flexiseal to help her retain the enema.

Her K+ was down to 4.95 after the bicarb, and the next draw wasn't til am.

So, any have any helpful tips for the next time ( which I hope isn't for another 10 years!) ? Or maybe the hospital updates the P&P by then.

thanks in advance.

[littlern820126]

What I do is insert a flexiseal first, use the flushing port to give the diluted Kayexalate. I don't remember how much to dilute it with at this time, but your pharmacy should be able to tell you. Then tie the flexiseal of with a rubber band let it sit for the amount the MD perscribed and then untie it. Some stool and Kayexalate will have already drained due to the consistency. It does take time for it to actually go in and you have to hold the flexiseal up while you do this . Good luck for next time.

[lkwashington]

In the ICU I work you need an order for a Flexi Seal. Do dont forget about getting the order prior of doing a procedure.

[grandmawrinkle]

Using a flexiseal sounds like a really expensive way to give an enema. I think those things are over 100 bucks a pop, maybe more.

What we usually do is get a plain old foley cath with a balloon on it, insert and blow up the balloon, take a 60cc cath tip syringe and infuse the kayexelate, then clamp it off with a hemostat. This works fine.

I have never heard of prepackaged kayexelate enemas. I wish we got those!

[Esme12, ASN, BSN, RN]

Instead of the flexiseal......call x-ray as they give BA rectally through a foley type cath with a 60 cc balloon......it leaks less than a regular foley

[lkwashington]

You can also use a suds enema liter bag with warm water and kayexalate. This may work also.

[grandmawrinkle]

Instead of the flexiseal......call x-ray as they give BA rectally through a foley type cath with a 60 cc balloon......it leaks less than a regular foley

I forgot about that. We have to call to have a foley with a 60cc balloon delivered as we don't stock them...good pickup

[cheltoe]

You can also use a suds enema liter bag with warm water and kayexalate. This may work also.

Be sure to put the water in first.

[nursej22, MSN, RN]

Thanks to all for your replies. I did try asking my pharmacy for dilution guidelines, they told me this was a nursing task. So I'm still not sure about how much diluent if any. Medipedia recommends 100 cc of aqueous diluent such as sorbitol, and I think that is what is it already mixed in.

I will check with x-ray about the 60 cc balloon foleys, I have a feeling they will be less than willing to send one. And the last time I tried to get a particular foley from CS it took half a shift because they couldn't figure out what I was talking about without an item number.

I will check with the nurse practice council about coming up with a policy and procedure--this would at least give one some legitimacy when asking for proper supplies.

[Esme12, ASN, BSN, RN]

I forgot about that. We have to call to have a foley with a 60cc balloon delivered as we don't stock them...good pickup

Thanks :)

[Esme12, ASN, BSN, RN]

http://www.tagpeoria.org/HYPERKALEMIA%20ADULT%20GUIDELINES.pdf

[nyrn5125]

i havent done in a while but we use the kayexelate po that is mixed in sorbitol add 100cc warm water and use soap suds enema bag leave in 30 minutes then lower the bag for removal