Banana Bags. Etoh. Rate.

  1. 0 Hey guys.. I've got a question.. Hope I don't sound too dumb...

    Banana Bags.. the hospital I work at always does Etoh levels first, is this a must? I just didn't know if the level of alcohol has anything to do with what goes into each bag. Also, the rate... We normally hang the Banana bag at the rate the primary iv will be at when it is done (after 3 days). However the other day I had a patient with several different orderes 1. LR @ 83 2. Banana Bagx200ml/hr. 3. Banana Bag over 24 hours.

    Hello can you say confusing! The nurse prior to me had the rate at the 200ml/hr. However I changed the rate to 83 when I got the patient, and yes I know I should have called and asked what the doctor wanted. Also the combinations.. I know each banana bag is different.. Our is usually vit K, LR, thiamine, folic acid, mag sulfate... so if we would have ran the patients iv at 200/hr for the 3 days... would this have caused issued with blood clotting/vit k?
  2. Tags
    Visit  JeepAnnie profile page

    About JeepAnnie

    32 Years Old; Joined Sep '08; Posts: 3.

    29 Comments so far...

  3. Visit  Roy Fokker profile page
    6
    That's an interesting question.

    Our banana bags in the ED usually consist of saline/LR bags with MVI, mag, folate and thiamine. As such - so long as the patient's fluids don't NEED to be rate controlled (e.g.: heart failure, hyponatremia etc.) we just run the fluids wide open.

    Our general rule of thumb in the ED is: "As long as the fluids/medications infusing into the pt. isn't one of the controlled substances [Potassium, Insulin, Nitro, Propofol, pressors etc.] and the pt. doesn't present with history/symptoms of fluid overload/pump failure/cardio-pulmonary distress; the nurse has standing orders/protocols with regards to fluid administration."

    JeepAnnie: as regards to your ETOH levels question, ask yourself this - why do we administer banana bags to patients?

    cheers,
    cardiacRN2006, Elvish, BrnEyedGirl, and 3 others like this.
  4. Visit  leslie :-D profile page
    1
    annie, i'm not understanding the 3 day infusion, since banana bags are knowingly stable for 24 hrs only.

    and since these particular solutions are typically indicated for alcoholics, i would think the md would want a level to put in notes.

    definitely check out the 3 day order w/pharmacy.

    leslie
    HM2VikingRN likes this.
  5. Visit  FireStarterRN profile page
    1
    I think some doctors just like to pretend they're intensivists and order complicated IV orders.
    TinyHineyRN likes this.
  6. Visit  Altra profile page
    7
    Vit. K goes into your banana bags? Interesting.
    Daisy Doodle, canoehead, Roy Fokker, and 4 others like this.
  7. Visit  LilyBlue profile page
    0
    Vitamin K doesn't go into ours. But a lot of doctors do strange things with ours - some give only one liter per 24 hours, some give 3 liters per 24 hours. We have a terrible drug/alcohol problem in my area, at any given time I have 4 patients out of nine actively detoxing/ at risk for or in DTs.
  8. Visit  JeepAnnie profile page
    0
    I work at a level one trauma center and our banana bags always go for 3 days.. Yes I know the bag is only good for one day.. we get multiple bags depending on the rate.. we just send our pharmacy a message telling them that the bag is low and that we need a new one..

    This particular patient just confused me b/c he NEVER had an etoh test.. yes the patient said he was drinking, but what if it was 2 drinks!... does that really warrant a 3 day supply of banana bags.. esp. w/ the vit. K?!?!
  9. Visit  BrnEyedGirl profile page
    1
    I'm in ED,.our ETOH with drawl order's include a banana bag every day until the pt is eating at least 50% of meals. We hang the bag wide open unless contraindicated (ie CHF), and give one every day, we don't actually have the bag hanging all day. The ETOH level has nothing to do with the rate of the banana bag, and we do not give Vit K IV.
    Altra likes this.
  10. Visit  hypocaffeinemia profile page
    0
    Quote from JeepAnnie
    I work at a level one trauma center and our banana bags always go for 3 days.. Yes I know the bag is only good for one day.. we get multiple bags depending on the rate.. we just send our pharmacy a message telling them that the bag is low and that we need a new one..

    This particular patient just confused me b/c he NEVER had an etoh test.. yes the patient said he was drinking, but what if it was 2 drinks!... does that really warrant a 3 day supply of banana bags.. esp. w/ the vit. K?!?!
    Nevermind the ETOH, what did his labs look like?

    I mean, considering the risk for GI bleed, some vitamin K might make sense. Especially if the dude's INR was >1.5.
  11. Visit  leslie :-D profile page
    0
    Quote from hypocaffeinemia
    Nevermind the ETOH, what did his labs look like?

    I mean, considering the risk for GI bleed, some vitamin K might make sense. Especially if the dude's INR was >1.5.
    an inr of 1.5-3, let's say...that would warrant vit k???

    leslie
  12. Visit  hypocaffeinemia profile page
    0
    Quote from earle58
    an inr of 1.5-3, let's say...that would warrant vit k???

    leslie
    Depends on the patient and the how cautious the doc was going to be. And also how much vitamin K: RDA of Vitamin K is 1 mcg/kg/day, however, anticoagulation reversal doses are as high as 50mg. I can see why it'd be added as a supplementation dose given the typical vitamin-deprived state an alcoholic is in.
  13. Visit  Angie O'Plasty, RN profile page
    4
    Quote from hypocaffeinemia
    Nevermind the ETOH, what did his labs look like?

    I mean, considering the risk for GI bleed, some vitamin K might make sense. Especially if the dude's INR was >1.5.
    Not to split hairs, but an INR of over 1.5 is fine. Again, you'd have to find out what caused the INR to be high. If the guy's taking Coumadin for a valve replacement or something, you sure do not want him to be as low as 1.5.

    Usually we don't start giving Vit K until they're up over 5.0 or so and even then, cautiously depending on the patient's cardiac situation.

    And I've never known our hospital to give Vit K in a banana bag, we usually give it as an SC injection.
    BrnEyedGirl, cardiacRN2006, Altra, and 1 other like this.
  14. Visit  JeepAnnie profile page
    0
    This patient is 62yr old, only medical hx of htn. No INR done. No Etoh... This is the BIG reason I HATE working with ... Residents.. and a very busy hospital... We have way to many patients with way to many issues to do enough research for patient safety...

    Thanks to everyone for replying.. I ask these questions at work.. And most of the nurses are very new and just do whatever is on the work list for the shift... they never think about the WHYs...

    Vit K... its a 'standard' in our banana bags.. I haven't had one without it yet!


Nursing Jobs in every specialty and state. Visit today and find your dream job.

A Big Thank You To Our Sponsors
Top
close
close