K+ bolus?

  1. K+ bolus?

    Hi All....

    I was just wondering if anyone has ever bolused K+? I had pt a few weeks ago that I was getting ready for a c-sec.....not a real emergent one (baby was breech). After recieving pre-op labs back.....her K+ was found to be 2.4.... this was rechecked by lab 3x. The md ordered......40meq K+, with 10cc of 1% lidocaine in a 250cc bag of LR to be bolused. Then to recheck K+ after bolus. Nothing else......no EKG or anything. Pt was fine too.....

    Well I'm a fairly new RN......and I remember being told in school to never bolus K+. Another rule I read was not to give more than 10meq in an hr.

    Needless to say I didn't bolus it......Of course the md was ticked.....

    What do you guys think ?



    RN,@yourcervix.....
    •  
  2. 15 Comments

  3. by   ERNurse752
    In my hospital, I've never seen it bolused...ever. And whenever I've given it, it's been usually over 2-4 hours.
    I'm not an OB nurse or anything...but it seems funky to me!
    What ended up happening?

    lol...nice quote!
  4. by   Stargazer
    In VERY severe cases of hypokalemia, I have been ordered to, and have safely administered it, at 15 mEq /hour. No faster. And those were pts on continuous cardiac monitoring. IMO, that was a dangerous order which you were absolutely correct to refuse.

    Love your sig line!
  5. by   fedupnurse
    We bolus all the time in the ICU where I work. No more than 10mEq via peripheral line and no more than 20 mEq via central line. Our patients are also on monitors all the time too. You were right to not do that bolus without a monitor. If the pt. has pain we can go lower on the infusion rate. With pts. with NG tubes we try to give half down the tube (if they are being fed and aren't bleeding) and half IV. Another thing to watch for with a low K is new onset A Fib. We see that pretty regularly. Fix the K and the rhythm usually goes back to normal. (Only have ever seen this in really sick pts. with cardiac histories).
    fedupnurse
  6. by   catlady
    I gave many K+ boluses in my hospital days, never more than 20 mEq per hour, IIRC. Slower with the peripherals, because the K+ burns so much (I see you have Lidocaine in your bag).

    Maybe what you are remembering from school is never *push* K+. Never, never, never. Potassium given IV push is part of the cocktail when they give lethal injections!
  7. by   hoolahan
    First of all, with a K of 2.4, she should be monitored period! She could go into v-fib! Yes I have given K "bolus" though I would say IVSS is a more appropo term, since it is given over time, always on a pump, and rarely ever peripherally. I have given it 10 mEq per hour periph, and 20 centrally, in fact I have given 20 over 30 minutes, via pump in my post op hearts who had low K's, and having ectopy, repeated x 1 usually, so toal of 40 over an hour. In the heart unit where I used to work, of course this is an entirely different scenario post-op heart, but I have seen doc's push 5 mEq in 10cc over 5 minutes via central line. Only attendings were allowed to do that. When given carefully, and pt monitored appropriately, K "bolus" can be very safe. Would never recommend doing this on a floor, with high nurse-to-pt ratios. Not sure what your ratios were like when you were with this pt.

    Why on earth do you suppose her K was so low? Was she hyperemesis or something? Vomitting a lot, diarrhea, on diuretics?? Makes you wonder how a healthy "mom" ended up with a K of 2.4. Is that common in the intrapartal period? (mind you I hate OB nursing myself, I stay deliberately ignorant, but this is interesting.)
  8. by   CriticalCareOnc
    i have given plenty of KCL boluses at 20mEq/hr mostly for patients with hypokalemic paralysis. i haven't encountered a fatal arrythmia secondary to this bolus, other than the already existing EKG change for the hypokalemia. the only complaint of patients is the burning pain along the course of the vein.
  9. by   sharann
    Mosleyrn,
    You did the correct thing. 2.4 IS a very low K+ indeed, but a bolus with lido is a monitored bed type high risk thing. A cardiology consult was in order stat. Do you know why the K was so low? This sounds strange to me to. WHO did give the "bolus" if it was given?
  10. by   nurs4kids
    Did he want it PUSHED or as a BOLUS?? We "bolus" with IVF containing K+ all the time on our kids, but it's usually over 30min-1 hr and we have strict guidelines on the max per minute safely adm according to weight.

    but..i don't know nuthin' about adults or safe doses on them
  11. by   bestblondRN
    I have never seen K+ delivered at more than 15 mEq/hr, and the norm is 10. I would be very uncomfortable giving it at a higher rate.
  12. by   Ted
    On the hematology/oncology/BMT floor I used to work on, we had a protocol that allowed potassium to be given up to 20 meq/hr for the BMT patients (without cardiac monitoring). Of course, these patients were potassium depleted from all of the chemo and its associated vomiting and diarrhea. These poor chaps couldn't get enough potassium.
  13. by   MPHkatie
    Lets see, if the patient showed up in our ER she would have had a cardiac workup, ekg, monitoring and a "bolus of K" it would have been put on a pump and probably given over 1-2 hours. Giving K rapidly is poor practice, and could result in you losing your job since in court an expert would testify that accepted practice is not to bolus K fast and that a prudent RN would know that (which you did know- Good for you
    Just because this one patient was fine doesn't mean that every patient who gets K fast is going to do well. We have a specific protocol for giving K and mag at our hospital and it has come in handy. I imagine your hospital has one too, but I am assuming that K isn't one of the more common drugs given in OB (Like I know we have some sort of policy on Pitocin, but I'd have to look it up) So good for you for recognizing that this order was strange. I imagine that the OB doc doesn't always deal with low K's either so, giving him the benefit of the doubt maybe thats where that order came from.
  14. by   misti_z
    To repeat what everyone has said. I too give K bolus quite frequently. Usually 10 mEq/hr via per peripheral IV and 20 mEq/hr via central line. She should be on a monitor. However with my renal folks they are usually hyper- not hypo-. We do monitor if >5.3 although I usually get an EKG just to cover my bases (aka a$$). Had a renal pt the other evening admitted for hyperkalcemia, she was walking and talking just fine so I figured it was 5.5 or so.....but it was 9.0!!!!!!!!!!!

    Originally posted by MPHkatie
    We have a specific protocol for giving K and mag at our hospital and it has come in handy.
    I called a resident the other morning with a Mg of 1.5. She said 'Give 2 grams Mag over 15 minutes', I said 'Excuse me??!!'; her reply was 'In the book it says you can do that', i went on to tell her I was sure that was in code situations and that we usually give 2 gm Mag over 4 hours, she said do what ever your comfortable with.

    Never be afraid to speak up. You did the right thing.

close