Feedback on the use of lidocaine with IV Potassium

[Xcited 2B-N-RN]

I'm currently in nursing school and have to do a short EBN paper on the use of lidocaine with IV potassium administration. Although evidence strongly suggests that the practice of using this combo be discontinued, I find that many hospitals continue to have standing orders, and that doctor's are still prescribing lidocaine PRN for pain during infusion.

I would like to get some feedback from practicing nurses on what you see as the "pro's and con's" of using, or not using, lidocaine during K+ infusion and the incidence of adverse patient reactions to this combo.

[traveler85]

I would not give it simply because it could mask the pain from an infiltrated IV. If I have a pt on K+ complaining of pain at the IV site, the first thing I do is check the patency of the IV. If the IV is good, I will either decrease the rate of the K+ or start running it saline (this usually helps decrease pain). I always tell my patients to let me know if their IV start hurting or if the burning gets worse.

[cardiacmadeline, RN]

We stopped giving lidocaine a while ago with our IV potassium. If the potassium infusion is painful for someone, I either 1) slow down the rate 2) add another line with saline running through so the potassium is more diluted or 3) apply a warm pack to the site. One of these things or a combination of them usually does the trick, so I don't really miss the lidocaine. If lidocaine is going to mask the signs of an infiltrated IV, I would rather not use it anyways and do something else to help with the pain associated with the potassium.