Y-porting potassium IV - what's your policy?

  1. At my hospital we do not have a policy for y-tubing peripheral IV potassium. Myself and couple of other nurses are trying to find evidence based research to submit to the powers-that-be so that we can get a written policy. As a new RN, I was given instruction by more experienced RNs that when hanging IV potassium to a peripheral IV that the best thing to do to prevent extravasation/burning is to get 2 pumps, hang the potassium on 1 pump and y-port it to NS which is hung using its own pump. However, I cannot find any research/articles on doing this. The closest I can find is that many articles say "be careful/aware of extravasation and take measures to avoid it" but do not say what those "measures" should be. I have even had our hospital librarian search for articles and he didn't find anything pertinent.

    So my question is: what is your personal policy as an RN when you hang potassium AND does your facility have a written policy for y-porting or diluting potassium in some way? I'm hoping that maybe if I can at least get an RN consensus that I can present that and get a written policy to help out our new RNs (and more experience RNs too!) AND prevent harm to our patients.

    Thanks in advance for any help/suggestions/comments!
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  2. 13 Comments

  3. by   Tramore35
    We always do it the same way as you. Two pumps....Y sited below NS pump. I have very few patients who complain of burning. I know of no articles but this is the way I was taught and seems to work well.
  4. by   MunoRN
    While I've heard this theory before I don't think there's any reason to believe it's true.

    If your goal is to avoid extravasation then increasing the rate of the combined infusion by y-siting it into a concurrently running fluid would only increase the chance of extravasation, not decrease it, although increased rate still wouldn't be fast enough to be a likely cause of extravasation either way.

    If the goal is to reduce discomfort by diluting it with another fluid, then it would depend on the patient's need or potential tolerance of the extra fluid. If their maintenance fluid is NS @100 and they can tolerate the 500ml NS with 40kcl at 100 hr then there would no reason continue running the plain NS at 100/hr while it's infusing, since they would still be getting NS@100/hr through the K rider.
  5. by   akulahawkRN
    Just "my own" practice for doing K+ riders... I'll start a "small" bag of NS (enough to "cover" 100ml/hr for however long the rider is supposed to run with a little extra) and use that as a "carrier" or the primary fluid. That goes on one pump or one channel. The K+ rider gets its own primary line (usually) that is Y-sited into the primary as close to the hub as I can. I want the K+ to mix with the primary before it reaches the patient but have as small volume between the K+ and patient so I can change rates on either pump and quickly get a response.

    What I've found is that NS w/ 20K+ is usually very well tolerated as the actual K+ concentration per mL is quite low compared to a K+ rider. Running a 10 mEq/L rider straight into a vein, even if very slow, is usually fairly uncomfortable. Therefore I dilute it... and if I have to run the K+ in over 1 hour, I can vary the concentration of the K+ that the patient's veins see by changing the infusion rate of the carrier fluid. Typically the max that runs through a peripheral line is 200 mL/hr. This is usually well within the flow rate of nearly any peripheral line.
  6. by   MunoRN
    Quote from akulahawkRN
    Just "my own" practice for doing K+ riders... I'll start a "small" bag of NS (enough to "cover" 100ml/hr for however long the rider is supposed to run with a little extra) and use that as a "carrier" or the primary fluid. That goes on one pump or one channel. The K+ rider gets its own primary line (usually) that is Y-sited into the primary as close to the hub as I can. I want the K+ to mix with the primary before it reaches the patient but have as small volume between the K+ and patient so I can change rates on either pump and quickly get a response.

    What I've found is that NS w/ 20K+ is usually very well tolerated as the actual K+ concentration per mL is quite low compared to a K+ rider. Running a 10 mEq/L rider straight into a vein, even if very slow, is usually fairly uncomfortable. Therefore I dilute it... and if I have to run the K+ in over 1 hour, I can vary the concentration of the K+ that the patient's veins see by changing the infusion rate of the carrier fluid. Typically the max that runs through a peripheral line is 200 mL/hr. This is usually well within the flow rate of nearly any peripheral line.
    So to infuse a 40meq dose, you're infusing more than 4 liters of fluid?
  7. by   akulahawkRN
    Quote from MunoRN
    So to infuse a 40meq dose, you're infusing more than 4 liters of fluid?
    No, maybe 800mL total fluid. Of course another way to infuse a 40 meq dose would be to hang NS with 40 meq and run it at 250ml/hr... but that's a full liter infusion over 4 hours. If I know I'm going to infuse a total dose of 40 meq, I'll hang a 500 ml bag of NS and have that run at 100ml/hr along with the K+ rider at a fixed rate of 10 meq/hr. This way the max fluid infusion is 400 mL + fluid from the K+ riders, with 100ml left over in the primary bag. This can infuse at KVO until I can get a chance to get to the room to stop the infusions. When I'm all done, I have a primed primary line and a few empty K+ riders.
  8. by   MunoRN
    Quote from akulahawkRN
    No, maybe 800mL total fluid. Of course another way to infuse a 40 meq dose would be to hang NS with 40 meq and run it at 250ml/hr... but that's a full liter infusion over 4 hours. If I know I'm going to infuse a total dose of 40 meq, I'll hang a 500 ml bag of NS and have that run at 100ml/hr along with the K+ rider at a fixed rate of 10 meq/hr. This way the max fluid infusion is 400 mL + fluid from the K+ riders, with 100ml left over in the primary bag. This can infuse at KVO until I can get a chance to get to the room to stop the infusions. When I'm all done, I have a primed primary line and a few empty K+ riders.
    It sounded like you were saying you were diluting it beyond 10mq per liter, which would have been more than 4 liters per 40meq, I misunderstood.
  9. by   applewhitern
    Our potassium only comes as 20mEq/100ccNS. We don't have any 500cc bags with potassium. Sometimes we do as you suggested, and run some saline concurrently, but sometimes we add lidocaine to the potassium bag.
  10. by   CVSU
    10 mEq/50 mL bags for peripherals and 20's for central lines, run over an hour, run a 30mL NS flush behind it. I've given a thousand bags of these and I've never had an issue with peripheral burning. I don't know what they are talking about with the two pump thing...
  11. by   johosa12
    Save yourself the headache and ask if they can get it PO? Down the NGT/OGT or pills...if they can't, our pharmacy always mixes it up for us if it's going peripheral. 40/250mls of NS. That being said, in my ICU, I feel like almost EVERY patient of mine has a central line so I'm always running the high concentration peripheral potassium through those - 20meq/50 and 40 meq/100. To be honest, when someone orders it PO, I'm always like "woah, woah, woah....can we give that through an IV? I'm not dealing with PO meds!" haha
  12. by   hawaiicarl
    Our potassium comes in 2 concentrations, 10mEq/100 ml NS, or 20 mEq/100ml NS. Peripheral IVs can only be used with the lower concentration. I understand why people would think running NS concurrently is better, because basically you are diluting it like what we get from our manufacturer. I agree with Muno, too much fluid with the K is counterproductive, usually K gets low when we are diuresing. If someone complains about the IV burning we'll get an order for "Neut" which is basically a small amount of bicarb that we inject into the bag which helps with the burning. My recommendation would be for you to talk to your supplier about getting a lower concentration for your peripheral IVs. Hope this helps.

    Cheers
  13. by   tacticool
    There's nothing wrong with Y-siting KCL. If it were a high-risk drug like Cardizem, or heparin, yeah, get it going through it's own pump.Many patients get an order for two bags of KCL as a one-time order and won't need it again, so piggyback it. Besides, do your patients have two IVs, or just one? If you have two IVs , then if it makes you feel better, run two separate pumps. Just remember, you don't need a written policy for everything. If there are no contraindications to Y-siting, go ahead and do it. Nothing wrong with using common-sense.
  14. by   tacticool
    Quote from applewhitern
    Our potassium only comes as 20mEq/100ccNS. We don't have any 500cc bags with potassium. Sometimes we do as you suggested, and run some saline concurrently, but sometimes we add lidocaine to the potassium bag.
    Adding lidocaine? Hmmm? That sounds interesting!

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