- 0Jan 9, '05 by limabeanI have a question regarding the administration of IV potassium. I recently graduated from nursing school, so I am always trying to learn and I ask a lot of questions. I received an order from doctor to run a potassium bolus over 1 hour. When the potassium came down from pharmacy they had typed on the label to run it over 1 1/2 hrs. I had read somewhere that potassium should not run faster than 10meq/hr peripherally which at the concentration supplied would have been over 1 1/2 hrs. So I asked my preceptor which one I should go with. She said that I should always follow the MD's order, but that if I was worried about it then SHE would hang it. (I think she was tired of me asking questions.) So she goes into the room, hangs the potassium (which I had already primed), sets the pump to run it in over 1 hr, hooks it up to the patient, and she leaves the room. Well a few minutes later I heard the pump beeping so I went in to check it. In her rush, the preceptor had not hooked the tubing up to the pump (even though she had set the pump) and the potassium would have been running in at a wide open rate. Fortunately, for some reason, when I primed the tubing I had clamped it off and when the preceptor hung it she did not unclamp it which caused the pump to beep. So the K+ did not run in at the wide open rate that it would have. I told the preceptor about this and she said that I needed to stop worrying and that it is okay for potassium to run without a pump. (She did not mention anything about it running wide open). She said that there will be times when I dont have a pump and I will have to run it without one. So my question after all that is....can potassium run without a pump? Is it safe? If not what rate can it run in peripherally? Was the preceptor correct? Thanks.
- 0A potassium bolus run too fast can cause an MI that would kill the patient. Potassium can also extravasate and cause necrosis to the surrounding tissue.
Even giving potassium at the prescribed rate, via a pump, causes a lot of irritation to the vein and patients c/o pain at the site.
Your hospital should have a policy on running IV Potassium. Call Pharmacy and have them print you a copy so you can show your preceptor.
Her patient got lucky this time, believe me.
- 0PS No matter what the MD prescribed, you'll be held to the nursing standard of care, so follow hospital policy. If the MD prescribes something that hospital policy does not allow, it's your job to call him and inform him and get the order changed. If he won't change it, go up your chain of command and get your supervisor to talk to him. I usually try to give my Charge nurse or supervisor a heads-up in these situations just so they'll be prepared with the situation should the need arise to talk to the MD themselves.
Also, here's the link from Davis's Nursing Drug Guide. Your drug guide should be the first place to look and there should be at least one on every unit.
- 0ps #2: here's a great link about kcl administration, and it's a pretty recent one from this site, plus the med errors thread, which you also might find helpful.
- 0Jan 9, '05 by nursbee04You did the right thing. If YOU as a nurse had hung the K+ and it went in wide open and the pt developed an arrhythmia or arrested, in court YOU (not the doc who wrote the order) would be held to the standards of safe nsg practice. You are responsible for knowing whether an order is safe or not.
Don't ever worry about questioning things. I would rather go overboard and know that I protected my pt than brush it off and put my pt at risk.
Recently we had a pt c/o leg cramps. The doctor ordered Quinidine, which is an antiarrhythmic. This pt had no cardiac history, her only complaint was leg cramps. If we hadn't questioned the order and given the quinidine, the pt could have died. He was very thankful when we called back and asked if he meant Quinine, which is for leg cramps. That is a prime example of why you shouldn't always just follow the order and not question it.
- 1Jan 10, '05 by talaxandraQuote from limabeanNope - if that were true you wouldn't need to have an education! While I'm sure there are a few doctors (and administrators) out there who would like a fleet of robot nurses, you learn about pathophysiology and pharmacology etc for a reason. As has been said before (on other threads), if a doctor writes up the wrong med/dose/route and a pharmacist doesn't pick it up, and you give it, it's your registration on the line. Saying 'but the doctor ordered it' will get you nowhere.She said that I should always follow the MD's order
I understand that you're quoting her, but I just want to be crystal clear when I say that she's wrong!
You could run K+ without a pump, but only if you were prepared to sit and watch it for the duration of the infusion! The fact that she's so unconcerned about this if a bit troubling, frankly.
You, on the other hand, on the ball - bravo!
- 0Jan 10, '05 by actioncatI am floored that anyone would tell you that a Potassium piggyback does not have to be run on a pump. We run 10 Meq over one hour, but we will go slower to make it easier on the vein. NEVER faster than that speed.
Myself, I would always follow the paharmacy's directions. They are the ones that really know what they are talking aobut when it comes to med administration. Often, I will call the paharmacy with a question before I call a doctor then let the doctor know what the pharmacist said. They always appreciate the input. Our pharmacists are pretty sharp.
- 0Jan 10, '05 by CritterLoveri think you will find that in general, most docs don't care if you run most of your piggy-backs (abx, electrolytes) slower than ordered. maybe there are some old-school docs who want it done their way, but most will defer to your judgement as an rn.(an exception would be iv dilantin, which can crystalize in solution if it is left mixed too long.)
i did have a resident once who didn't like how slowly i was pushing the cacl2. he took the syringe from me and pushed it on it.....and pushed the patient right on in to v-tach! doubt he will ever to that again.
as for potasssium, you can give it faster than 10 meq/hr in certain situations. most literature will tell you that you can run it at 20 meq/hr if the patient is on a monitor. lippincott's criticle care drug guide tells you that if the k level is <2, you can run it at 40 meq/hr. of course, you still follow your hospital's policy, no matter what a drug guide says.
though i've worked in icu where my patients were always on a monitor, i never ran routine k boluses in at 20 meq/hr. however, i have run it at 40 meq/hr on a patient whose k level was way less than 2. i think it was somewere around 1.5, and he got the first 40 over an hour, the second 40 over 2 hours, and then we slowed down to 10/hr. (the level was rechecked somwhere in there, too.)