K+ bolus?

  1. 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 a 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 ?
    •  
  2. 8 Comments

  3. by   canoehead
    I would be OK with giving that over 1h, prefer a central line though and monitering if it was given any faster. And of course there would not be any other conditions being corrected that would affect K level, like glucose, NA, CL levels.

    I don't see any reason why you wouldn't be able to take your time though if you were uncomfortable...maybe the OR team had somewhere they needed to be?
  4. by   shelbyL&Drn
    I am sure each facility has their on policies concerning K+ replacement. When I have given K+ bolus, we have pre-mixed bags. K+ 20meq/100ccNS, and we have a protocal that our md's and pharmacy came up with.

    I personally usually give the bolus over 2 hours., but of course when you have a pt waiting on surgery this can be a major pain.
  5. by   live4today
    When in doubt of carrying out a physician's order, have the physician carry out his/her own order if they so desire, or get another staff member to do it. I've done it, much to the docs dismay!
    Well, whatever! Protect your license first, honor the patient second, third, never let the doc forget that you have no intention of proceeding with a medical order when you are uncertain of its effect on the patient FOR THE BENEFIT OF THE PATIENT AND THE PROTECTION OF YOUR NURSING LICENSE.
    Last edit by live4today on May 8, '02
  6. by   NurseDennie
    Nope, nuh-uh, no, no way, not EVEN.

    I'm afraid of K+ and I always believe that it's better to be safe than sorry. I agree with cheerfuldoer - if it HAS to go in that fast, then the doc HAS to do it.

    Sorry doc, it's not that I won't do it, I CAN'T.

    I did the same thing with a frequent flyer with a central line and an order for a HUGE amount of demerol Q2. I was diluting it and putting it in over 5 minutes (I'm embarassed to even tell you how much demerol I was giving this woman). She said "Just push it in! I can take it." Which I knew intellectually that she could. I could have slammed the entire (enormous) dose and it wouldn't have even made her sleepy. But MY nerves wouldn't let me do it.

    Love

    Dennie
  7. by   mother/babyRN
    I agree with Cheefuldoer and Nurse Dennie...If you have the slightest doubt speak up. It doesn't matter that just because a doctor says somethng you are protected. If he or she is making a questionable order, you would be the one found negligent if something happened. If it wasn't the correct thing to do, even the go ahead by a supervisor won't protect you. We do not give potassium boluses..I wouldn't do it even if it WERE allowed unless I had the patient on telemetry and pretty frequent labs, but thats just me...And, if the doctor wouldn't do it if you protested, then I would be hesitant about passing it off on another staff member who might not feel as against it as you were because the court could contend that you knowingly enlisted another person to permit harm to a patient. Once you take a few legal courses you will see whats at stake. Basically, the nurse is ultimately responsible for everything...
  8. by   bassbird
    Our K+ protocol calls for 40mEq (4 bags of KCL 10mEq in D5W 50ml) to be given over 2 hours total if the serum level is less than 3.0, and over 4 hours if the serum level is 3.0 to 3.5. We add lidocaine to the bags if it is going into a peripheral line.

    Does your hospital have a protocol for K+ bumps? We split the 40mEq up into the four bags to prevent it from being infused too quickly.
  9. by   ma kettle
    here's one for you, When I started, we use to mix the K in the IV bags as we needed it. K use to come in a 1occ container much like nss. Well on day a patient was in need of a ivp drug. the nurse accidently drew up K instead if the vial nss for a flush.
    OOPS that lady arrested and died. Now this patient happen to be very old(90) and in multiple organ failure to start with.... BUt this also ended this girls career at that hopsital and I am not sure if she ever nurses again. True story, but very sad for all concerned.
    When it comes to K , use caution.
    Sandy
  10. by   mark_LD_RN
    check your hospitals protocol before giving K+ bolus. Our hospital we can give 10 MeQ per hour if not on monitor,20 MeQ an hour if on continuous ekg monitoring, and up to 40 MeQ an hour in iv only

close