Had a pt. with a K+ of 6.5 the other night, r/t respiratory acidosis. MD had me give 2 amps bicarb, mg of Bumex, and wanted me to give a Kayexalate enema. Well, I started with the bicarb and bumex knowing they would work quickest and had to wait for the Kayexalate to come up from pharmacy.
I had only ever seen prepackaged Kayexalate enemas and was a little taken aback when they sent me 2 bottles of the po solution. So I consulted with the stat RN about how to give because I knew it wasn't going in through a regular enema bucket. She advised that it be given po, doc said fine po but he wanted it given pr as well.
So I call ICU again, because per doc, "they give it all the time." I ended up using a 60 cc catheter syringe and the biggest red rubber catheter I had,( an 18Fr.) and cut the tip off. It was still kind of a mess, drawing it up and injecting it, and my poor pt had trouble retaining it because of the Bumex. But she was able to retain most it for about 30 minutes.
In hind sight, I'm not sure if the po and pr solution were equivilent, should I have added more diluent, or tried to insert a flexiseal to help her retain the enema.
Her K+ was down to 4.95 after the bicarb, and the next draw wasn't til am.
So, any have any helpful tips for the next time ( which I hope isn't for another 10 years!) ? Or maybe the hospital updates the P&P by then.
