Jump to content

Banana Bags. Etoh. Rate.

Posted
JeepAnnie JeepAnnie (New) New

Hey guys.. I've got a question.. Hope I don't sound too dumb...

Banana Bags.. the hospital I work at always does Etoh levels first, is this a must? I just didn't know if the level of alcohol has anything to do with what goes into each bag. Also, the rate... We normally hang the Banana bag at the rate the primary iv will be at when it is done (after 3 days). However the other day I had a patient with several different orderes 1. LR @ 83 2. Banana Bagx200ml/hr. 3. Banana Bag over 24 hours.

Hello can you say confusing! The nurse prior to me had the rate at the 200ml/hr. However I changed the rate to 83 when I got the patient, and yes I know I should have called and asked what the doctor wanted. Also the combinations.. I know each banana bag is different.. Our is usually vit K, LR, thiamine, folic acid, mag sulfate... so if we would have ran the patients iv at 200/hr for the 3 days... would this have caused issued with blood clotting/vit k?

Roy Fokker, BSN, RN

Specializes in ER/Trauma.

That's an interesting question.

Our banana bags in the ED usually consist of saline/LR bags with MVI, mag, folate and thiamine. As such - so long as the patient's fluids don't NEED to be rate controlled (e.g.: heart failure, hyponatremia etc.) we just run the fluids wide open.

Our general rule of thumb in the ED is: "As long as the fluids/medications infusing into the pt. isn't one of the controlled substances [Potassium, Insulin, Nitro, Propofol, pressors etc.] and the pt. doesn't present with history/symptoms of fluid overload/pump failure/cardio-pulmonary distress; the nurse has standing orders/protocols with regards to fluid administration."

JeepAnnie: as regards to your ETOH levels question, ask yourself this - why do we administer banana bags to patients? ;)

cheers,

annie, i'm not understanding the 3 day infusion, since banana bags are knowingly stable for 24 hrs only.

and since these particular solutions are typically indicated for alcoholics, i would think the md would want a level to put in notes.

definitely check out the 3 day order w/pharmacy.

leslie

FireStarterRN, BSN, RN

Specializes in LTC, Med/Surg, Peds, ICU, Tele. Has 15 years experience.

I think some doctors just like to pretend they're intensivists and order complicated IV orders. :rolleyes:

Altra, BSN, RN

Specializes in Emergency & Trauma/Adult ICU.

Vit. K goes into your banana bags? Interesting.

LilyBlue

Has 10 years experience.

Vitamin K doesn't go into ours. But a lot of doctors do strange things with ours - some give only one liter per 24 hours, some give 3 liters per 24 hours. We have a terrible drug/alcohol problem in my area, at any given time I have 4 patients out of nine actively detoxing/ at risk for or in DTs.

I work at a level one trauma center and our banana bags always go for 3 days.. Yes I know the bag is only good for one day.. we get multiple bags depending on the rate.. we just send our pharmacy a message telling them that the bag is low and that we need a new one..

This particular patient just confused me b/c he NEVER had an etoh test.. yes the patient said he was drinking, but what if it was 2 drinks!... does that really warrant a 3 day supply of banana bags.. esp. w/ the vit. K?!?!

BrnEyedGirl, BSN, MSN, RN, APRN

Specializes in Cardiac, ER. Has 18 years experience.

I'm in ED,.our ETOH with drawl order's include a banana bag every day until the pt is eating at least 50% of meals. We hang the bag wide open unless contraindicated (ie CHF), and give one every day, we don't actually have the bag hanging all day. The ETOH level has nothing to do with the rate of the banana bag, and we do not give Vit K IV.

hypocaffeinemia, BSN, RN

Specializes in Critical Care.

I work at a level one trauma center and our banana bags always go for 3 days.. Yes I know the bag is only good for one day.. we get multiple bags depending on the rate.. we just send our pharmacy a message telling them that the bag is low and that we need a new one..

This particular patient just confused me b/c he NEVER had an etoh test.. yes the patient said he was drinking, but what if it was 2 drinks!... does that really warrant a 3 day supply of banana bags.. esp. w/ the vit. K?!?!

Nevermind the ETOH, what did his labs look like?

I mean, considering the risk for GI bleed, some vitamin K might make sense. Especially if the dude's INR was >1.5.

Nevermind the ETOH, what did his labs look like?

I mean, considering the risk for GI bleed, some vitamin K might make sense. Especially if the dude's INR was >1.5.

an inr of 1.5-3, let's say...that would warrant vit k???

leslie

hypocaffeinemia, BSN, RN

Specializes in Critical Care.

an inr of 1.5-3, let's say...that would warrant vit k???

leslie

Depends on the patient and the how cautious the doc was going to be. And also how much vitamin K: RDA of Vitamin K is 1 mcg/kg/day, however, anticoagulation reversal doses are as high as 50mg. I can see why it'd be added as a supplementation dose given the typical vitamin-deprived state an alcoholic is in.

UM Review RN, ASN, RN

Specializes in Utilization Management.

Nevermind the ETOH, what did his labs look like?

I mean, considering the risk for GI bleed, some vitamin K might make sense. Especially if the dude's INR was >1.5.

Not to split hairs, but an INR of over 1.5 is fine. Again, you'd have to find out what caused the INR to be high. If the guy's taking Coumadin for a valve replacement or something, you sure do not want him to be as low as 1.5.

Usually we don't start giving Vit K until they're up over 5.0 or so and even then, cautiously depending on the patient's cardiac situation.

And I've never known our hospital to give Vit K in a banana bag, we usually give it as an SC injection.

This patient is 62yr old, only medical hx of htn. No INR done. No Etoh... This is the BIG reason I HATE working with ... Residents.. and a very busy hospital... We have way to many patients with way to many issues to do enough research for patient safety...

Thanks to everyone for replying.. I ask these questions at work.. And most of the nurses are very new and just do whatever is on the work list for the shift... they never think about the WHYs...

Vit K... its a 'standard' in our banana bags.. I haven't had one without it yet!

I'm not familiar with the phrase banana bag - are you talking about TPN (total parenteral nutrition)?

thanks, Marion

hypocaffeinemia, BSN, RN

Specializes in Critical Care.

Not to split hairs, but an INR of over 1.5 is fine. Again, you'd have to find out what caused the INR to be high. If the guy's taking Coumadin for a valve replacement or something, you sure do not want him to be as low as 1.5.

Usually we don't start giving Vit K until they're up over 5.0 or so and even then, cautiously depending on the patient's cardiac situation.

And I've never known our hospital to give Vit K in a banana bag, we usually give it as an SC injection.

Let me rephrase, I didn't mean to say an INR >1.5 requires treatment. I'd just imagine that if they were wanting to add vitamin K as a nutritional supplement, taking a peek at his prothrombin time would be handy to make sure you weren't about to give vitamin K to a guy that was already hypercoagulable. Dehydration from alcoholism plus a pre-existent hypercoaguable state + vitamin K may not be the best combination, after all. :p

Then again, I'm not sure if vitamin K in supplement doses exerts a huge therapeutic effect anyways. I'm just speculating here.

hypocaffeinemia, BSN, RN

Specializes in Critical Care.

I'm not familiar with the phrase banana bag - are you talking about TPN (total parenteral nutrition)?

thanks, Marion

A banana bag is a merely a bag of IV fluid (In my limited experience, I've seen D5LR and D5NS) that has added to it multivitamins, magnesium, folic acid, and thiamine. And in some places/situations, apparently, vitamin K.

It's called a "banana bag" because the MVI solution injected into the bag gives dyes it a yellow color.

hypocaffeinemia, BSN, RN

Specializes in Critical Care.

JeepAnnie,

Next time you're at work, call the pharmacy and ask exactly how much vitamin K they add to a typical banana bag.

UM Review RN, ASN, RN

Specializes in Utilization Management.

Let me rephrase, I didn't mean to say an INR >1.5 requires treatment. I'd just imagine that if they were wanting to add vitamin K as a nutritional supplement, taking a peek at his prothrombin time would be handy to make sure you weren't about to give vitamin K to a guy that was already hypercoagulable. Dehydration from alcoholism plus a pre-existent hypercoaguable state + vitamin K may not be the best combination, after all. :p

[\quote]

Totally agree there.

Let me rephrase, I didn't mean to say an INR >1.5 requires treatment. I'd just imagine that if they were wanting to add vitamin K as a nutritional supplement, taking a peek at his prothrombin time would be handy to make sure you weren't about to give vitamin K to a guy that was already hypercoagulable. Dehydration from alcoholism plus a pre-existent hypercoaguable state + vitamin K may not be the best combination, after all. :p

Then again, I'm not sure if vitamin K in supplement doses exerts a huge therapeutic effect anyways. I'm just speculating here.

I'd think it could, given the fact that most Coumadin patients are warned about eating Vit-K enriched foods.

But this whole concept of adding K to a banana bag is new to me; I've never seen it, so I'm all for learning more about it.

Guest
This topic is now closed to further replies.