Banana Bags. Etoh. Rate.

JeepAnnie · Feb 28, 2009

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!

HealthShepherd · Feb 28, 2009

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

thanks, Marion

hypocaffeinemia, BSN, RN · Feb 28, 2009

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.

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 · Feb 28, 2009

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 · Feb 28, 2009

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 · Feb 28, 2009

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.
[\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.
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.

Vito Andolini · Feb 28, 2009

Dumb me, what's a banana bag?

LovingNurse, BSN, RN · Mar 1, 2009

Here ya go: "Banana Bag"

cardiacRN2006, ADN, RN · Mar 1, 2009

We have tons of ETOH'rs and our Banana bags don't have Vit K in them.

And most of those pts are coagulopathic-severly even. If we need to treat with Vit K then we do it SubQ.

Altra, BSN, RN · Mar 1, 2009

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...

I'll come back to the lack of an ETOH level you were concerned about ...

An alcohol level only indicates a level of intoxication at the time it was drawn. Consider a long-time ETOHer who stopped drinking 4 days ago. His/her ETOH level may now be zero. That has no bearing on the big picture, and the need to correct deficiencies in folate, thiamine, etc. ... and that is what is accomplished with a banana bag.

Your patient may "only" have a documented hx of HTN because he has never before discussed his drinking with a health-care provider. He may have, up until this point, been functioning relatively well despite daily ETOH. Many, many people do.

august07 · Mar 1, 2009

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

Does anyone else call them Rally Packs (not sure why we call them this?)

leslie :-D · Mar 1, 2009

Does anyone else call them Rally Packs (not sure why we call them this?)

yep, i've heard them called that, too.

all those vits/minerals, get those pts up and rallying.:)

leslie