Can you piggyback critical meds like IV Potassium or Mag at your hospital?

[UM Review RN, ASN, RN]

I was taught that we cannot piggyback potentially dangerous IV meds like KCl and Magnesium.

Instead, we hook up the KCL to a primary line that goes directly to the pump and then to the patient. That line is labelled.

Then, if the patient needs IV fluids like NS and we've okayed it with Pharmacy, we can add that to the port closest to the patient on a drip or with a flow meter, but it will not be on the pump. It is not required to label that line.

Question: Are you allowed to piggyback medications like that at your hospital? Why or why not?

[Advocate1]

At my hospital K+ or MG+ are always piggybacked. K+ is very irritating to the veins so we always run it concurrently with NS. Actaully, last night my pt needed 4 K+ riders and a Mg+ rider- I verified with pharmacy that you can run Mg K+ via the Y-line on the IV tubing.

So here's the breakdown-

Pump #1: primary line 0.9 NS

piggyback: K+

Pump #2: primary line 0.9 NS this line was attached via Y-site

piggyback Mg+

hope that helps.

[meandragonbrett]

We put everything on a separate pump but I am in ICU and typically have a double lumen cordis and a TLC and PIV's to go along.

[Agnus]

maybe I am not understanding you but here is what we do. a K or Mg rider is always run as a secondary. With the primary either NS, D5W, or some other plain chrystaloid.

If you need to run abx or some other med you run it on a seperate line an a seperate pump..

[Nurse Lulu]

We always piggyback. We have concurrent pumps for this purpose CAT

[JohnW]

We always piggy back K, Mg, Abx, etc. I don't see any reason not to assuming you make sure they are compatible with the carrier. When you run then on a dedicated primary line, the patient does not get all the drug, as they miss out on whatever is the line - that and it's real PITB to have these goofy primary lines around.

[JohnW]

At my hospital K+ or MG+ are always piggybacked. K+ is very irritating to the veins so we always run it concurrently with NS. Actaully, last night my pt needed 4 K+ riders and a Mg+ rider- I verified with pharmacy that you can run Mg K+ via the Y-line on the IV tubing.

So here's the breakdown-

Pump #1: primary line 0.9 NS

piggyback: K+

Pump #2: primary line 0.9 NS this line was attached via Y-site

piggyback Mg+

hope that helps.

As an aside, probably not good practice to replete mg and k at same time. Always replete Mg first. Don't forget, the Na-K pump is Mg dependent!

[Laughs-a-lot, RN]

New nurse, so I don't know what the norm is, but at my hosp, we hang primary ex. NS, they piggyback 2gm Mg bolus in 250 NS usually to run over 2-4 hrs.

[P_RN, ADN, RN]

Have you seen a Y adapter/anti-reflux device fail? I have.

We had a clin. spec who insisted you could hook a PCA up to any old Y port. We took some meth. blue and colored some water in a pca syringe and showed her that if the infusion is slow enough the PCA could override the anti-reflux. I don't really like the term piggy-back. Secondary line is my preference.

What you DON'T want is the K+ to back up into the un-pumped bag. Oooops BOLUS.

[defeatedcreek]

Our hospital stopped using IV potassium because we had too many sentinel events involving their use. In my time there we have still never used IV potassium and opt for PO k-dur instead. Our patients hate those because they're enormous pills.

As far as the magnesium goes we don't piggyback it most of the time. The prescribed rate is the rate most of our mag patients need it. However, by the time they need something like mag we are usually monitoring vital signs and telemetry pretty closely. The changes you can observe from the biochemical exchanges are fascinating.

As always, consult your intravenous medication reference book for further information.

[wayunderpaid]

Our hospital stopped using IV potassium because we had too many sentinel events involving their use. In my time there we have still never used IV potassium and opt for PO k-dur instead. Our patients hate those because they're enormous pills.

As far as the magnesium goes we don't piggyback it most of the time. The prescribed rate is the rate most of our mag patients need it. However, by the time they need something like mag we are usually monitoring vital signs and telemetry pretty closely. The changes you can observe from the biochemical exchanges are fascinating.

As always, consult your intravenous medication reference book for further information.

So, what kind of policy does your hosp. have with NPO pts who need electrolyte replacement? I agree with you that K-dur is the preferred method because potassium is absorbed and retained better in the GI tract. But this rule should not apply to NPO of C-diff patients, as they are actually losing their electrolytes through their stools... IMHO

wayunderpaid

[JohnW]

Our hospital stopped using IV potassium because we had too many sentinel events involving their use. In my time there we have still never used IV potassium and opt for PO k-dur instead. Our patients hate those because they're enormous pills.

.

What about people that are NPO?