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

[UM Review 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?

[mcpnurse]

sry, a little off track... what is the main concerns for IV postassium? What should I look for? sry, im a newbie

[cjcsoon2bnp, MSN, RN, NP]

sry, a little off track... what is the main concerns for IV postassium? What should I look for? sry, im a newbie

I'm a nursing student too so I'm no expert but when I think of Potassium I think first and foremost of Cardiac. With IV Potassium you are probably treating hypokalemia and one of the biggest risks with IV potassium is infusing it too fast which would cause cardiac arrhythmias and bradycardia (I'm pretty sure) and could ultimately result in death with the wrong infusion. That's why if possible it is encouraged that patients receive Potassium PO if it is at all possible (in some cases it is not, such as with potentially life threatening hypokalemia and NPO status.) So that is why IV Potassium requires careful calculation and observation. Another issue with patients receiving IV Potassium is that it can be very painful to the patient at the IV site because it causes a burning sensation in the vein it is being delivered into and many times it will be hung with another bag of NS or something similar to reduce the pain at the IV site caused by the Potassium. Any nurses out there feel free to correct me if I'm wrong on this...

!Chris

[LeaRN2008]

At our hospital a lot of our pt get iv K+. If they do not have a central line we pharmacy always adds lidocaine (with the dr order of course) and it can be piggy backed in. But you still have pt who are overly sensitive and still have burning with it. We just have to deal with it on a pt to pt basis. But you are right it has to be calculated and labs watched carefully. We have pharmacist on all of our floors who calculate and a pharmacy who mixes everything for us to everything is checked and double checked.

[TalldiNY]

Hello,

I have never worked in a hospital where IV K+ was piggy backed as a bolus bag. Always have to have own site, a TLC, or dual acess PICC. Will be interested to hear what others have done. Best of luck.

DI

[scoochy]

My former hospital policy:

1. KCL 10 meq IV can be given in peripheral line. Must be diluted in 100cc D5W or NS. If the patient is c/o burning, more IV fluid can be added; you'd be surprised what a difference another 20-30cc can make! It must be given over 1 hour.

2. KCL 20 meg can only be given via central line.

3. All KCL infusions must run on an infusion pump...no exceptions!

4. Must document IV site check before, during, and after the infusion.

5. KCL can be run as secondary on IV pump, so long as there are no compatability issues. Running it as a secondary provides dilution of the KCL infusion; less c/o pain.

[ivorybunny]

My hospital only supplies KCl 10meq/100ml... we piggyback it with NS and run them concurrent to help with the burning. I've never ran a replacement KCL IV without another fluid... anything higher in concentration requires a central line and is mixed by pharmacy- our usual orders are KCl 40meq over 4 hours- which is basically one bag an hour if the pt can tolerate it- I don't think I've ever met the time limit though.

[MarciCRN]

Yes we piggyback, Mag first then K, K is painful , so we run it on separate pump, along with at least 50ml/hr of NS.

[Miss Kitty00]

we piggyback at my facility.

Although I have gotten a Mag and K mixed together in a piggyback before.

[LoveANurse09]

We always piggyback Mg or K! I would not want straight K in my vein!

[GM2RN]

I'm not entirely sure what some of the others mean when they say they "piggyback" potassium and magnesium. I work in the ED, and when I piggyback an IV med, to me that means running NS in a primary line on a pump and the piggybacked med on secondary tubing attached to the primary tubing but not on it's own pump. When it's done this way it's no different than running potassium alone.

When I run IV potassium, I run it with NS. Potassium and NS are both on primary tubing, each on its own pump. Potassium is then attached to the NS tubing below the pump. That's policy where I work.

[Ellekat]

We do not have pumps that allow K and Mg to run concurrently. Our K is delivered 10 mEq/50NS in a primary line that is attached as a secondary line below the pump to a line of running NS to dilute it further and lessen the irritation to the vein. The magnesium (1g/100ml) is run as a secondary on the pump; the primary IVF does not run while it is being infused. Only pharmacy is allowed to add potassium to a bag of fluid and we have no nighttime pharmacy coverage. Our physicians do order potassium /magnesium PO if the patient is able to eat/drink, but many of our patients aren't to that point when those meds are needed.

[ZippyGBR, BSN, RN]

Once again i am amazed that people are still routinely mixing or piggybacking Potassium solutions rather than using pre-mixed , it is extremely rare outside of critical care in the UK for anything other than premixed solutions and critical care areas will generally use premixed solutions unless there is a particualr overwhelming reason for extra strong solutions.