Dose angio catherter size matter angiopain when potassium fluid injected via IV?

[Ironprostate]

Today, i met a patient who complain about her arm pain. she was injected 10 DW mixed potassium 40mEq 1L via 24G IV catherter. No signs of phlebitis and redness and swelling. But she so painful so I removed it. Other than this, My senior nurses order me to keep the more larger size IV catherter like 18G or 20G. I dont understand what national beneath this?

[Susie2310]

In addition to KCl 40 mEq causing vein irritation, D10W can also cause irritation of a peripheral vein. If a small vein was used, this would compound the problem. The rate of the above infusion could also contribute to the vein irritation.

[bgxyrnf, MSN, RN]

I haven't read through this discussion but I offer the following from the perspective of a mechanical engineer who has studied fluid dynamics.

What you want is the very smallest cathether in the very largest vein in order to achieve the very highest rate of dilution.

Think of the catheter size as a percentage of the vessel size. The larger the percentage (that is, the more space that is occupied by the catheter), the more that flow is occluded through the vessel and hence the higher the local concentration of the potassium solution and the higher the likelihood of pain.

There is absolutely no reason to infuse potassium - or anything else for that matter - preferentially through a larger IV catheter. Large bore catheters are indicated for only one thing: Higher flow rates (that is, aggressive resuscitation). To the preceding is one caveat... for a deep vessel or a vessel in a site of flexion, larger catheters (at least 18g v 20g) can last longer (plenty literature that you can find if you're interested) simply because they are stiffer and less likely to kink.

[Esme12, ASN, BSN, RN]

Whoever originally described the pain of PIV potassium rider as a burn kind of underestimated IMHO. Unmedicated childbirth? No biggie. Potassium? Feels like your arm being sawed off with a butter knife @ the shoulder.

Ever since I found that out, I do whatever I can (asking for orders to be altered, for example) to not have a patient go through it.

JM $.02.

Amen! I have never felt anything as painful...I was shocked! I apologize to any patient that I thought was exaggerating!

[LibraNurse27, BSN, RN]

I am also curious about the absorption of PO potassium vs IV. We have standing orders in my stepdown unit for prn replacement of potassium based on labs but due to the painful IV administration of IV potassium I often ask the doctors to change the orders to PO if the patient can take pills. One doctor said "that's fine, PO is absorbed better anyway and a lot of the IV potassium gets excreted in the urine anyway". I can't find any research so far to back this up... anyone have any info? Interesting thread!

[AnnieOaklyRN, BSN, RN, EMT-P]

Hi,

A lot of people think irritating medication need a bigger catheter. That is all wrong. If you have a medication that is irritating you want a larger vein with a smaller catheter, no smaller than a 22 G however. A 24 G is to short and will infiltrate way to easy on an adult. The purpose of the smaller catheter is so that blood can flow around it during infusions which will lead to less irritation to the vein..

Annie