Hanging IV Potassium

  1. 0 What is the normal procedure you use when hanging KCL? Meaning, when you admin it how is it diluted??
    I had to hang 2 bags of 20 meq KCL diluted with 100cc saline each--one after the other--this is premixed by the pharmacy & sometimes they'll add lidocaine to it since it can be very irritating to the veins.
    Is this how most of you hang potassium or do you usually dilute it more? This seems to be the norm on my floor, but one nurse passing thru was very surprised it wasn't diluted more. Your feedback appreciated!
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    About MrsMinor

    Joined: Jul '05; Posts: 71; Likes: 1


  3. by   hrtprncss
    #1 0
    Same as your's 20 meq/100 cc without the lido. Infuse 10 meq/h. Max rate 20 meq/h if needed.
  4. by   irshnrse
    #2 0
    Same here. Just Friday. 40mEq in 400mL over 4hrs. but in an internal jugular.
  5. by   Corrin1RN
    #3 0
    we always hang 20 0r 40 meq bags diluted in 100cc at no faster anan 10 meq per hour with lido if needed, does anyone know if there are any incompatibilitys of K with anything, this is a frequent question at my facility, heparin also.
  6. by   luvmysgt
    #4 0
    Well where I work the potassium already comes pre-mix in the IV bag however often I found it that my patients get irritated by it, so I have the doctor write a order for Nuet, which neutralizes it so it doesnt burn the patient.
  7. by   NotReady4PrimeTime
    #5 0
    I work in a primarily cardiac surgical PICU and we often run KCl 1mmol/mL infusions centrally to correct critical hypokalemia. We usually start at 1 mmol/hr (depending of course on how low it starts out), and check the serum K+ hourly, increasing or decreasing the infusion as indicated. We often have as much as 80 mmol/L in our maintenance as well, because our kiddies are so fluid restricted that they are hardly getting any maintenance on top of their other infusions. KCl is compatible with a lot of drugs, but three very important incompatibilities exist: amphotericin B cholesteryl sulfate complex, diazepam and phenytoin.
  8. by   MrsMinor
    #6 0
    So, I'm not hanging this wrong then?? Thanks to all who replied.

    I had a pt who needed a new IV site prior to hanging the potassium.
    The IV nurse (who is not a staff/floor nurse on my particular floor, but part of an IV team for the hospital), got extremely upset with me.

    She called down the hall to me after she changed the IV site & asked if I was planning to hang the potassium that I had ready & waiting to go. (I thought it odd that she was asking my plans with my pt to begin with!)
    Anyhow, she instructed me how I should NOT be hanging it the way it was (the 20meq c 100cc saline pre-mixed) & that I needed to have it diluted more & it was NOT OKAY to hang it up.
    I was taken back by this....BTW, I'm still on orientation & I had already checked my IV infusion book, and had talked to BOTH my preceptor AND charge nurse once I received the order to initiate the med.
    When I walked back into my pts room he stated "what are you trying to do, kill me??" I had no idea what he was talking about until he continued...."that IV nurse said that you should not be hanging that the way it is & that you need to hang a couple ringers with it, it will be harmful to my arm, etc. etc."
    I then proceeded to tell him my plans, what to expect/any SE that he may notice (burn/sting....) & that I would start slow & stop the med stat if needed, etc.
    He then asked me if he was my guinea pig.....!! After I talked to him & answered any questions/concerns he was okay & he ended up not having any problems with the med.
    I was very upset how this nurse talked at me the way she did--in a very disapproving tone, but most of all how she undermined my competency as a nurse & made my patient question my nursing care!! I felt placed in a very awkward situation with my patient. My preceptor had to go in to talk to
    him as well.
    My patient told me later how "that nurse has come by twice more to stick her head in here & shake her head." How frustrating!! If she had such an issue with this, she should have asked to speak with me in private--but NOT at me from down the hallway....OR TO MY PATIENT!!!!

    I was truly hoping to hear that others hang potassium similarly!! Thanks again & sorry so long!!
  9. by   20yearsandcounting
    #7 0
    Hi, I'm an ICU and ER nurse and do IV team per diem...That IV nurse was out of line to say anything to the pt , if she had a problem she should have spoken directly to you in private (the professional thing to do) and in a helpful manner.However it is within the realm of the IV team nurses duties (rights?) to offer advice and instruction on infusion therapy and practices. But she handled herself poorly. It is a lot of hospitals policy/protocol to infuse 10meq kcl in 100cc peripherally and 20meq kcl in 100cc should go centrally only because it is very irritating to the small peripheral veins. Pt's can and do get severe burning which some describe as painful and redness/phlebitis at the site which renders that site useless and then it must be changed. I have given 20meq in 100cc peripherally when it is piggybacked into other IV fluid so that is further diluted and less caustic and I've even given it peripherally (In the ER or ICU when in a pinch and without central access)with lido 1-2cc in the bag and 1cc injected into the heplock to help with the pain.Most people have the pain and redness, though I have seen a few,very few, come out unscathed. Hope this helps.
    Last edit by 20yearsandcounting on Oct 25, '05
  10. by   Tweety
    #8 0
    Our pharmacy mixes KCL in large volumes if it's a peripheral site. They will call the nurse and ask if it's peripheral and if there's any contraindication to large volumes. I forget what they put 20 meq's in, but they put 40 meqs in 500 cc bags.

    Central lines get mixes in volumes of 100 cc or 250.

    I would be like the nurse passing through, very suprised it's not diluted more. `
    Last edit by Tweety on Oct 24, '05
  11. by   20yearsandcounting
    #9 0
    A lot of ICU's and ER's too ( I was a traveling nurse for several years in several states and several hosps), have 10meq's in 100cc and 20meq's in 100cc. Even our Med/Surg floors use 10meq's in 100cc to replete k+ levels of 3.5 and under. There are liter bags of say... D5.45 with 20meq's etc. but those are typical IVF bags for pt's needing a little extra K+ that does not need to be replaced/corrected quickly.
    Last edit by 20yearsandcounting on Oct 25, '05
  12. by   hrtprncss
    #10 0
    Sorry but that nurse had no business poking in your patient's room unless A) You asked for help B) An IV pump or some machine is beeping C) The call light was on D) The patient called her specifically E) She's the charge nurse and she's making rounds.

    She would have heard a very very huge earful from me if that ever happens. She has no business being in there.
  13. by   MrsMinor
    #11 0
    Thanks hrtprncss--that was pretty much my take on it.
    It wasn't necessarily who was right or not & I gladly take in all the advice/tips etc. that I can at work as I'm still learning. It was more the way that this nurse talked down to me & overstepped her boundary by directly talking to my patient about how I wasn't doing the right thing concerning his care. That to me was HUGE & not acceptable.
    I know that wherever you go, things are done differently. I was following how things were done on my floor, used my book, preceptor, charge nurse, & pharmacy as resources....to me, I thought I was thorough & went about my prep the right & appropriate way. I just wish I had been approached with this extra "instruction" differently. Anyway, thanks responding
  14. by   janetrette
    #12 0
    i had given 20meg k with 250ml. if the patient complaint of pain just reduce the rate in half so it's less irritating. that's what i had been told to do.

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