Giving Vitamin K IV

[SweetTeaRN, BSN, RN]

I had an instance at work where a pt. came by ambulance from the nursing home with a lower GI bleed about an hour before the end of my shift. The PT was approx. 40, H/H were about 9 and 27. Pt. has stable VS, good pressure and is responsive and at baseline orientation, but skin is pale and has slightly dry membranes. ED doc ordered Vitamin K 10mg IV. I placed the order to pharmacy, and 20 min. later received bag mixed by pharmacy of 10mg Vitamin K in 100ml NS with instructions to deliver IVPB over 30 min. I was hanging the bag as the nurse taking over for me came to get report. When I told her I had hung the IVPB, her eyes got really wide and said, "You're giving it IV?" We asked another ED doc (first one's shift ended when mine was supposed to), who gave me a verbal order to change it to 10mg SQ. When I called pharmacy to change and verify the new order, they stated that "we have just started giving it IV. We had an inservice, and they said you can give it IV now." Although, same pharmacist told me that giving it PO or SQ is just as effective as the IV route. I also had orders for 2 units FFP, which were being prepped by the blood bank as this was going on. Has anyone had any experience giving it IVPB before? Is SQ as effective? I know if the pt. isn't actively bleeding, then IV isn't necessary, but what if the pt. is massively bleeding and is heading towards unstable?

[hellerd2003, RN]

I had an instance at work where a pt. came by ambulance from the nursing home with a lower GI bleed about an hour before the end of my shift. The PT was approx. 40, H/H were about 9 and 27. Pt. has stable VS, good pressure and is responsive and at baseline orientation, but skin is pale and has slightly dry membranes. ED doc ordered Vitamin K 10mg IV. I placed the order to pharmacy, and 20 min. later received bag mixed by pharmacy of 10mg Vitamin K in 100ml NS with instructions to deliver IVPB over 30 min. I was hanging the bag as the nurse taking over for me came to get report. When I told her I had hung the IVPB, her eyes got really wide and said, "You're giving it IV?" We asked another ED doc (first one's shift ended when mine was supposed to), who gave me a verbal order to change it to 10mg SQ. When I called pharmacy to change and verify the new order, they stated that "we have just started giving it IV. We had an inservice, and they said you can give it IV now." Although, same pharmacist told me that giving it PO or SQ is just as effective as the IV route. I also had orders for 2 units FFP, which were being prepped by the blood bank as this was going on. Has anyone had any experience giving it IVPB before? Is SQ as effective? I know if the pt. isn't actively bleeding, then IV isn't necessary, but what if the pt. is massively bleeding and is heading towards unstable?

We give vit. K IVPB all the time-- usually when we're looking for a quick correction of INR. In fact, I just hung vit. K two days ago in a pt with subarachnoid hematoma hx (hematoma stabilized), in a pt whose INR was starting to rise-- along with 2 units FFP-- to bring INR down quickly and (hopefully) keep the hematoma stable.

[litbitblack, ASN, RN]

I had that question a while back to the rx and they said it was ok. I had previously heard NEVER give it iv

[allele, LPN]

We gave it a handful of times in the unit I used to work on, I'd say out of 5 times giving it two patient's had an anaphylactic reaction, the pharmacy always gave us a hard time about it because they said a lot of people do have reactions to it. I have to tell you, the reactions were quite sudden! Anyway, if any MD ordered it again we had to let them know that the patient would have to go to ICU for 1:1 nursing during administration, needless to say they usually changed the route! lol I never heard it wasn't okay to give it IV, just high risk for anaphylaxis, according to our pharmacy. :)

[CaLLaCoDe, BSN, RN]

We give vit. K IVPB all the time-- usually when we're looking for a quick correction of INR. In fact, I just hung vit. K two days ago in a pt with subarachnoid hematoma hx (hematoma stabilized), in a pt whose INR was starting to rise-- along with 2 units FFP-- to bring INR down quickly and (hopefully) keep the hematoma stable.

I think where RNs get into trouble is when the order is for IVP rather than a piggyback...there lies the problem. A patient on my old floor went into cardiac arrest from an RN following doctor's orders to push the Vit K.

[MedicalLPN, LPN]

I've given it IVPB several times, it is okay and effective just monitor the patient closely for adverse effects. I still prefer to give it SQ though as I still get nervous administering it IVPB.

[nuangel1, BSN, RN]

in the 22 yrs i have worked have never been allowed iv use of vit k .policy was po or sc

[neneRN, BSN, RN]

I've given it IV only once or twice, when a pt was truly unstable and had critical lab values...otherwise IM or SQ.

[Aneroo, LPN]

I've never given it IV due to the reaction risk.

I liked po. Usually the patients didn't have good veins to being with, and I am going to try my best to avoid poking you with anything since your INR is so high! If it was an emergent situation, I'd give it SQ. If it was a case where they had their levels checked and it was elevated but is otherwise asymptomatic, they'd get it po.

[SweetTeaRN, BSN, RN]

Update...at work today, my supervisor approached me to thank me for "doing the right thing" by hanging the IVPB. Apparently the new policy per our pharmacy is to give PO when the pt. is stable, but give IVPB (diluted in at least 50ml NS and given no faster than 1 mg/min) when the pt. is actively bleeding or unstable. I was told that the SQ route is no longer to be used since the bioavailability is unpredictable. Thanks for all the replies. My manager is going to be doing an inservice since so many people in my department were unaware of the new policies.

[canoehead, BSN, RN]

I've given it IVP, and IVPB only when the patient is actively bleeding.

[Misty1]

I love your dog! Looks just like a dog I had as a kid..... her name was Boots.

Sorry way off topic just had to tell you

To keep on subject. I have given vit K IV.