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?
That is correct facilities that still use the SQ method are out of date with standard practice. It is more effective and controllable with the IV route.
The most important thing with IV K+ is the rate of aministration, do not exceed a rate of 10 mEq/h in stable patients and 40 mEq/h in unstable patients. Always use continous cardiac monitoring and hospital specific protocols.
After we had a non-monitored Pt that received IV vit K go into V-Tach (probably), one of the pharmacists gave us an inservice. He said it takes 12hr for onset of action no matter what route. Personally, I don't have a warm, fuzzy feeling about giving this drug IV.
After we had a non-monitored Pt that received IV vit K go into V-Tach (probably), one of the pharmacists gave us an inservice. He said it takes 12hr for onset of action no matter what route. Personally, I don't have a warm, fuzzy feeling about giving this drug IV.
I've always given it to monitored patients and luckily never had anything happen.
Thank you though something to be aware of. I always was but its a good reminder.
That is correct facilities that still use the SQ method are out of date with standard practice. It is more effective and controllable with the IV route.
The most important thing with IV K+ is the rate of aministration, do not exceed a rate of 10 mEq/h in stable patients and 40 mEq/h in unstable patients. Always use continous cardiac monitoring and hospital specific protocols.
You are very correct my friend regarding the K+ potassium! But this discussion is in regards to Vitamin K an adjunct therapy for active bleeding or potential risk for bleeding with a high PT INR lab value from a sometimes likely culprit of a patient that received too much Warfarin/ Coumadin.
Specializes in Level 1, Level 2, Level 4 trauma and med.
Yes Vit K is a dangerous drug to give IV, but it is an acceptable route per the PDR. And that is what the lawyers go by.
Consider this, if you had someone in hypovolemic shock, cool, clammy, pallor skin, from a GI bleed, and they are on coumadin. How well do you think the absorbtion would be on a subq injection for that person? THe body is shunting the blood volume to the core vital areas.
You are very correct my friend regarding the K+ potassium! But this discussion is in regards to Vitamin K an adjunct therapy for active bleeding or potential risk for bleeding with a high PT INR lab value from a sometimes likely culprit of a patient that received too much Warfarin/ Coumadin.
Doh! I feel so stupid. Potassium SQ out of date, yeah
I had a discussion about this the other day with a newer nurse and a doctor who is on our P & T commitee. My facility has recently change its preferred route to IV vs SQ or IM. Heres why you are giving it to correct a bleeding issue when you give a injection you whether you know it or not cause bleeding, pts with abnormal clotting are going to have a larger hematoma which this med is going to be in the middle of. How fast it gets absorbed is erratic at best. Giving it IV guarantees its absorption.
I've seen the "K-riders" ordered all the time for unstable pts..either with high INR or very low K+. Well, we don't like to give it anyways because of the risks, and it just is very painful for the pt, and not good for the vein that the IV is infusing in. Never ever give K+ as an IV push. You can cause someone a cardiac arrest. This is always what we are taught in school, it's in the book, and it should be in your hospital protocols. I've heard of a bad story of a student/Rn pushing K+ in a kid, kid died.
Check K+ levels before you give, and pt should be on tele.
I've seen the "K-riders" ordered all the time for unstable pts..either with high INR or very low K+. Well, we don't like to give it anyways because of the risks, and it just is very painful for the pt, and not good for the vein that the IV is infusing in. Never ever give K+ as an IV push. You can cause someone a cardiac arrest. This is always what we are taught in school, it's in the book, and it should be in your hospital protocols. I've heard of a bad story of a student/Rn pushing K+ in a kid, kid died.
Check K+ levels before you give, and pt should be on tele.
You seem very confused. This thread is about giving Vitamin K, not about giving Potassium.
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mmutk, BSN, RN, EMT-I
482 Posts
That is correct facilities that still use the SQ method are out of date with standard practice. It is more effective and controllable with the IV route.
The most important thing with IV K+ is the rate of aministration, do not exceed a rate of 10 mEq/h in stable patients and 40 mEq/h in unstable patients. Always use continous cardiac monitoring and hospital specific protocols.