Hanging IV Potassium

janetrette · Oct 25, 2005

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.

tejram · Oct 25, 2005

we are using 10 meq in 50 ml by infusion pump centrally

peripherally if no fluid restriction 40meq in 500

20yearsandcounting · Oct 25, 2005

The author wrote that the IV team nurse was called to start a new line for the infusion,therefore she had every right to be in the pt's room, she was called there.The IV team nurse is an expert in Infusion therapy, they just don't start a line and go. As an expert in IV therapy for the hospital they are or should be knowledgeable of the hospital's policies and protocols for all infusions,and therefore it behooves them to speak up when they see something that may be against accepted practice for that hospital.The "charge nurse" and pharmacy will not be cognizant of what the policy and protocols are. The IV team has this P&P book in their office and use it as their practice bible. A charge nurse and hospital pharmacist will only have a book or med quest function (if computerized).It is within the scope of practice for the IV team to instruct and give advice on infusions. You perhaps do not have an IV team at your hospital so therefore are not familiar with their role. To say that "she would have had a very very huge earful from me" sounds territorial and immature. We are all pt advocates.We don't just watch out for the ones we are assigned to that day.Wouldn't you speak up if you saw something that was "not right" with someone else's pt? Relax, and don't be so defensive! Yes, that IV nurse was out of line by talking down to the staff nurse and it was totally unacceptable and unprofessional to say anything derogatory about the nurse to the pt. She (the IV nurse)should have been reported to her nurse manager about that and reprimanded. The author was on orientation and obviously a new nurse, unfortunately she had this bad experience with someone who is into intimidation.I'm sure that won't be her last experience with such individuals, as we old timers are only too aware. Try not to sweat the small stuff, don't be so territorial, don't get so defensive and offended by everything.Maintain your dignity and professionalism by not throwing back an attitude of your own,stay calm when sticking up for yourself and go "through the channels" to get results. You'll come out looking the better for it.You have along career ahead of you,don't stress and just move on.

hrtprncss · Oct 25, 2005

The author wrote that the IV team nurse was called to start a new line for the infusion,therefore she had every right to be in the pt's room, she was called there.The IV team nurse is an expert in Infusion therapy, they just don't start a line and go. As an expert in IV therapy for the hospital they are or should be knowledgeable of the hospital's policies and protocols for all infusions,and therefore it behooves them to speak up when they see something that may be against accepted practice for that hospital.The "charge nurse" and pharmacy will not be cognizant of what the policy and protocols are. The IV team has this P&P book in their office and use it as their practice bible. A charge nurse and hospital pharmacist will only have a book or med quest function (if computerized).It is within the scope of practice for the IV team to instruct and give advice on infusions. You perhaps do not have an IV team at your hospital so therefore are not familiar with their role. To say that "she would have had a very very huge earful from me" sounds territorial and immature. We are all pt advocates.We don't just watch out for the ones we are assigned to that day.Wouldn't you speak up if you saw something that was "not right" with someone else's pt? Relax, and don't be so defensive! Yes, that IV nurse was out of line by talking down to the staff nurse and it was totally unacceptable and unprofessional to say anything derogatory about the nurse to the pt. She (the IV nurse)should have been reported to her nurse manager about that and reprimanded. The author was on orientation and obviously a new nurse, unfortunately she had this bad experience with someone who is into intimidation.I'm sure that won't be her last experience with such individuals, as we old timers are only too aware. Try not to sweat the small stuff, don't be so territorial, don't get so defensive and offended by everything.Maintain your dignity and professionalism by not throwing back an attitude of your own,stay calm when sticking up for yourself and go "through the channels" to get results. You'll come out looking the better for it.You have along career ahead of you,don't stress and just move on.

Yes I have worked with IV nurses before and they put in the PICC line and their responsibility ends there. She has no right to berate this nurse regarding IV therapy on her patient. She can suggest ways to keep an IV but she is in no position to say what is right or not, especially not in front of the patient. An IV nurse would not tell me wether to use that particular 20 gauge for the albumin drip or the picc line for this and that. She stated 20 meq/100cc of kcl. An IV nurse who goes around the hospital placing IV's would not know the patient as much as the primary nurse. Yes it's the standard volume of most KCL infusions we all know this. If an IV nurse comes up to me like this wihout knowing the patient's status then yes she would hear an earful. WHY? Not because of ego or being unprofessional on my part. Because she doesn't know the patient. I know how to ask for IVPB or Riders to be diluted for extra volume for patients if the patient needs it. If not then I use the standard dilution of this medication that was provided. Bottom line this nurse and it doesn't matter that she is a new grad was doing what is Standard of care on most hospitals and this IV nurse overstepped her boundaries. If she's such a good IV nurse then she should know herself that the standard solution used in KCL infusion is 20 meq/100 cc, and if the patient needs more dilution then she can convey that to the nurse privately. And yes Pharmacy and Charge nurses in most cases are adept at being the resource person on the floor. Any charge nurse who's not doesn't belong in that position.

papawjohn · Oct 25, 2005

Hey Y'all

Just a little contribution. With the new IV site and the KCL concentration of 10mEq in 100ml running at 10mEq/hr, the thing that's going to dilute the KCL is BLOOD. So the big issue in how large the vein is that the IV site is in. Reducing the flow rate to 5mEq/hr is approp if the vein becomes painful--but that indicates a low blood flow thru the vein.

And a PICC (which someone mentioned above) is of course a CENTRAL line.

Good conversation--I agree the IV Team nurse was out of line.

Papaw John

christianRN · Oct 25, 2005

We hang 20, 30, or 40 meq KCL in 100 cc sterile water, to infuse at 10 meq/hr, or 2,3, or 4 hours respectively.

20yearsandcounting · Oct 25, 2005

Yes I have worked with IV nurses before and they put in the PICC line and their responsibility ends there. She has no right to berate this nurse regarding IV therapy on her patient. She can suggest ways to keep an IV but she is in no position to say what is right or not, especially not in front of the patient. An IV nurse would not tell me wether to use that particular 20 gauge for the albumin drip or the picc line for this and that. She stated 20 meq/100cc of kcl. An IV nurse who goes around the hospital placing IV's would not know the patient as much as the primary nurse. Yes it's the standard volume of most KCL infusions we all know this. If an IV nurse comes up to me like this wihout knowing the patient's status then yes she would hear an earful. WHY? Not because of ego or being unprofessional on my part. Because she doesn't know the patient. I know how to ask for IVPB or Riders to be diluted for extra volume for patients if the patient needs it. If not then I use the standard dilution of this medication that was provided. Bottom line this nurse and it doesn't matter that she is a new grad was doing what is Standard of care on most hospitals and this IV nurse overstepped her boundaries. If she's such a good IV nurse then she should know herself that the standard solution used in KCL infusion is 20 meq/100 cc, and if the patient needs more dilution then she can convey that to the nurse privately. And yes Pharmacy and Charge nurses in most cases are adept at being the resource person on the floor. Any charge nurse who's not doesn't belong in that position.

"Standard solution" for KCL infusion is 20meq/100cc?? Yes, when given CENTRALLY. Get a clue hrtprncss and stop the vitriol. You may have "worked with" an IV team but you know NOT of what you speak. No one said the IV team nurse was "such a good nurse" go back and read the posting again, without your ego. We all agree she was out of line in what she said and how she said it.Period. And no, she doesn't know the pt as well as the floor nurse does,that's a given. But you don't have to know ANY pt's history to know if what is being done goes against THAT hospital's policy.You state "MOST hospital's standards of care are.".. How many hospitals have you worked at that you can make such a blanket statement. As far as charge nurse and pharmacy being a resource person for the floor.Of course they are!!! Who said otherwise?? I simply stated that they could NOT possibly be aware of EVERY departments policies and protocols. Do you?? NO every department has their own P&P manuals.I'm not sticking up for the IV nurse,if you'd care to reread my postings you would see that. I'm just trying to be fairminded and stating the facts as I know them from the original posting and from my own experience of 20 years of nursing in which I've been a traveler (having worked in numerous hospitals across the country),a staff nurse on med/surg floors, ICU, ER,OR,IV TEAM, and as a Masters prepared nurse educator/CNS in a University hospital. Believe me, I've been there and done that.Your continued vitriolic postings only prove the point of my earlier postings. Now, just stop it and move on.

hrtprncss · Oct 25, 2005

If I were you I'd read your post again before you say ''vitriolic". The negativity came from you. FYI if you've read most of the post here you can see what dilution is used most. I am standing up for the OP. And yes if you are the IV nurse I'd stand on my ground and give you an earful. This is not your patient. An IV therapy nurse doesn't know everything encompass. You have IV nurses who come from the floor that have no experience with drips, yet they place IV's. This does not make them an expert on how to deliver drips. The nurse itself administering that medication is more informed regarding that patient. If you insert an IV and start telling me that I'm wrong because that said medication should be in a different dilution without knowing the patient then be prepared that you would hear something. An IV nurse puts the IV in, does she know the patient's fluid status among other things? There are a lot of variables that an IV nurse is not aware of, and that is my point. Her job was to insert the IV and NOT I repeat NOT to administer the medication.

20yearsandcounting · Oct 25, 2005

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NurCrystal22 · Oct 25, 2005

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!

Usually pharmacy mixes it up, 20meq KCl in 1000ml of 1/2 Normal Saline, we infuse at 75ml/hr, decrease rate if burning/irritation/etc sensation is felt by patient.

~Crystal

SmilingBluEyes · Oct 25, 2005

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