Help with IV Potassium administration

[sediaz]

I had a pt who needed yet another Potassium run. She told me that it had burned when a previous nurse had run the potassium. Being a new nurse, I went seeking advise on what rate to run the potassium. I was expecting the nurse I asked to tell me to run it slow but she came into the room with me and set up NS going through a pump and primary line connected to the IV site. She then set up the postassium going throug another pump with its primary line connected to the NS tubing at the port closest to the IV site. I don't remember what rates she set the pumps at but I do know that the patient had no complaints of burning sensation:yeah:. Can someone help me with what the rates might have been? Would I use the same set-up with a mag run?

[Son Tava]

Why does K+ burn? It irritates the intimal lining of the vein. Why do we infuse TPN into a large vein? Otherwise, it irritates the vein. Try using a larger peripheral vein and smaller cannula lumen for K+ infusions.

[dnnc52]

Ray: Years ago we used lido in our K+. I have mentioned this to my unit and they think I am crazy. Do you have any protocols a on this and data that supports this practice to be safe. I had 3 pt's getting K-runs today and they all c/o pain. My IVs were in great shape good sites. thanks in advance for the reply...

[BmichelleRN]

One thing I commonly had to do with potassium infusions to stop/prevent pain issues was to slow the rate. I never had a complaint once I did that. Of course, the doc had to agree...

A little ice near the infusion site also helped for the more sensitive people. I let them know that it is not something to be alarmed about, that slowing the rate was almost 100% effective. Sometimes I never made it to a rate decrease because with their anxiety decreased they often didn't mention it again and I would come back from calling the doc to find them denying any further pain.

[RheatherN, ASN, RN, EMT-P]

We run it pback as well w/ ns as the first poster stated as well. we can run it as we see fit, i do try and run it as fast as i can, and explain to the pt that the bag takes 30 min, but i do know it burns like heck. we use warm blankets to heat the entire arm all the way up to the shoulder, and that does wonders!! there have been times were we have had to run it as slow as 30 though. that sucks for us, but the pt is comfy. whatever works and doesnt hurt us or them right?

-H-RN

[cardiacmadeline, RN]

We are no longer allowed to mix lidocaine with IV potassium. If I remember correctly, it is because lidocaine can mask the effects of infection and phlebitis. I have used all of the already mentioned interventions when administering IV potassium, and they usually work pretty good.

[Lady Shmoe]

We usually do not dilute it. Pharmacy sets a standard 2 hour window for administration of 40 mEq and more often than not I end up running one bag in at 25 ml/hr or so due to c/o discomfort. Wish we had a protocol allowing us to dilute in NS if not contraindicated. Lowering the infusion rate lengthens the duration of administration, obviously, so our electronic MAR ends up showing bag #2 or 3 or 4 as "OVERDUE!" and that is quite annoying for this OCD nurse who likes the tasks to be out of the overdue column on her screen.

Bottom line, I will slow it down to the fastest rate that doesn't hurt. I've even ran it at 10, once.

[mandaaRN]

Changing the rate needs an order or is that at the nurses discretion?

[Silverlight2010]

Changing the rate needs an order or is that at the nurses discretion?

Where I work it's always been at nursing discretion. We just chart reasons for doing so. Might be a different story if the K+ was critically low and the patient was symptomatic. Even then I would try to come up with something that would allow me to run the infusion at the prescribed rate but still prevent discomfort. Most of our patient are fluid restricted so running a primary line isn't always an option. Fortunately our potassium replacement is usually given PO either with Slow K or liquid KCL.

[PMFB-RN, RN]

she came into the room with me and set up NS going through a pump and primary line connected to the IV site. She then set up the postassium going throug another pump with its primary line connected to the NS tubing at the port closest to the IV site. I don't remember what rates she set the pumps at but I do know that the patient had no complaints of burning sensation:yeah:. Can someone help me with what the rates might have been? Would I use the same set-up with a mag run?

*** That is the standard, normal way to run IV K and Mag into PIVs in every hospital I have ever worked at. We start with running the NS at the same rate as the K, usually 50ml/hour. If there are any patient complaints we will double or even tripple the rate of the NS to run in ar 100ml/hour or 150ml/hour while keeping the K infusion at 50ml/hour.

Same for Mag. We usually run Mag in at 200ml/hour and set up a NS IV to run at the same rate.

Running IV K as a piggy back in a PIV is bad practice and something I though had been done away with back in the dark ages.