Help On giving a pt bolus

[1_Dedicated_RN]

Hello I am a new grad I had a pt recieving fluids with k the doctor wrote an order for K bolus in NS because the patient pottassium level was 2.7. My question is would u continue to run the main fluids that the pt had from the jump along with the bolus. I am still in orientation, but I was thinking maybe i should have just did the bolus fluids. THANKS !!!

[suanna]

As a rule most boluses interupt the maintenance IV but in my practicce K+ is an exception. Potassium is VERY painful for the patient through a peripheral IV- running it through a compatible maintenance fluid can help alleviate some of the discomfort and reduce the phlebitis by diluting the potassium. If you were giving it through a central line (or PICC) then running it as a IVPB is usually OK unless the patient has a need for the mantenance fluid at a higher rate. You must run a KCL bolus over 1-2 hours and if the patient is requiring D5NS (or whatever) at 150cc/hr for fluid support, as a caloric source then you don't want to interupt the IV for an hour or two to give the KCL. Most hospitals have a written policy for this med. Since you work in a cardiac unit it would be a good idea to look it up. If they don't- why not write one- administrators love people with an eye for new policies!

[queenjean]

The only thing I have to add to suanna's comments is that sometimes you have to slow it. While it'd be nice to run it over 1-2 hours, if your pt doesn't have a picc, a lot of times you can't run it that fast. I've given it over 4 or more hours just to try to prevent pain and preserve a peripheral IV. I don't typically interrupt regular IVF administration, either. I don't run it as a piggyback, I put it in a different chamber, put it in a hub lower down on the line, and run it in addition to the regular fluid (if they are compatible, of course).

[JBizzleRN, ADN, RN]

I agree with the above. On our pumps we just set the K rider to go in at it's speed concurrent with the primary IVF (if it's compatbile)...of course if you have a renal patient or CHF or some other pt that can't handle a lot of fluid I would cut back on the primary IVF first.

I agree though it has taken almost 8 hours before to get 40 mEq of K in a patient with a 22 guage IV in her hand....but no doctor would give me and order for a PICC line because she was going home the next day if her K was up...and at the time I was not certified to put in Midline Catheters or I would have crammed one in her :-)

[browen02]

I have a similar question. I was told by my preceptor to use standard IV tubing on a KCL bolus ( 20mEq in 100 NS ) to be infused into a peripheral IV ( 22g in the hand) over 2 hours. The purpose of the standard tubing was because IVBP tubing obviously would not be long enough to run through the IVAC. I questioned as to the need for a saline KVO as the main with the K+ running along with it. She said not the way the hospital does it. Patient c/o much discomfort and burning. Should I question the clinical manager?