HELPPP Piggyback compatibility

THELIVINGWORST, ASN, RN · Dec 9, 2013

Also, potassium HURTS. But its the priority in the patient with a K of 3.0 and Na of 116. If their heart malfunctions, does it really matter that they are dehydrated?

@Esme12 is this correct? The KCl with D5 1/2 NS can help replace the K and Na while the LR can run the Multi and rehydrate after the all important electrolyte correction?

MendedHeart · Dec 9, 2013

Id still Y it in with NS and not stop either if It were me probably

nurseprnRN, BSN, RN · Dec 9, 2013

Also, potassium HURTS. But its the priority in the patient with a K of 3.0 and Na of 116. If their heart malfunctions, does it really matter that they are dehydrated?
@Esme12 is this correct? The KCl with D5 1/2 NS can help replace the K and Na while the LR can run the Multi and rehydrate after the all important electrolyte correction?

No, it will replace the K+ but IV saline does not replace serum sodium. Serum sodium tells you about water balance; half normal saline is half water, and if the serum Na+ is 116, there should be at least full NS (or D5NS), no more free water.

The answer to your question, though, is that it doesn't make any difference at all from a compatibility standpoint. From a medical plan of care standpoint, you would need to get the MD prescription for which fluid to put on hold while you run piggybacks if you can't figure out a way to run them all at once (however, there is no reason at all to hold any maintenance line to run a compatible piggyback concurrently).

Esme12, ASN, BSN, RN · Dec 9, 2013

Id still Y it in with NS and not stop either if It were me probably

So would I.....but that isn't the schools question. This is where school and bedside nursing differ. frankly I'd call the MD to add the MVI to one replacement bag daily...problem solved.

Esme12, ASN, BSN, RN · Dec 9, 2013

Also, potassium HURTS. But its the priority in the patient with a K of 3.0 and Na of 116. If their heart malfunctions, does it really matter that they are dehydrated?
@Esme12 is this correct? The KCl with D5 1/2 NS can help replace the K and Na while the LR can run the Multi and rehydrate after the all important electrolyte correction?

Another bad question. The sodium concerns me the main IVF needs to be changed like grnTea said to D5NS.] and maybe alternate replacement with 0.9NS.

In this exact scenario I would not stop the IVF with the KCL

KelRN215, BSN, RN · Dec 10, 2013

So I have final scenario coming up in a couple of days. In the scenario, the patient has two peripheral lines: 1. KCL20 mmol/L D5W 0.45% Sodium Chloride that should infuse at 75 mL/hr and 2. Ringers Lactate continuous IV infusion for gastric loss replacement. Multi-1000 IVPB (Vitamins, multiple) should also be administered. I'm not sure where to piggyback the Multi1000, should I piggyback on KCL or LR? Why?
Also, the patient has an order for gastric loss replacement of 1:1/2, latest gastric loss is 1675 mL.
Lab values are:
Potassium 3.0
Sodium 116
Chloride 99
Thanks so much!

Serum sodium of 116 and this person is on 0.45% NS? That's kind of a problem.... I've seen a patient with a serum sodium that low once- she was immediately transferred to the unit and started on 3% normal saline.

happyinillinois · Dec 10, 2013

I'd start another line and run them both. Problem solved.

bebbercorn · Dec 10, 2013

Call pharmacy ;-)

lub dub · Dec 10, 2013

Serum sodium of 116 and this person is on 0.45% NS? That's kind of a problem.... I've seen a patient with a serum sodium that low once- she was immediately transferred to the unit and started on 3% normal saline.

I thought the same thing. That sodium level needs to be corrected.