Is My Thinking Flawed?

[blondy2061h]

On my unit we give a lot of potassium and magnesium. They're both ordered to go at 25ml/hr. Often if we have a line crunch we'll dump them both in a buretrol together. People then run this at 25ml/hr. My thinking is that the mix should be able to run at 50ml/hr, as long as they're evenly mixed. Wouldn't this be equivalent to running them separately, but at the same time, at 25ml/hr each? I understand wanting to be cautious with electrolytes. Would you feel differently if I was talking about two compatible antibiotics?

[jadelpn, LPN, EMT-B]

I have zero experience with pre term labor pts. I do believe that the Mag is given in OB to relax the uterus rather than as an electrolyte replacement. I could be wrong. Wouldnt it be better tolerated in a pt with pre term labor vs a critically ill hypovolemic pt? Just wondering.

I think that sometimes mag is given to labor patients for blood pressure reasons--

And as for the OP--whatever the ordered rate is, the ordered rate is--I would not increase the rate without an order.

With the introduction of smart pumps, it is amazing how my math goes out the window--and it happens a lot for nurses--so always check you math with nurse #2.....

[blondy2061h, MSN, RN]

I think that sometimes mag is given to labor patients for blood pressure reasons--

And as for the OP--whatever the ordered rate is, the ordered rate is--I would not increase the rate without an order.

With the introduction of smart pumps, it is amazing how my math goes out the window--and it happens a lot for nurses--so always check you math with nurse #2.....

But I'm not talking about increasing the rate. I'm talking aboutu tiring to accurately run it at the ordered rate when we need to mix it, for lack of pumps.

[KelRN215, BSN, RN]

Yep, I figured that out in my third post in this thread. But still, our current practice is to run the 150 ml combined mixture at 25ml/hr, making it take 6 hours to go in, compared to 2 hours for the mag and 4 hours for the K when done separately. Wouldn't running the mixture over 4 hours (i.e., going with the longest necessary infusion) at 37 ml/hr be superior to running it at 25? It would get it done in 4 hours and be closer to the prescribed rate.

If it's taking 6 hours anyway, what is the point of mixing the drugs? Just run them separately and then you won't have this issue. You're not saving yourself any time by mixing them. What kind of lines do your patients have? All my patients who go through stem cell transplant have at least double lumens. Magnesium and Potassium are compatible so you could theoretically also put a bifuse on the end of one of the lumens and Y them both in, running each on its own pump, right?

[blondy2061h, MSN, RN]

If it's taking 6 hours anyway, what is the point of mixing the drugs? Just run them separately and then you won't have this issue. You're not saving yourself any time by mixing them. What kind of lines do your patients have? All my patients who go through stem cell transplant have at least double lumens. Magnesium and Potassium are compatible so you could theoretically also put a bifuse on the end of one of the lumens and Y them both in, running each on its own pump, right?

My patients all have 5 lumen central lines. The issue isn't a lack of lumens. It's a lack of pumps. We don't keep extra pumps on the floor and supply processing is closed at night when these are usually being hung. It doesn't take 6 hours when done separately. It takes 2 or 4 depending on the supplement, if they're running simultaneously on two separate pumps. This is annoying me that they're getting run over 6 hours when combined because then those are med lines tied up when I'm trying to get AM antibiotics, steroids, GI meds, etc up.

[klone, MSN, RN]

IIt's if two meds that both go at 25ml/hr are mixed together, isn't running the mixture at 50ml/hr the same as running them separately but simultaneously together at 50ml/hr?

Yes, it would, if that's all you're giving. If you run them simultaneously but separate at 25ml/hour, they would both be done running in one hour. If you combine them to create a 50ml solution, and ran it at 50ml/hour, the combined solution would also be done running in....one hour.

[klone, MSN, RN]

I have zero experience with pre term labor pts. I do believe that the Mag is given in OB to relax the uterus rather than as an electrolyte replacement. I could be wrong. Wouldnt it be better tolerated in a pt with pre term labor vs a critically ill hypovolemic pt? Just wondering.

MgSO4 is not a treatment for preterm labor. It is used as seizure prevention in pre-eclamptic patients. For women who are at risk of delivering preterm, it is given for "neuroprotection" of the fetus, as it's been shown to reduce incidence of CP.

I should clarify - MgSO4 is not an EVIDENCE-BASED treatment for PTL. Alas, some OBs will still use it, because that's what they were taught, and they don't follow EBP.

[Esme12, ASN, BSN, RN]

But I'm not talking about increasing the rate. I'm talking aboutu tiring to accurately run it at the ordered rate when we need to mix it, for lack of pumps.

A Lack of pumps? Are you in Acute care? Can't your supervisor get more pumps? Can't you borrow from another unit?

My patients all have 5 lumen central lines. The issue isn't a lack of lumens. It's a lack of pumps. We don't keep extra pumps on the floor and supply processing is closed at night when these are usually being hung.

You have 5 lunmen catheters and can't use them because you lack pumps on nights? This became weird for me...it annoys you and you can't get more pumps on nights? Are you working 12 hour sifts? Can you get more pumps before central goes home by planning ahead?

I am more confused that before.

I can't give you an answer. I need exact information about the drugs being mixed (dosage and amount of fluid) policy on these drug at your facility, the patient, the patient's history before I can make that determination and even then I would call pharmacy to double check policy and if this can be done safely.

[Esme12, ASN, BSN, RN]

Yep, I figured that out in my third post in this thread. But still, our current practice is to run the 150 ml combined mixture at 25ml/hr, making it take 6 hours to go in, compared to 2 hours for the mag and 4 hours for the K when done separately. Wouldn't running the mixture over 4 hours (i.e., going with the longest necessary infusion) at 37 ml/hr be superior to running it at 25? It would get it done in 4 hours and be closer to the prescribed rate.

Right but as previously stated the Mag take twice and long and the K+ is correct. With it running at 6 hours total..they are both over the "ordered time" which isn't a "bad" thing.

Is the consideration about fluid overload on these patients? I have never worked BMT. Is there a consideration to not slam them with fluid but shortening the time infused? There are more things to consider than an inconvenience or frustration of the nurse.