IV fluids to gravity, infiltration?

[kmoonshine]

If you hang 0.9% NS w/o to gravity and the IV site is no longer patent (catheter displaced into tissues, blown vein, etc), would the IV fluids stop infusing or would the fluids continue to flow and cause infiltration?

I like to hang 0.9% NS to gravity when possible because I always thought that the fluids would stop infusing if the IV site blows. A co-worker of mine disagrees and said that IV fluids hung to gravity would continue to flow and infiltrate if an IV site blows.

Thoughts?

[kmoonshine, RN]

excerpts from the following article: http://findarticles.com/p/articles/mi_qa3689/is_200102/ai_n8935095

[color=#333333][color=#333333]"potassium: getting to the heart of the matter"

[color=#333333][color=#333333]numerous reports of adverse drug events, some of them fatal, have been associated with i.v. therapy using potassium chloride (kcl), potassium acetate, or potassium phosphate. errors include rapidly injecting undiluted potassium and confusing a potassium concentrate with another solution, such as heparinized 0.9% sodium chloride solution used for catheter flushing.

• [color=#333333][color=#333333]"too little or too much potassium in the bloodstream can trigger a deadly cardiac arrhythmia".
  
  
• [color=#333333][color=#333333]"[color=#333333][color=#333333]always dilute potassium and give it via i.v. infusion, but never as an i.v. bolus".
  
  
• [color=#333333][color=#333333]"because potassium can severely irritate your patient's veins and other tissues, you must dilute it in a large volume of i.v. solution that's appropriate for his condition (such as 40 meq of kci in 1 liter of 5% dextrose in 0.45% sodium chloride solution)."
  
  
• [color=#333333][color=#333333]"if your patient is receiving potassium at more than 10 meq hour, perform continuous cardiac monitoring".
  
  
• [color=#333333][color=#333333]"monitor for extravasation because potassium leakage into the subcutaneous tissue can cause necrosis. if you suspect extravasation, immediately remove the catheter".

[siggie13]

okay, alittle clarification: there are two ways to give iv fluids, by pump or by gravity. by pump means that the pressure of the pump maching is forcing the fluids to leave the bag and run through the tubing into the vein. by gravity means that the force of gravity is causing the fluid to leave the bag and infuse through the tubing. any controller on the tubing is doing just that, controlling how fast gravity affects the flow of the fluid.

in the "old days", nurses would raise and lower the bag to help gravitational flow work better.

iv's running by gravity will still infiltrate up to the point of saturation of the site. we once use to give something called "clysis". this was giving ivs subq when no veins were available in babies : fluids were infused by gravity slowly into upper legs and titrated by the reabsorbion of the fluids by the body. worked to hydrate but was slow. fyi:twocents:

[ERRNTraveler, RN]

excerpts from the following article: http://findarticles.com/p/articles/mi_qa3689/is_200102/ai_n8935095

[color=#333333][color=#333333]"potassium: getting to the heart of the matter"

[color=#333333][color=#333333]numerous reports of adverse drug events, some of them fatal, have been associated with i.v. therapy using potassium chloride (kcl), potassium acetate, or potassium phosphate. errors include rapidly injecting undiluted potassium and confusing a potassium concentrate with another solution, such as heparinized 0.9% sodium chloride solution used for catheter flushing.

• [color=#333333][color=#333333]"too little or too much potassium in the bloodstream can trigger a deadly cardiac arrhythmia".
  
  
• [color=#333333][color=#333333]"[color=#333333][color=#333333]always dilute potassium and give it via i.v. infusion, but never as an i.v. bolus".
  
  
• [color=#333333][color=#333333]"because potassium can severely irritate your patient's veins and other tissues, you must dilute it in a large volume of i.v. solution that's appropriate for his condition (such as 40 meq of kci in 1 liter of 5% dextrose in 0.45% sodium chloride solution)."
  
  
• [color=#333333][color=#333333]"if your patient is receiving potassium at more than 10 meq hour, perform continuous cardiac monitoring".
  
  
• [color=#333333][color=#333333]"monitor for extravasation because potassium leakage into the subcutaneous tissue can cause necrosis. if you suspect extravasation, immediately remove the catheter".

moonshine- this information is correct, and directly contradicts your earlier post where you said it was ok to give a bolus containing kcl and that you didn't need a pump.....

[cardiacRN2006, ADN, RN]

It's gets confusing, but Kmoonshine is the OP, and nursemoons14 is the one who said it was ok to bolus potassium.

[ERRNTraveler, RN]

oops- I just saw "moon"!

[cardiacRN2006, ADN, RN]

I know! I kept getting them confused myself!

[nursemoons14]

alright guys i think we all know K can cause arrythmia's I don' think 9 posts saying the same thing is really necessary.

[cardiacRN2006, ADN, RN]

If you still think it's ok to run K without a pump, or as a bolus, then YES, 9 posts (or more) is totally necessary.

And for the record yes you can run that without a pump

[nursemoons14]

Well boss, at our hospital it is not protocol to run a ba of 1000ml nacl with 20kcl on a pump. Bolus yes, pump no, so I shall continue to do so. Its recommended, but nowhere does it say you have to. when you have a 42 bed emerg with 35 admitted pt's and most of those pt's requiring a pump, and all you need it is for maintenance IV, sorry to break it to you but its the only thing you have to use. What do you think they used before pumps?

[ERRNTraveler, RN]

Well boss, at our hospital it is not protocol to run a ba of 1000ml nacl with 20kcl on a pump. Bolus yes, pump no, so I shall continue to do so. Its recommended, but nowhere does it say you have to. when you have a 42 bed emerg with 35 admitted pt's and most of those pt's requiring a pump, and all you need it is for maintenance IV, sorry to break it to you but its the only thing you have to use. What do you think they used before pumps?

So can you tell us what hospital you work at, so I can be sure NOT to be a patient there.... or take an assignment there!:icon_roll

[siggie13]

Well boss, at our hospital it is not protocol to run a ba of 1000ml nacl with 20kcl on a pump. Bolus yes, pump no, so I shall continue to do so. Its recommended, but nowhere does it say you have to. when you have a 42 bed emerg with 35 admitted pt's and most of those pt's requiring a pump, and all you need it is for maintenance IV, sorry to break it to you but its the only thing you have to use. What do you think they used before pumps?

Having been in nursing a long time, I used to do many things according to hospital protocol that make me cringe now. WE learn and improve our patient care and are constantly finding safer and more therapeutic means of doing care. Once, I did not put KCL infusions on a pump BUT now would not think of doing that because I know better and data shows that KCL infused too fast can kill. We are patient advocates and need to insist for safer and more up-to-date care for our patients. :thnkg:

[cardiacRN2006, ADN, RN]

Well boss, at our hospital it is not protocol to run a ba of 1000ml nacl with 20kcl on a pump. Bolus yes, pump no, so I shall continue to do so. Its recommended, but nowhere does it say you have to. when you have a 42 bed emerg with 35 admitted pt's and most of those pt's requiring a pump, and all you need it is for maintenance IV, sorry to break it to you but its the only thing you have to use. What do you think they used before pumps?

Well, good luck in nursing. And good luck when an adverse or sentinel event happens to you because you won't have a leg to stand on.

Because no nurse in the universe will stand in a court of law and state that running K off pump is their standard of care.