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?

[brent_25, RN]

I have seen patients 'play' with their IV's too many times..it is so easy for a roller clamp to get opened (or closed)..I think what everyone is saying is that infusing KCL without a pump just isn't safe. If your confused patient opened the roller clamp and ran that bag of KCL through in 20 minutes - you're responsible - and your actions would be deemed unprudent. KCL needs to go on a pump THAT IS LOCKED OUT. Your job is to do everything in your power to ensure that first - we do no harm to our patients. That is what will be asked of your actions - did you did everything in your power to ensure the safety of your patient? - and if you say you ran it to gravity for whatever reason - then the answer would be no.

[sfsn]

Why attack nursemoons14? She is being honest and saying what the policy and standard is for her ER. As nurses we should be supporting and educating each other, not judging and insulting. For those of us who believe that her ER's policy re: IV KCl is unsafe, we could be empowering her to get that policy changed, rather than criticizing the care she and her coworkers give to their patients.

[alkaleidi]

Why attack nursemoons14? She is being honest and saying what the policy and standard is for her ER. As nurses we should be supporting and educating each other, not judging and insulting. For those of us who believe that her ER's policy re: IV KCl is unsafe, we could be empowering her to get that policy changed, rather than criticizing the care she and her coworkers give to their patients.

Um, I agree with you to a point that, in general, we should support and educate each other. However.

When someone rolls up on here with an attitude that is that easily interpreted in TEXT, I don't blame everyone for getting excited. From reading all the posts, the person who thinks it's ok to run in a liter bolus with potassium is looking for a lawsuit and is NOT someone I want to work alongside, let alone have cover me for a lunch break and leave my patients in her care -- no way!

It's one thing to be wrong, be corrected, and learn something. It's a whole different ballgame to, as a nurse, be incorrect in a potentially dangerous practice and insist that you are not only WRONG, but you have no intentions of correcting your wrongdoing or incorrect practice, and plan on continuing what you are doing despite evidence that it could be very harmful, if not fatal, to your patients. If this is how she responds to this isolated practice, who knows what other habits she has gotten into as a nurse out of lack of supplies, convenience, or pure laziness.

[kmoonshine, RN]

There isn't a policy at my work that says to run dopamine on a pump...so, should I run it as a bolus? HECK NO.

All current drug books state that rate and concentration must be closely controlled for high alert medications, including potassium and dopamine. This is the STANDARD of care. Written nursing policies and procedures would be a stack of papers 10+ feet tall if they were written for each and every medication.

[UM Review RN, ASN, RN]

We routinely run 1 Liter of fluid with 20 mEq's of KCL in it by gravity. It's either regulated by a roller clamp or a dial-a-flow, but we call it "to gravity." (The phrase is also used for Foley catheters, BTW.) Personally, I prefer to regulate the flow with the dial-a-flow. I like to use a pump, but they're not always available.

A bolus is called a bolus but the flow could also be regulated. As in the order I got last week for a CHF'er having severe hypotension, "Give a 250 NS bolus slowly, take BP, and if not >85, give another slow bolus of 250 ml NS."

Hospital policy says we don't use a pump till we have over 20 mEq's in 1 Liter of fluid. In fact, there was a big push a couple of years back to educate the nurses on what needed a pump and what didn't. That's how I learned the policy.

We also use the phrase "hang by gravity" which only means "don't use a pump." This is for some IV fluids and quite a few routinely given antibiotics, such as Rocephin, Ancef, and Zosyn, to name a few offhand.

And yes, OP, it can infiltrate and cause problems to the tissues when it does.

The only patients I see that don't routinely get IV fluids are CHF'ers and hyponatremic patients.

[ERRNTraveler, RN]

The fact that there are hospitals out there that actually have policies that state not to run KCl on a pump is SCARY! I work as a travel nurse, and have worked at many different hospitals, but have never worked at any with such a policy. Why on earth would a hospital write up a policy that goes AGAINST best practice and DOESN'T err on the side of patient safety??? If I ever end up at a hospital that has a policy like this, you can bet I will STILL use a pump to run high-risk meds.

[cardiacRN2006, ADN, RN]

OK, we routinely run 1 Liter of fluid with 20 mEq's of KCL in it by gravity. It's either regulated by a roller clamp or a dial-a-flow. Personally, I use the dial-a-flow. I prefer to use a pump, but they're not always available.

A hospital that forces you to run KCl on a dial a flow or clamp doesnt' care about your patient's safety or your license.

I work at a poor, poor hospital. We have enough pumps for what we need.

No pump? Nexium, fine. Abx, fine. KCl-not fine. Not a standard of care, not appropriate...not safe.

[UM Review RN, ASN, RN]

A hospital that forces you to run KCl on a dial a flow or clamp doesnt' care about your patient's safety or your license.

I work at a poor, poor hospital. We have enough pumps for what we need.

No pump? Nexium, fine. Abx, fine. KCl-not fine. Not a standard of care, not appropriate...not safe.

I wouldn't exactly say "forced," Cardiac. We're a JCHAO accredited Magnet facility that uses evidence-based practice to write policy.

My thinking is, that being the case, there have been no problems r/t hanging IVFs that way. Otherwise, the policy would've been changed long ago.

Also, there's no such thing as the "IV Police" where I work. If you want to use a pump on an IVF that contains K+, by all means do so. You only MUST use a pump when that K+ is >20 mEq's per liter.

[UM Review RN, ASN, RN]

Of course, next time I work, I'll be asking the Pharmacist why this policy is OK, and get back to the thread when I get an evidence-based answer.

Because who knows? I could be wrong, policy could've changed, and in any case, I'm too curious to let it go.

[cardiacRN2006, ADN, RN]

By forced, I mean that you don't have enough pumps to do your job properly. I think we can all agree that it's safer to infuse potassium, and any drug for that matter on a pump.

[nursemoons14]

We routinely run 1 Liter of fluid with 20 mEq's of KCL in it by gravity. It's either regulated by a roller clamp or a dial-a-flow, but we call it "to gravity." (The phrase is also used for Foley catheters, BTW.) Personally, I prefer to regulate the flow with the dial-a-flow. I like to use a pump, but they're not always available.

A bolus is called a bolus but the flow could also be regulated. As in the order I got last week for a CHF'er having severe hypotension, "Give a 250 NS bolus slowly, take BP, and if not >85, give another slow bolus of 250 ml NS."

Hospital policy says we don't use a pump till we have over 20 mEq's in 1 Liter of fluid. In fact, there was a big push a couple of years back to educate the nurses on what needed a pump and what didn't. That's how I learned the policy.

We also use the phrase "hang by gravity" which only means "don't use a pump." This is for some IV fluids and quite a few routinely given antibiotics, such as Rocephin, Ancef, and Zosyn, to name a few offhand.

And yes, OP, it can infiltrate and cause problems to the tissues when it does.

The only patients I see that don't routinely get IV fluids are CHF'ers and hyponatremic patients.

Thank you, some back up

[cardiacRN2006, ADN, RN]

I dont' consider this backup, sorry. To quote you from earlier, this is what happens when you ran a bolus on NS with KCl in it...remember, this is YOUR quote...

I had a old lady about 4 days ago, cute lady, too nice to even bother us, we had her getting a bolus NS w 20 kcl. Her arm looked like popeye and that potassium cannot feel too good. most pumps will detect the infiltration and will not run.