K+ bath

[LPN2RNBSN]

Many of our patients who have a K+ level of 5.1 or 5.2 and even 5 are on a 2K bath. Some of our patients whose K+ levels are 5.1 are on 3K bath. Although orders specify 2K the doctor has several patients on 3K. Over the last month, their potassium levels have not gone higher than 5.3 even on 3K bath. When I ask about this no one really has time to explain. Is it cost effective for units to use 3K versus piped in wall 2K? Interested in feedback? :uhoh21: need ideas. thx.

[DeLana_RN, BSN, RN]

Good question. 2K is the "standard" dialysis bath, for the obvious reason that most patients need to have their K+ level reduced; however, there are a few exceptions, and the nephrologist will usually adjust the bath based on recent lab results.

However, this may get overlooked. If a pt consistently presents with a K level >5, a 3K bath may not be necessary or advised. As a nurse, you can - and should - bring this to the MD's attention. They don't always keep up with labs like they should, and they can sometimes change significantly before the next routine review.

I would bring this to your charge nurse's or manager's attention. They should tell you when to bring this up with the nephrologist.

DeLana :)

P.S. In acutes, we normally place pts on 3K baths (although our routine order is 2K as well) if their K+ level is less than 4 or so.

[LPN2RNBSN]

Thank you. The physician apparently want to continue this particular patient on a 3K . The labs for K+ are done weekly and have been ranging between 4.7 and 5.3. I was told that alot of units use 3K on all patients. Is this true?

[DeLana_RN, BSN, RN]

Thank you. The physician apparently want to continue this particular patient on a 3K . The labs for K+ are done weekly and have been ranging between 4.7 and 5.3. I was told that alot of units use 3K on all patients. Is this true?

I doubt that, since it wouldn't be a good idea if they already have a high K+ - and in an outpatient setting, how would you know?

DeLana :)

[LPN2RNBSN]

How would I know?" The RN told me as well as I checked the patient's bath, run sheet and order sheet. Apparently this patient questioned the physician and he was not concerned. The 2K is piped into the system, otherwise the jugs have 1K and 3K.. Is the 2K more expensive? The dcotor is in and out so fast that I can't even catch him. I am being precepted as part of my rotation that I selected in school.

[DeLana_RN, BSN, RN]

How would I know?" The RN told me as well as I checked the patient's bath, run sheet and order sheet. Apparently this patient questioned the physician and he was not concerned. The 2K is piped into the system, otherwise the jugs have 1K and 3K.. Is the 2K more expensive? The dcotor is in and out so fast that I can't even catch him. I am being precepted as part of my rotation that I selected in school.

No, actually it's cheaper (since it comes from a big tank and the company buys it in bulk). To make 3K, you have to mix a certain amount of 2K acid solution with an additive package; 1K is only available in special order jugs (and not normally used in outpatient/clinic dialysis).

I do find it strange that 3K would be the standard in a clinic.

DeLana