K+ given in the a Docs office?

Esme12, ASN, BSN, RN · Oct 27, 2011

Hi all, I have a question. I am a new nurse and I work in a rural doctors office. Recently we were asked to start fluids for a pt. that has cancer. This pt. has a porta-cath so no peripheral IV was needed. Pt. was low on K+ his level was 3.2 and the orders were to give 1L of NS with 10mEq of K+ over 1 hour. I work with nurses that have lots of experience and they refused to give this pt. fluid in the clinic. Their reasoning, because we have no policy on running K+ in the clinic as well as their skill level in using a porta-cath were not up to date. Was their reasoning justified? Why or why not. If I were to gain the skills with the porta-cath is this something that should be done in a doctor’s office?
Thanks for your help in advance

Technically there is nothing wrong with 10meq of KCL given diluted over an hour. I would be careful of fluid overload... but the patient doesn't have to be monitored. If the nurses refused becasue they were not up to date or competent on accessing the port a cath they were right to refuse.

However I would contact your particular state board of nursing to see if there is a restriction of IV's in a MD's office (which I doubt there is) or IF the MD needs special certifications or approvals to allow this to be done in the office. You could call surrounding MD's offices and ask how they do it and develop a policy.

If the nurses with "lots of experience" don't want this skill at "their" office ....I'd lay low.....good luck! :)

psu_213, BSN, RN · Oct 27, 2011

Was the port accessed? If the RNs would have to access it, then I would say that unfamiliarity is a good reason to not use it. If it already was accessed, then using it is basically no different from using any other central line (I'm guessing I will get burned on that statement) and I would not see why they can't infuse through that.

As for the issue of the potassium: if there is no policy for administering IV K+ in the office, why is there infusions with K+ available to be used? I've never bolused with a liter of fluid with K+ in it--I've either given a liter of NSS or 10 meq of K+ over a hour, but not both in the same solution. Then again, I would not feel uncomfortable doing it. In the ED we give liters all the time. We also frequently give 10 of KCl to pts who are not on a monitor. So, I don't see the big problem with it, but I also agree with Esme that it would be a good idea to see if other offices have a policy on this type of infusion and what those policies are.

melabonic · Oct 27, 2011

Was the port accessed? If the RNs would have to access it, then I would say that unfamiliarity is a good reason to not use it. If it already was accessed, then using it is basically no different from using any other central line (I'm guessing I will get burned on that statement) and I would not see why they can't infuse through that.
As for the issue of the potassium: if there is no policy for administering IV K+ in the office, why is there infusions with K+ available to be used? I've never bolused with a liter of fluid with K+ in it--I've either given a liter of NSS or 10 meq of K+ over a hour, but not both in the same solution. Then again, I would not feel uncomfortable doing it. In the ED we give liters all the time. We also frequently give 10 of KCl to pts who are not on a monitor. So, I don't see the big problem with it, but I also agree with Esme that it would be a good idea to see if other offices have a policy on this type of infusion and what those policies are.

The port was accessed by a nurse from the hospital. The potassium was available because our clinic is attached to a LTC facility and a hospital. There is hospital policy with regards to running the K+ but can the policy work in the clinic? I think you both you and Esme are right I need to call other clinics. Thanks for your help.

MomRN0913 · Oct 27, 2011

Was the port accessed? If the RNs would have to access it, then I would say that unfamiliarity is a good reason to not use it. If it already was accessed, then using it is basically no different from using any other central line (I'm guessing I will get burned on that statement) and I would not see why they can't infuse through that.

I won't burn you for that one. If it's accessed, you flush it and hook up the fluids...... even some patients are taught to do this at home. Flush it again when disconnected. However, you should obtain an order from the physician for the flushing.

psu_213, BSN, RN · Oct 27, 2011

I won't burn you for that one. If it's accessed, you flush it and hook up the fluids...... even some patients are taught to do this at home. Flush it again when disconnected. However, you should obtain an order from the physician for the flushing.

Hehe, thanks. After I wrote about it being like any other central line after the port is accessed, I began to think of any differences in how it's treated compared with a PICC, Broviac, etc., and I couldn't think of any. I've taken care of patients who give themselves fluid boluses at home through their ports...even took care of one who came in to the ER with her at home PCA attached to her port.

ChristineN, BSN, RN · Oct 27, 2011

I would be more concerned about the doctor's reasoning for giving K in that much fluid. I don't give healthy pts K in that much fluid. Typically it is diluted 10mEq replacement in 100ml

Esme12, ASN, BSN, RN · Oct 27, 2011

I would be more concerned about the doctor's reasoning for giving K in that much fluid. I don't give healthy pts K in that much fluid. Typically it is diluted 10mEq replacement in 100ml

This is a cancer patient with a port. As a NP to be, I am sure you are thinking along the same lines as I am........I am thinking dehydrated from hyperemsis and chemo needing K+ and fluids.

netglow, ASN, RN · Oct 27, 2011

Well, do you have a pyxis code to get into the other areas and their pyxis, that would say something? Some offices give chemo, some offices eg rheumatology give infusions too.

melabonic · Oct 27, 2011

Esme, you are right, the pt is dehydrated. :yeah:

Netglow, I work in a rural clinic, no pyxis available. We just have to call the pharmacy and they bring you what you need. We usually will run a bolus of fluids for pt. or medication like reclast as well. My main concern is the safety of the patient and the lack of a policy to cover me. With the K+ infusion.

ChristineN, BSN, RN · Oct 27, 2011

This is a cancer patient with a port. As a NP to be, I am sure you are thinking along the same lines as I am........I am thinking dehydrated from hyperemsis and chemo needing K+ and fluids.

I'm also thinking about fluid overload. Without knowing the rest of the pt's history it's hard to say but unless the pt was dehydrated I would see no reason to give that much fluid that quickly in the clinic.

Laurie52 · Oct 27, 2011

Hi all, I have a question. I am a new nurse and I work in a rural doctors office. Recently we were asked to start fluids for a pt. that has cancer. This pt. has a porta-cath so no peripheral IV was needed. Pt. was low on K+ his level was 3.2 and the orders were to give 1L of NS with 10mEq of K+ over 1 hour. I work with nurses that have lots of experience and they refused to give this pt. fluid in the clinic. Their reasoning, because we have no policy on running K+ in the clinic as well as their skill level in using a porta-cath were not up to date. Was their reasoning justified? Why or why not. If I were to gain the skills with the porta-cath is this something that should be done in a doctor's office?
Thanks for your help in advance

Why do you need a policy for KCL? Do you have a seperate policy for every single med given in a clinic? Forgive my ignorance---I have never worked in a clinic.