K+ given in the a Docs office?

[melabonic]

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

[classicdame, MSN, EdD]

I bet the other nurses were afraid of it, knowing their skills were not up to date. They are right. Things can go wrong. Maybe attending a skills lab or having somone in to teach skills might help everyone feel more comfortable.

[xtxrn, ASN, RN]

My primary MD's office (free-standing, no pharmacy/hospital) gave fluid boluses with no issue . 10 mEq of K is nothing. 30 minutes in 100cc would have been safe. I would wonder why PO wasn't used for a lousy 10 mEq.

"Just" having cancer isn't a contraindication for PO KCl (gads, I got a boatload of the stuff- orally and IV, as chemo can suck out KCl; IV fluids in the free-standing PCP office was years before CA). jmo :)

[melabonic]

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.

No we do not have a policy for every medication. I am fairly new to nursing and have never run K+. With the other nurses not willing to run it I want to make sure I am doing the right thing for my patient and my licence.

[Noimanurse]

I would say you need to speak with your nurse manager about various policies.

[Esme12, ASN, BSN, RN]

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.

on a dehydrated adult with no cardiac issues a liter is pretty standard. on kids it's a ton...

standard, large (eg, 14- to 16-gauge) peripheral iv catheters are adequate for most fluid resuscitation. with an infusion pump, they typically allow infusion of 1 l of crystalloid in 10 to 15 min and 1 unit of packed rbcs in 20 min. for patients at risk of exsanguination, a large (eg, 8.5 french) central venous catheter provides more rapid infusion rates; a pressure infusion device can infuse 1 unit of packed rbcs in

patients in shock typically require and tolerate infusion at the maximum rate. adults are given 1 l of crystalloid (20 ml/kg in children) or, in hemorrhagic shock, 5 to 10 ml/kg of colloid or packed rbcs, and the patient is reassessed. an exception is a patient with cardiogenic shock who typically does not require large volume infusion.

patients with intravascular volume depletion without shock can receive infusion at a controlled rate, typically 500 ml/h. children should have fluid deficit calculated (see dehydration and fluid therapy in children: symptoms and signs) and replacement given over 24 h (1⁄2 in the first 8 h).

http://www.merckmanuals.com/professional/critical_care_medicine/shock_and_fluid_resuscitation/intravenous_fluid_resuscitation.html

[TriciaJ, RN]

I don't see how 10mEq of K+ in a litre of fluid is going to raise anyone's potassium level. When doing fluid replacement on postop patients, 20mEq K+/1L was standard, just to keep from flushing the existing potassium.

Your pt would do just as well if he could choke down a couple of bananas.

[RN-LOGIC]

Sounds like a joke to me. Giving 10 meq of kcl for a level of 3.2 its like having the appetizer without the entree. Giving 1liter of fluid within a hour for dehydration in this setting, I mean in the clinic doesn't make sense either. Only poor perfusion and low blood pressure due to hypovolemia mandate rapid volume replacement. Don't get me wrong. I have given fluids and blood products within a couple of minutes. 40 meq of kcl in 1 liter bag in a 2 hr period sounds more appropriate in your setting. The chest port is a central access so you can infuse large amounts of fluids. In this case, I don't think that the chest port or giving the fluid is the issue. The issue is what's right for the patient or the reasoning behind it, why am I doing this or is there a better way to do it? Also if your kcl is low I can assure you that his mag is low as well, patients like this need to have the mag given first than the kcl. The mag helps the kcl stay in the body. Did you checked a creatinine level? is it high due to dehydration or ARF? WOULD YOU TREATED DIFFERENT? AND REMEMBER. IT'S OKAY TO EDUCATE DOCTORS AS WELL, WE ARE PART OF A TEAM. JUST EDUCATE YOURSELF AND THEN VOICE IT.

[TheCommuter, BSN, RN]

No we do not have a policy for every medication. I am fairly new to nursing and have never run K+. With the other nurses not willing to run it I want to make sure I am doing the right thing for my patient and my licence.

Whatever you do, never give K+ IV push unless your plan of care involves administering a lethal injection.