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Discussion

KCl through central access

I'm in the process of hanging my first 20 mEq of KCl on a patient with a 3.1 K+ who is having runs of SVT, and another nurse comes in and tells me if I have central access, I can run it at 100 ml/hr. Normally, I would trust this person's opinion entirely, but since I've never done it, seen it done, or seen any literature on it, I played it safe and stuck to the normal infusion rate.

QUESTION: How fast can you SAFELY run KCl through central access??

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  • Experts

The advantage of infusing it through a central access is that it reduces the problem of vein irritation. As with all potassium infusions, you don't want to infuse it any faster than 20mEq over an hour maximum and definitely on a pump. Infusing any faster than 20mEq an hour will put the patient in heart block. Even then, you want to make sure subsequent potassium levels are being monitored.

20mEq in 100cc's over 1 hour is appropriate thru a central line.

Our policy is 10meq/hour - regardless of access. Have given it through a peripheral IV with lido added. CVL is much preferred.

Check your policy to be sure!

20 jeq over 1 hour is acceptable via cnetral line. B ut policies do vary hospital to hospital

  • Author

I really appreciate everybody's input! I guess I should have been a bit more clear in my first post. My hospital's standard dose of 20 mEq comes in 50 ml. And the policy is 20 mEq over one hour. Which is why I was so suprised to hear this other nurse tell me I could infuse it over 30 minutes. For all the reasons that Daytonite mentioned, I stuck with the policy. But I was curious, and wanted to see if anyone else had heard differently. Thanks!

Most facilities permit up to 20meqs of KCl per hour through a central line. It may be permitted more rapidly in the ICU, but you better check your hospital P&P first.

in our hospital, you can run it as fast as you like if the patient is on a cardiac monitor... on non-monitored floors, you have to run it a lot slower (always over 1-2 hours)...

We do 20meq in a 100ml bag over an hour always through a pump. If its a peripheral line we'll dilute it by piggybacking NS, and thats usually pretty effective in preventing the vein irritation.

  • Experts
in our hospital, you can run it as fast as you like if the patient is on a cardiac monitor... on non-monitored floors, you have to run it a lot slower (always over 1-2 hours)...

Sorry, but that should not be true, there is a limit as to what the body can safely handle. Faster and you are essentially pushing it, which you never, ever want to do?

Why? Instant cardiac arrythmias, etc. And death.

Just because you have the patient on a monitor, it doesn't change how fast that is should be given, a petient still remains that same person and they still have the same heart.

  • Experts

Many facilities stock pre-mix bags from the manufacturer, and they come in either 50 ml or 100 ml bags. You can also find them in 10 meq, as well as 20 meq concentrations.

Rule of them to go by, and keep you out of trouble: never more than 10 meq per hour in a peripheral IV for a patient on the floor, and 20 meq per hour for a patient in the ICU and with a Central Venous Line.

Do not rely only on the number of mls being given, but go by the concentration of the piggyback.

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