OK to piggyback IV potassium?

RNKPCE · Apr 10, 2016

Dangerous. Look at what is the max amount of IV potassium you can give an hour on your unit. Probably 10meq. Check with your pharmacy. ICU can give 20 in a central line where I work but never in the manner you described.

jamisaurus · Apr 10, 2016

In the ICU, we give 20 mEq over 1 hr diluted in NS. So a 40 mEq k rider goes in over 2 hrs, never faster. Agreed with above poster, dangerous!

MeganC012 · Apr 10, 2016

She had it set to run over 2 hours, so the patient would receive 10meq per hour. Im sorry I don't understand why this is dangerous if patient will receive 10meq per hour. Can you please explain?

SquishyRN, BSN, RN · Apr 10, 2016

I can't think of an example off the top of my head how it is dangerous since it would still run at 10meq per hour, but this is certainly the lazy, shortcut way of doing it and is not best practice. We all take shortcuts here and there, but potassium is not something I personally would take shortcuts on. Don't get in the habit of picking up bad habits so early in your career.

RNKPCE · Apr 10, 2016

Ok to piggyback potassium into normal saline, that's how it is done, but piggybacking potassium into potassium just is not good practice. It is a lazy technique. A peripheral IV should be assessed before each new K rider. How is she charting this if you scan meds? Does potassium require a second RN to double check? I would not be the double check for two bags hung like that. Best practice is important, potassium is not a drug to take lightly.

MunoRN, RN · Apr 10, 2016

I think there's maybe some confusion about what the OP is describing, correct me if I'm wrong, but it sounds like they are only stocked with 10 meq bags of potassium, so to give 40 meq they are hanging 2 bags, one as a primary and one as a secondary, which means only 1 bag is infusing at a time. The advantage being that after the first bag (secondary) is finished the second (primary bag) will then automatically run if the pump was set to run at the prescribed rate for the volume of both bags. There's nothing unsafe about this, maybe somebody could explain why they see it as unsafe.

The reason why there is a common belief that potassium should not be hung as a secondary is the concern for the rate switching to the primary rate before the potassium has infused. Lets say the already programmed rate for the primary maintenance fluid is 200ml/hr, a bag of potassium is hung and the pump is programmed to run secondary infusion for 100mls at 25ml/hr (usually 10meq/hr), after the 100mls has infused the pump will automatically go back to infusing at 200ml/hr even though there may be more potassium remaining, so that potassium would infuse too fast.

It's not actually the primary/secondary setup that is unsafe with potassium, and I've worked places where that's required for safety reasons, it's how the pump is programmed. A risk to running potassium not as part of a primary/secondary setup is that there is no automatic clearing of the line when it's done, leaving concentrated potassium in tubing that could be accidently flushed, which I've seen happen and cause (temporary) cardiac arrest. Hanging the kcl bag as a secondary with a primary flush but setting the pump only as a primary infusion will avoid both of these risks.

MeganC012 · Apr 10, 2016

Yes, this is what I am trying to describe. Thanks for the clarification

Julius Seizure · Apr 11, 2016

My only concern would be the "what if" someone were to assume that primary line was saline and not potassium, and without paying attention started infusing it inappropriately. Potassium is not something you expect to find hung as the primary line. I would make sure everything was clearly and obviously labeled as being KCL - the bags and also the tubing (label at the pump and at the patient). In my hospital KCL is labeled with fluorescent pink stickers.

akulahawkRN, ADN, RN, EMT-P · Apr 11, 2016

Where I work we have pumps that can be programmed to have a secondary bag but "above" the pump it's like a regular gravity setup. Setting up a secondary potassium drip on one of our pumps would mean the patient would be getting just the potassium until the line was cleared by the NS and hopefully the patient doesn't have any pain/discomfort in the process. When we run potassium drips, we always put the potassium on a pump and usually the carrier NS drip is also on a pump. This way we can titrate both rates independently.

As long as the pump doesn't malfunction, you could hang a potassium secondary on the potassium line for a total of 20 mEq dose and run that total over 2 hours, or have a call-back every 10 mEq so you can evaluate the IV line before continuing on. I wouldn't say that doing this is inherently unsafe, just not "normal" practice. You want to reevaluate the line periodically and a good way to do this is to run just one potassium bag at a time. Also, if you set the VTBI to something below the full volume, you should have the time (and fluid remaining) to obtain your next bag, reprogram the pump to complete the drip, and wait a couple minutes for the "current" bag to empty and simply spike the new one before the drip chamber runs dry.

MunoRN, RN · Apr 11, 2016

Janey496 said:
My only concern would be the "what if" someone were to assume that primary line was saline and not potassium, and without paying attention started infusing it inappropriately. Potassium is not something you expect to find hung as the primary line. I would make sure everything was clearly and obviously labeled as being KCL - the bags and also the tubing (label at the pump and at the patient). In my hospital KCL is labeled with fluorescent pink stickers.

Potassium is almost universally hung as a primary infusion, due the reflexive belief that it shouldn't be hung as a secondary even though many nurses don't seem to know why, so I'm not sure why you think the risk of mistaking it for NS would be any different if it was hung as both a primary and secondary, if anything that makes it more obvious when you follow the tubing up from the pump.

MunoRN, RN · Apr 11, 2016

There's absolutely no difference in safety between hanging 20 meq's as a single bag or two bags y'd together, functionally it's the exact same thing since it becomes a single fluid column despite being in two bags. Whether the second 10meq to infuse exists in the same bag as the first 10 meq or off the side and lower makes no difference, although it does improve the likelihood the patient will receive the ordered dose in a timely manner, so overall it's probably safer.

Can somebody explain why they think this is not safe?