OK to piggyback IV potassium?

Nurses Medications

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I am a new nurse in a telemetry unit. One of my patients was ordered 4 runs of 10meq IV potassium. My preceptor primed a primary line with one bag of potassium, and then piggybacked a 2nd bag into that line. She then put it into an IV pump and set it so that both bags would run, one right after the other. I spoke to another nurse and she said that this is dangerous to do. Which one is right? I looked on the internet but found no results. If this is not safe, can you please explain why?

Bottom line is what is your hospital policy. Follow that and you won't have an issue

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Specializes in Critical Care.
RNKPCE said:
Bottom line is what is your hospital policy. Follow that and you won't have an issue

You can actually have issues following hospital policies, they aren't foolproof and don't supersede the requirements of your license. More importantly, you should always understand the basis of your policies, blindly following them isn't safe.

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Specializes in Pediatric Critical Care.
MunoRN said:
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.

Probably because I've never hung more than a 60ml syringe of KCL at once (usually less than 10ml), so I've never had that particular experience ? Learned something new!

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Specializes in Emergency Department.
MunoRN said:
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.

This is why I hang two primary lines, the primary being a carrier fluid of NS and the other being KCl, both on their own pumps, and the KCl Y'd into the carrier below the pumps. I don't hang KCl as a secondary on a single pump because of the potential for a rate change issue that is described here that effectively could bolus a high concentration of KCl into the patient. The other reason I don't do this is so that the patient doesn't feel much (if any) discomfort/pain during the KCl infusion. While the patient still gets their 10 mEq/hr infusion with a 2 primary line setup as described above, the concentration of the KCl at the tip of the catheter would be much less at any one specific moment in time. The other reason I do this is that if I have to titrate the NS infusion rate, up or down, the patient only gets a small bolus of the current in-line concentration that's still less than the 10 mEq/L concentration present in the KCl-only line and only if I turn the NS line off would there ever be a full 10 mEq/L concentration present in the line below the Y-site where the KCl joins the NS line.

Also, when the KCl infusion is done, the NS automatically clears the line at it's current rate and there's no "bolus" KCl done at a higher flow rate.

The risk associated with having a KCl-only line with a KCl secondary is that of a pump malfunction and you'd have that same risk without the KCl piggyback. The patient would get a bigger dose of KCl (20 mEq instead of 10 mEq) but the fluid concentration wouldn't change if you're using the same concentration of KCl in the primary and secondary bags.

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MunoRN said:
You can actually have issues following hospital policies, they aren't foolproof and don't supersede the requirements of your license. More importantly, you should always understand the basis of your policies, blindly following them isn't safe.

I agree!

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Specializes in Med/Surg.

The order is NOT for 40 mEq -- the order is for four 10 mEq bolus potassium bags -- which means - one at a time!! I have been a nurse (faculty and practicing) for over 35 years, and never would I run 2 or more of these at a time. I have worked med/surg as well as oncology floors all of my nursing career, and I have never seen this protocol as described above.  VERY unsafe because these patients are typically NOT all on monitors, and I would never take the risk. There has to be some protocol in the hospital pharmacy policy on how this procedure should be done!  

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Specializes in Critical Care.
On 12/2/2020 at 12:16 PM, Kim Miller said:

The order is NOT for 40 mEq -- the order is for four 10 mEq bolus potassium bags -- which means - one at a time!! I have been a nurse (faculty and practicing) for over 35 years, and never would I run 2 or more of these at a time. I have worked med/surg as well as oncology floors all of my nursing career, and I have never seen this protocol as described above.  VERY unsafe because these patients are typically NOT all on monitors, and I would never take the risk. There has to be some protocol in the hospital pharmacy policy on how this procedure should be done!  

4 X 10meq is 40 meq, so yes, the ordered dose is 40 meq.

In the set-up described, the bags are infusing one at a time, although regardless of the number of bags feeding the pump, the rate of infusion is still 10 meq/hour since that is controlled at the pump.

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