Potassium piggybacks

meownsmile, BSN, RN · Dec 29, 2004

Do you not set it up so it runs as a piggyback into the iv pump? You are using 2 pumps with the K+ infusing to the lowest Y port? Not sure,, sounds a little risky if you are infusing a rider without a pump.

When i run K+ riders, and i have patients complain i slow as much as possible,, then if it still is burning,, i will restart the IV to a larger vein. That usually does the trick. If the patient is getting other things piggybacked it could be that there is already irritation present. Restarting a new site will keep the K+ from further irritating an already irritated vein.

begalli · Dec 29, 2004

Because it's an ICU, our patients usually have central lines that we give our potassium through but occasionally we have just a peripheral line and so what we do is get an order for 1% or 2% lidocaine in 2 mls and add it to the potassium bag. This works! I sometimes further dilute the piggy back as well with about 40-50ml NS.

geekgolightly, BSN, RN · Dec 29, 2004

Because it's an ICU, our patients usually have central lines that we give our potassium through but occasionally we have just a peripheral line and so what we do is get an order for 1% or 2% lidocaine in 2 mls and add it to the potassium bag. This works! I sometimes further dilute the piggy back as well with about 40-50ml NS.

this is why i love to read this board. thank you so much.

CCURN · Dec 29, 2004

When we give Potassium peripherally we ususally add Lidocaine, you can always run it a little slower....

DutchgirlRN, ASN, RN · Dec 29, 2004

(Formerly RN1976Nurse) I run 10 meq in 100cc and run it at 25cc an hour on a seperate pump but running into the main line. If there is no complaints about it burning I turn it up but never faster than 50cc/hr. I rarely have a complaint about burning.

I would like to explore adding the lidocaine. I've never heard of that before. Can somebody tell me how much and do you have to have an order to add it?

plumrn, BSN, RN · Dec 29, 2004

We have to have an order for the lidocaine. Sorry, I cannot remember how much we add.

geekgolightly, BSN, RN · Dec 29, 2004

found this.

http://www.ismp.org/MSAarticles/Safety.htm

KarafromPhilly · Dec 29, 2004

I would restart the IV in a larger vein. The last place I worked they used to use an ice pack at the site but a nurse at my present place of employment told me that the burning is an indication that damage to the vein is occurring. The max amt of KCl in our IVPBs is 20mEq in 250 cc. I've never heard of the lidocaine--I assume there is no injury to the vein after the infusion?

lockjaw · Dec 29, 2004

I would like to know of any tricks to alleviate burning while adminstering Potassium IVPB. Right now I am running NS{faster rate} and the K+{slower rate} together using two primary IV lines with the K+ connected to the y port closest to the patient. Are there any more tips for alleviating the burning? This is frustrating to me because it takes sometimes an entire shift for a 100cc bag to infuse because the pt is complaining of burning.

why don't you try a larger vein. also, don't dump all of your iv's into the same vein if you can help it, give it a rest!. Be sure to flush and check for blood return before, and flush after. If all else fails, ask the doc to prescribe an additive to reduce the pain. Oh, and also, can some of it be given orally or per tube? You may have to go to a central line if the patient's condition is so fragile that you are constantly replacing potassium.

Be sure to constantly assess for fluid overload if you increase the fluid volume as you have suggested. Does the patient have a bad heart or CHF?

good luck!

gwenith, BSN, RN · Dec 29, 2004

We have a limit to how much K+ can be given per hour via a peripheral veing and that is 5 mmol. If the patient requires more than that we give oral suppliments if the patient can't take oral suppliments and is requiring more than 5 mmol/hour they need to be off the general floor and into a higher care facility where the electrolytes WILL be monitored closely. We dilute the 5 mmol with 50 mls and I think I would prefer to find a larger vein than to add lignocaine. Too much risk of cardiac depression. Remember the ISIS study on lignocaine and cardiac survival was stopped before it was completed because the death rate of those recieving the lignocaine was so much higher - I know that you are not giving the same quantities but unless you have a recent EF of your patient I would not risk it. All you are doing is masking the damage to the vein.

One doctor I worked (breifly) would not listen when I told him of the burning the patient was experiencing so I offered to give him a paper cut and pour some K+ in - he listened after that:devil:

louloubell1 · Dec 29, 2004

We have a limit to how much K+ can be given per hour via a peripheral veing and that is 5 mmol. If the patient requires more than that we give oral suppliments if the patient can't take oral suppliments and is requiring more than 5 mmol/hour they need to be off the general floor and into a higher care facility where the electrolytes WILL be monitored closely. We dilute the 5 mmol with 50 mls and I think I would prefer to find a larger vein than to add lignocaine. Too much risk of cardiac depression. Remember the ISIS study on lignocaine and cardiac survival was stopped before it was completed because the death rate of those recieving the lignocaine was so much higher - I know that you are not giving the same quantities but unless you have a recent EF of your patient I would not risk it. All you are doing is masking the damage to the vein.
One doctor I worked (breifly) would not listen when I told him of the burning the patient was experiencing so I offered to give him a paper cut and pour some K+ in - he listened after that:devil:

I agree with gwenith here about masking the damage to the vein. Though lidocaine might seem like a good idea so the patient can tolerate electrolyte replacement, it may also mask a serious problem, such as extravasation which will cause big time, nasty chemical burns if that KCl leaks out into the tissues. I would look at starting another line, and if the patient needs frequent IV KCl replacement, and can not take it orally, I think I would advocate for a central line.