Potassium piggybacks

scooterRN52 · Mar 22, 2005

Wow. I didn't realize it had to be run that slow. That's scary, because I run it at about 80cc/hour and that is slower than the others run it on my floor. I like the idea of running the fluids with, but one problem we have on my floor is so many of the pts have CHF. What really sucks is that usually we run it through PIV because the docs don't often order PICCs placed.

Your concentration is different, 40meq. in 250cc is less concentrated than 40

meq. in 100cc, so it probably won't hurt to run it at 80cc/hr. if so your pharmacy would tell you. I understand the dilemma w/ pts. who are at risk for

CHF, you would have to lower the amount infused, 40-60cc, but they should really have central lines. We run into the same problem sometimes. It can be a challenge!

Zachary2011 · Mar 22, 2005

I never understood why Docs order K-Riders for pts not NPO and who can tolerate Liquid, Tablet, or Capsule Potassium. Its VERY WELL ABSORBED po and not only do you not have to worry about discomfort to the pt., its one less line the pt. has to deal with. The effects are just as rapid as IV, and in my observation very more effective then IV. Now if the pt. is NPO or unresposive their is no other choice but IV.

Im also glad to hear about the Lidocaine additive, sounds like a great option , but the pt. would probably need close monitioring, as someone mentioned on the board that if the vein got infiltrated the pt may or may not recognize it as soon as we would all like. Id like more info. on that.

Just last week I had a pt. w/ a Potassium level of 1.8, and the docs ordered 2 k riders to infuse over 4 hours each. If I would have been there with the Docs when they wrote the order, I would have asked just give 40-50 PO potassium and the results would be better for his electrolytes and his comfort.

RNKPCE · Mar 23, 2005

I totally agree. I have seen the po work better for the same reasons you have stated. I have seen the docs move away from the IV Kcl replacement in the last few years( it is still used often but not as often) and our standard orders for CHF clinical path have po replacement.

I never understood why Docs order K-Riders for pts not NPO and who can tolerate Liquid, Tablet, or Capsule Potassium. Its VERY WELL ABSORBED po and not only do you not have to worry about discomfort to the pt., its one less line the pt. has to deal with. The effects are just as rapid as IV, and in my observation very more effective then IV. Now if the pt. is NPO or unresposive their is no other choice but IV.
Im also glad to hear about the Lidocaine additive, sounds like a great option , but the pt. would probably need close monitioring, as someone mentioned on the board that if the vein got infiltrated the pt may or may not recognize it as soon as we would all like. Id like more info. on that.
Just last week I had a pt. w/ a Potassium level of 1.8, and the docs ordered 2 k riders to infuse over 4 hours each. If I would have been there with the Docs when they wrote the order, I would have asked just give 40-50 PO potassium and the results would be better for his electrolytes and his comfort.

UnewmeB4 · Mar 23, 2005

In a peripheral IV?
The hospital I work is considered "world renowned." The only concentration of KCL we have for peripheral IV admin is 10 meq/100 ml to be given over an hour's time minimum.
500 ml of fluid to replace electrolytes IS an issue for 99% of our patients (CTICU). The amount of fluid used for electrolyte replacement is minimized...mag sulfate comes 8 or 16 meq/25 ml; calcium chloride or gluconate comes 1 gm/25 ml. We use these whether the patient has a central or peripheral line. And it's true....usually if a patient needs potassium...they need it now, not 2-3-4 hours from now.
The only lyte we replace over several hours is phosphorus and it comes in 250 ml. We rarely replace phos and I don't recall the concentration, but I think we run it over 4 or 6 hours.
For our central lines we give K in bags of either 10 or 20 meq/50ml and we run it over 30 minutes. The most I remember givng in a relatively short period of time was 160 meq total in about 4 hours.
Not saying what's right or wrong. It's pretty obvious things are done differently in different places.
This really IS an interesting thread!!

We use the prmixed bags as well. Our hospital allows NO K vials on the floor due to safety concerns. We TRY to get Drs to order p.o. for better absorption, esp when they order like 60meQ replacement. That will take 6 hours! And probaby kill a vein or two if no central line present.

mysticalwaters1 · Mar 28, 2005

kindof off subject but anyone find iv zithromax particularily painful when running it in pts? i find almost every pt i have complains about it. the problem also is how many iv's do you have to keep restarting to not let it burn so much? and often with zithromax since most pt's it's for pneumonia and stay several days piccs will not be used. i think sometimes i've seen some pts on it for up to 5 days. i usually run it very slow look out for redness and if it's still irritating restart the iv in a bigger vein make sure blood return run it slow and if it still burns i put an ice pack over or run it with nss through two pumps and that usually helps. any other suggestions for zithromax? if there's a thread on this sorry! if i ever get hospitalized and need it i'd freak!

TinyNurse, RN · Mar 28, 2005

in the ER we use lido in the bag, and also lido into the closest port...... you can always run it slower........

RoxanRN · Apr 16, 2005

My hospital policy for potassium replacement is 10mEq/50 ml over 1 hour (40mEq = 4 hour infusion). This is also reflected in the IV drug book we use (Intravenous Medications by Gahart and Nazareno, published by Mosby). It comes pre-packaged from the manufacturer in this amount. It's also relatively common for the main IVFs in my unit to have 10-40mEq/L for those potassium challanged patients. :)

A former neuro intensivist had a potassium replacement protocol he would order on most every patient. I don't remember the exact serum numbers, but if needed, we replaced up to 40mEq PO AND 40mEq IV. We could run the protocol twice per 24 hours if needed. He also had a standard magnesium replacement protocol (to bring mag into norm) which replaced at 1gm/2hr (if I remember correctly) and a high mag replacement protocol (goal to keep mag 5.0-7.0) with included a mag IVF titrated to labs with boluses of 1-4gm q4hr X3/24hr.

It is very rare that our patients don't have a central line of some sort (CVL/SG vs PICC/PILL). Pain issues r/t potassium doesn't come up very often.

Roxan, EMICT, RN

Neuro Critical Care Unit

scooterRN52 · Apr 16, 2005

My hospital policy for potassium replacement is 10mEq/50 ml over 1 hour (40mEq = 4 hour infusion). This is also reflected in the IV drug book we use (Intravenous Medications by Gahart and Nazareno, published by Mosby). It comes pre-packaged from the manufacturer in this amount. It's also relatively common for the main IVFs in my unit to have 10-40mEq/L for those potassium challanged patients. :)
A former neuro intensivist had a potassium replacement protocol he would order on most every patient. I don't remember the exact serum numbers, but if needed, we replaced up to 40mEq PO AND 40mEq IV. We could run the protocol twice per 24 hours if needed. He also had a standard magnesium replacement protocol (to bring mag into norm) which replaced at 1gm/2hr (if I remember correctly) and a high mag replacement protocol (goal to keep mag 5.0-7.0) with included a mag IVF titrated to labs with boluses of 1-4gm q4hr X3/24hr.
It is very rare that our patients don't have a central line of some sort (CVL/SG vs PICC/PILL). Pain issues r/t potassium doesn't come up very often.
Roxan, EMICT, RN
Neuro Critical Care Unit

Your hospital policy sounds very similar to ours as far as the amounts of K+

and mag infusions, we don,t encounter many pain issues either. :) I work in

an oncology hospital, cancer pts. have a lot of problems w/ electrolyte

imbalances. :)

butterflynurse03, RN · Apr 22, 2005

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.

Always ask the doctor to write for lidocaine to be added to the bag....that makes a world of difference.