Potassium piggybacks

CRNAdreamweaver2b · Dec 29, 2004

RNLou hit my main concern right on the head. Lidocain is great for the symptom, but does not prevent the problem if vasoirritation/extravasation is occuring.

Larger veins tend to work on periphs.

geekgolightly, BSN, RN · Dec 29, 2004

I think it's fine to restart first in a larger periph vein, but if the patient is entirely uncomfortable and is refusing to allow you to continue with the infusion, the lidocain is an avenue, that before this thread, i did not know was availible to me.

begalli · Dec 29, 2004

I agree with everyone about the lido possibly masking damage to a vein during administration of K. That's why as it's being given it's watched very closely and given at a very slow rate (never more than 10 meq in ~150 ml given over ~2 hours). I also agree that if a person doesn't have a central line and they need K replacement, they need to be on scheduled PO K.

But sometimes no matter what, even with a gigantic antecubital IV, the patient still complains of pain. Then I use the lido. Never had a problem with any cardiac depression and remember this is an ICU where the pt is on a cardiac montior and under continuous observation.

We do it all the time. The lidociane we use comes in 1 or 2 ml ampules of 1% lido. This type of lido is not really enough to cause cardiac problems. What would cause a problem is if the wrong concentration is used, but I've never heard of someone using the wrong concentration while doing this (at least where I work).

This report posted ealier by geekgolightly, http://www.ismp.org/MSAarticles/Safety.htm

contains several mistakes on the part of the healthcare team. The first is that the doctor was dead wrong for trying to give so much IV K to this patient without a central line. Second, 40 meq per bag was waaaaay too much in one bag no matter what the length of time it was to be given. By all standards I've ever seen, I don't think there should ever be more than 20 meq in 250 mls minimum for peripheral administration. 40 in 500 would maybe be acceptable but then you get into fluid status issues. Just a little bit of lido added to a bag does the trick. The problem in this report is that there is a HUGE difference between using the 1% lido for numbing an area before suturing or placing an arterial line or adding to KCL and the lido syringes used in codes. The nurses SHOULD HAVE KNOWN better simply by what the container looked like when they pulled the med. They obviously didn't read the concentration.

That's a great link and a great lesson for all of us.

Lido is safe to use if you are vigilant about what you are doing and really paying attention. There's no reason a patient should suffer the burning of potassium replacement.

tommycher · Dec 29, 2004

At our hospital we add sodium bicarbonate to reduce the burning, it is in small amounts and does the trick without causing imbalances. It comes in ampules and is loaded in the pyxis under the name "neut" as that is what it does to the burning of K.

starcandy · Dec 30, 2004

I would like to thank you all for giving me some good info on K+ piggybacks. I work on a renal floor where the pts usually doesn't have very good veins. I have never heard of using lidocaine before. There is a wealth of knowledge on this board.

geminikell · Dec 30, 2004

We also use Neut in the ED I work in. It seems to do the trick.

begalli · Dec 30, 2004

Adding NaHCO3 to potassium to stop the burning? I've never heard of this. I always run anything with bicarb separately from everything else out of fear of causing a preciptate.

I will definitely keep this one in mind.

Cool. :)

We use NaHCO3 to dissolve those little pepcid pellets that come in the PO capsule form of the drug. Makes it easier or possisble to administer through a feeding and/or NG tube without worrying about plugging up the tube.

beausud · Dec 30, 2004

i dont mean to hijack this thread.. but on a related topic. from what i've been told and have experienced myself.. liquid "po" K replacements seem to work more effectively compared to IV potassium replacements; other factors may obviously contribute to a patient's difficulty in holding onto their K, but anyhow.. is this assumption scientifically valid? thx for your time.

URO-RN · Dec 31, 2004

Just wondering .... can we get a "sticky" for this thread?. It's a very good one.

Jo-

zacarias, ASN, RN · Dec 31, 2004

. Second, 40 meq per bag was waaaaay too much in one bag no matter what the length of time it was to be given. By all standards I've ever seen, I don't think there should ever be more than 20 meq in 250 mls minimum for peripheral administration. 40 in 500 would maybe be acceptable but then you get into fluid status issues. Just a little bit of lido added to a bag does the trick.
That's a great link and a great lesson for all of us.

I agree that potassium should be given PO whenever possible. I will say that 40mEq in 250 ccs is VERY common even in renowned medical centers with top researchers. Fluid status may or may not be that large of an issue. In a 250 cc bag of 40mEq, we'd set it for 62ccs/hr or so and most people can take that.

stbernardclub · Dec 31, 2004

Nope....i Have Never Worked Anywhere That Added Anything But 250cc To Dilute It. Its Not A Medication That Can Run All Day! If A Patient Needs Iv K, Its Needs Given In A Timely Manner. I Would Never Put Ice On Arm Unless A Iv Was Pulled. Go For Another Vein.

begalli · Dec 31, 2004

...even in renowned medical centers... In a 250 cc bag of 40mEq, we'd set it for 62ccs/hr or so and most people can take that.

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!!