Potassium piggybacks

gwenith, BSN, RN · Dec 31, 2004

I would not have an issue with lignocaine being given on a monitored patient but I have to re-iterate to use extreme caution with an unmonitored patient.

geekgolightly, BSN, RN · Dec 31, 2004

just today i gave 40mEq in 200mL x2 into a subclavian. why is this considered to be a bad idea for those who say that one should never give that much K+ in that little fluid?

we ran it in 100mL bags (20mEq in each) at two hours for each bag.

brief hx: pt was in for UTI, a couple days ago she was prepped with golitely for a colonoscopy which is a possible reason for her critical K+ (2.7). she has no problem tolerating fluids.

gwenith, BSN, RN · Dec 31, 2004

Subclavian is a huge vein whose own flow through will dilute the K+ even further - very different from a teeny vein at the back of the hand.

Actually we don't use piggybacks here we add the K+ directly to the bags ourselves or add it to the burette.

Home Health Columnist / Guide · Dec 31, 2004

us guidelines:

vanderbuit policy...this is how i was taught and practiced:

http://vumcpolicies.mc.vanderbilt.edu/e-manual/hpolicy.nsf/alldocs/204559611f29d08c86256d4e007ef361

australia guidlines

http://www.safetyandquality.org/articles/action/kcalertfinal1.pdf

http://www.safetyandquality.org/articles/action/tools_royalhobart.pdf

[/url]

great britan:

implementing an iv potassium policy

potassium: an element of life contact hour

avoiding the pitfalls of iv therapy

http://nsweb.nursingspectrum.com/ce/ce94.htm

diminishing the risks of iv potassium chloride.

extravasation of vasoconstrictive or caustic agent protocol

http://www.resourcenurse.com/rn/refcenter/extravasation

error stories!

potassium chloride for injection concentrate errors table

http://www.usp.org/patientsafety/briefsarticlesreports/qualityreview/qr561996-10-01d.html

quizz: potassium balance and imbalances

stevierae · Dec 31, 2004

Subclavian is a huge vein whose own flow through will dilute the K+ even further - very different from a teeny vein at the back of the hand.
Actually we don't use piggybacks here we add the K+ directly to the bags ourselves or add it to the burette.

That's what I was wondering about--I don't think I have EVER seen KCl in a piggyback, and have been wondering if this is a new trend on med-surg and/or ICU.

Seems like every patient that comes to the operating room has a 1L bag of RL that ALREADY has (that is, the manufacturer supplied it that way; just as they do pre-Heparinized NS for art lines) 20 or 40 MEQ of KCl added. Presumably, it is set to run over 8 hours, or perhaps KVO. We always d'c it, because running KCl druing induction of general anesthesia can cause dysrhthmias.

It's been a long time since I saw a bag of IV fluid with the orange additive sticker, indicating a nurse or pharmacist had to add KCl--and I have NEVER seen KCL in less than a 1L bag. Then again, I don't work med-surg or ICU, and maybe they do this in patients we don't see in the OR--that is, medical patients.

I wonder why people ever got out of the habit of adding meds to a Buretrol, andyway, and using piggybacks? When I was in the Navy, we added everything to the Buretrol--just opened the primary--that is, the only--IV, filled it with 50 or 100 or solution, then added the med directly to the Buretrol at whatever rate we wanted. Then, when it infused, you would open the IV to flush it, and then readjust the drip rate to whatever you wanted the primary to run at. I remember getting my Heparin this way when I was hospitalized with DVT.

I could see whay you'd need a piggyback with Vanco or Flagyl--you want the extra volume that might not fit in a Buretrol (i.e., 250 or 500 cc) and you'd want to run it over an hour--but, as long as a med isn't incompatible with your primary IV, I never could understand why a piggyback (secondary bag) became preferable to a Buretrol. Sure would save time, money, and space in landfills!

Burnt Out, ASN, RN · Dec 31, 2004

If I have a patient that is getting IV K+ and they complain of burning, I will decrease the pressure setting on the pump and wait about 5-10 minutes to see if that helps: if not, I usually will restart the IV in another site.

Home Health Columnist / Guide · Dec 31, 2004

from Stevierae:
I wonder why people ever got out of the habit of adding meds to a Buretrol, anyway, and using piggybacks?

COST!

RN92 · Dec 31, 2004

Potassium can be soo painful. I have hurt with my pts sometimes - trying different things to make it not hurt so bad.. On a few occassions, I've had pts refuse it - after several minutes or so of painful infusion. The Doc would say, Oh, just give it to them po then. One dose now, and another dose in 30 min. WHAT?? Why wasnt it ordered like that to begin with? If the pts awake enough to complain, why cant it be given po (liquid) form.? I realize IV is faster, but is it really worth the pain?

KarafromPhilly · Dec 31, 2004

What's a Buretrol?

wooh, BSN, RN · Dec 31, 2004

What would be the standard dose of sodium bicarb? Is it added to the potassium bag, or is it infused beforehand? I've never seen it (or the lidocaine) at our facility, and we're constantly running KCl piggybacks. And as was said above, you can put a new perfect IV in a giant vein with lots of dilution and still get c/o burning. If this works, I'd love to look into seeing it done here. (Although I'd even more prefer to convince the docs to go the PO route more often!)

stevierae · Dec 31, 2004

COST!

What do you mean? A piggyback requires a NEW little bag of IV solution and a NEW set of IV (piggyback) tubing--every single time you set up an antibiotic--and that might be every 4 hours!!

The BURETOL, on the other hand, is built into the peripheral line tubing--it's the drip chamber for the main line--and can be used over and over, until the tubing is changed (per whatever the institutional policy is) to tubing with ANOTHER built in Buretrol--and the process repeated. No new solution is required--you pull the solution off the main 1L bag--you can even reconstitute the dry antibiotic with solution pulled off the main bag, if you'd like.

Please explain how you figure piggybacks to be more cost effective.

stevierae · Dec 31, 2004

What's a Buretrol?

A Buretrol (or Volutrol) is a drip chamber--tubular-- with its own flow regulator just below it. It can hold, I believe, up to 150 cc. of fluid--you release the fluid from the peripheral line to fill the chamber, and add your med to that. The Buretrol can be ADDED to peripheral line tubing, or it can come already built into the peripheral line tubing. In addition, you can get a Buretrol add on or built in Buretrol tubing with either minidrip or maxidrip capability.

The Buretrol I am most used to--and the most cost effective one--is the one built into the peripheral line tubing. You simply fill the Buretrol from the peripheral IV bag with the amount of fluid you want, and then inject your reconstituted antibiotic (or whatever you are adding) directly into the Buretrol. Agitate it a bit to mix, set your drip rate, and infuse it. When it's done, flush from the peripheral (primary, and only) IV and readjust your drip rate to whatever you want the primary to run at.

Damn, this makes me feel old--just like when I was telling someone to be sure to chevron her IV catheter before pulling the stylet (to avoid indaverdently dislodging the catheter and enabling her to take her time securing it, since the stylet would occlude the lumen and prevent blood spill) and she said, "What does chevron mean?"