Potassium piggybacks

[starcandy]

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.

[ST_NURSE_MLD]

In our facility, it is always 20 mEq in at least 250cc or 40 in 1L at 50 - 75cc per hr. Pain is damage. It seems that IV sites don't last long after pt starts complaining of pain. Now, I don't now about any type of quick administration, I'm under the impression you can't push it in fast. With the above mix and rate , it usually takes a shift or so before the vein goes bad.

[RNKPCE]

We do not stock vial/ampules of K on our unit anymore. The only injectable K is in 10meq in 100cc bags for replacment. This must be given over at least an hour. We do use 1% lido 1-3 cc for injection site pain with MD order.

However our clinical path for CHF patients has oral K for replacement as the first choice. It seems back 5+ years ago all the doctors were doin IV replacement now most are doing oral.

I remember one patient we had who had a K in the high 2.0 range and because we could only give 10meq and hour we couldn't ever catch up. We ulitmately asked for an oral order and after 3 days of trying to catch up and never getting above 2.8 using IV we got our first K of 3.5 4 hours after oral replacement. You can give a lot more orally over a shorter time than IV. Obviously this will only work if the patient isn't npo or nauseated etc.

[begalli]

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

Many years ago, we kept stock K+ in vials for adding to NS for IV administration. It was decided that it was just too dangerous as the vials looked similar to the 10ml NS flush vials and a mistaken idenity between the two was bound to happen sooner or later resulting in a tragedy.

Until this year, we used to draw up and add mgso4 and cacl to 25 ml bags ourselves to administer to a patient for replacement, but in response to JCAHO's goals in 2004 for "medication management standards", we now have the little 25 ml bags in our pyxis refrigerated unit stock premixed by the pharmacy. I LOVE it....one less thing for me to do!

[begalli]

--and I have NEVER seen KCL in less than a 1L bag.

Our standard post-op orders include D5NS with 20meq KCL to run at kvo. We also usually draw q 6 hour potassiums and replace to 5.0 with supplemental KCL (the 50 ml piggybacks).

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

Some of our patients come back with a volutrol. For me and most of the nursing staff I work with, we find them to be a hassel. We still have the piggypack bag and squeeze the entire amount into the volutrol, clamp the main fluid, open the air thingy on the volutrol, and reset the rate/volume for what needs to go in.

The problem arises for us dummies when after the volume goes in and we open the main clamp we might forget to close the air thingy...our volutrol fills to the top with fluid. DOH!! Then we have to take the time to draw that fluid out because the rate we run our maintenance is much too slow to clear out that volutrol in less than a day! It happens to me more times than I wish to admit. I guess it's just easier to hang the piggyback, set the pump to secondary and let it run it's course. The pump automatically switches back to the main volume and rate once the piggyback volume is infused. This procedure doesn't need my attention like the volutrol does.

Really it's not a big deal and I understand the importance of using a volutrol in pediatrics, but when I see a volutrol come back from the OR on our adults, I change it to regular maintenance tubing asap.

And also, we change our piggyback tubing q96 hours just like other lines that can go that long...not after every piggyback.

[begalli]

Now, I don't now about any type of quick administration, I'm under the impression you can't push it in fast.

Unless your patient in on death row, no, K+ is never pushed fast.

[gwenith, BSN, RN]

Many years ago, we kept stock K+ in vials for adding to NS for IV administration. It was decided that it was just too dangerous as the vials looked similar to the 10ml NS flush vials and a mistaken idenity between the two was bound to happen sooner or later resulting in a tragedy.

Until this year, we used to draw up and add mgso4 and cacl to 25 ml bags ourselves to administer to a patient for replacement, but in response to JCAHO's goals in 2004 for "medication management standards", we now have the little 25 ml bags in our pyxis refrigerated unit stock premixed by the pharmacy. I LOVE it....one less thing for me to do!

In general we have less pre-mixed drugs than you seem to. Some of our wards are going to the pre-mixed KCL bags but in ICU where the needs are very volatile and we need to get stingy with fluid we will mix it ourselves - usually on an hour by hour basis taking electrolytes again every so many hours depending on the amount we have given.

When people ask about working in Australia - this is one of the differences they encounter. And Potassium is ALWAYS given through an electronic pum like an IMED.

[beausud]

We do not stock vial/ampules of K on our unit anymore. The only injectable K is in 10meq in 100cc bags for replacment. This must be given over at least an hour. We do use 1% lido 1-3 cc for injection site pain with MD order.

However our clinical path for CHF patients has oral K for replacement as the first choice. It seems back 5+ years ago all the doctors were doin IV replacement now most are doing oral.

I remember one patient we had who had a K in the high 2.0 range and because we could only give 10meq and hour we couldn't ever catch up. We ulitmately asked for an oral order and after 3 days of trying to catch up and never getting above 2.8 using IV we got our first K of 3.5 4 hours after oral replacement. You can give a lot more orally over a shorter time than IV. Obviously this will only work if the patient isn't npo or nauseated etc.

?why does the oral K work faster than the IV route? :uhoh21:

[RNKPCE]

?why does the oral K work faster than the IV route? :uhoh21:

It may not actually work faster but you can give more meq's over a shorter time. You can give 40meq of powder or tablets at a time, but it would take 4 hours with my hospita's protocol to give the same amount IV.

[begalli]

IV K+ works immediately (important when replacing electrolytes to address ectopy) while PO K+ takes, on average, about 30 minutes minimum to kick in and most if not all forms of PO K+ are extended release so it's effectiveness occurs over time. The effectiveness of PO K+ also really depends on how well the person's gut is working. If their absorption is compromised for whatever reason, PO K+ may not work well at all.

When we give PO K+, the dose is usually 1 1/2 - 2 times what we would give if we were giving it IV.

[KR]

If patients are complaining about KCl riders, I slow down the rate, and/or put a bag of ice at the IV site. I don't put it directly on the skin though. I generally place a washcloth between the ice and the patients skin. I hope this helps.

[scooterRN52]

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.

Does yourIV pump have a concurrent setting? This way you can run your large volume fluid at 80-100cc an hr. Then set your k-rider at 25cc an hr. to finish in 4 hrs. If you can't run concurrently, then you need two IV pumps, hang the k-rider on separate pump and connect to large vol.IV on other pump at the lowest injection port on the tubing, use primary tubing for the k-rider, this way the pt is getting both fluids simultaneously and the K-rider is being diluted by the large vol. IV fluid.

[JustaMaleRN]

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

Our standing orders were to add 1 amp of lido to each bag of KCl. We were fortunate to have great standing orders written by one of the more progressive cardiology groups in the Chicago area.

You can check with Midwest Heart. I believe they are located out of Downers Grove, IL. I know they have shared their standing orders in the past. Their URL is:

http://www.midwestheart.com/home.html

Good luck!