Potassium piggybacks

GotHeartRN · Jan 5, 2005

First, check to see if you have a patent IV! If you have 2 IV's, try not to give IV K in the hand !! (Personal experience- it hurts like heck!!) The best way to alleviate burning is to slow the rate of the potassium down-don't increase the rate of the saline (unless there is an MD order to change the rate) because that too can cause burning! ALWAYS ALWAYS ALWAYS run IVPB's of potassuim via pump! If given too quickly, can cause bad (and possibly lethal) outcomes!

And remember there will always be those pts that no matter what you do, the IVF will be uncomfortable- Ice does help!!

Good Luck!

pwp1289 · Jan 6, 2005

i find the premixed 10 meq kcl in 100cc d5w have all the pts complaining but when pharmacy mixes 100 meq in ns the complaints are rare--there is no kcl vials allowed on the medical floors, we can only run 1o meq in 100cc over an hour on the floors--if higher strengths needed, the pt must go to icu---maximun in large volumes is 40meq in 1000cc at not more than 125cc hour

scooterRN52 · Jan 7, 2005

i find the premixed 10 meq kcl in 100cc d5w have all the pts complaining but when pharmacy mixes 100 meq in ns the complaints are rare--there is no kcl vials allowed on the medical floors, we can only run 1o meq in 100cc over an hour on the floors--if higher strengths needed, the pt must go to icu---maximun in large volumes is 40meq in 1000cc at not more than 125cc hour

At our hospital we infuse as much as 40 meq in a 100cc bag of nss, 25cc/hr. for 4 hrs. on al the med-surg floors, anything more is done in ICU. We do not infuse like an IVPB. WE always connect w/ primary tubing at the lowest injection port on the large volume tubing.

PHTLS · Jan 8, 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.

Warm packs for starters.

PHTLS · Jan 8, 2005

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.

Bag of ice? We use warm packs :imbar

ladylynx · Jan 9, 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.

Wow! I am disturbed by the answers of "Lidocaine use". Any medication that numbs will mask the real problem. "Pain " is the sign of a problem. It is up to the physician to order more effective ways of administering Potassium for those that may need various piggybacks, including Potassium, during the patient's stay. An order for a PICC line or central line is usually more effective. As for the nurse, when there is pain, we should change the IV site. A medication is named an "irritant" for a reason...this pain leads to major tissue damage. Many patients return weeks later or go to other hospitals when they find that the tissue damage occurs after discharge. How many of you just say "it will stop", when the patient complains of pain. Sad to say, many have permanent damage, including other healthcare workers that have been patients and I have performed home health visits, only to hear about these awful stories. I beg you all listen to your patient and become knowledgable of such effects.

scooterRN52 · Jan 9, 2005

Wow! I am disturbed by the answers of "Lidocaine use". Any medication that numbs will mask the real problem. "Pain " is the sign of a problem. It is up to the physician to order more effective ways of administering Potassium for those that may need various piggybacks, including Potassium, during the patient's stay. An order for a PICC line or central line is usually more effective. As for the nurse, when there is pain, we should change the IV site. A medication is named an "irritant" for a reason...this pain leads to major tissue damage. Many patients return weeks later or go to other hospitals when they find that the tissue damage occurs after discharge. How many of you just say "it will stop", when the patient complains of pain. Sad to say, many have permanent damage, including other healthcare workers that have been patients and I have performed home health visits, only to hear about these awful stories. I beg you all listen to your patient and become knowledgable of such effects.

I agree with you ladylynx, lidocaine in kcl riders are a no-no, we don't do that at our institution and actually, I never heard of this until now. If my pt.

has pain at their IV site, I stop the infusion and start a new IV access. Then put warmpacks on the old painful site.

scooterRN52 :rotfl:

actioncat · Jan 11, 2005

Bag of ice? We use warm packs :imbar

We use warm packs too. This usually works for me along with slowing down the rate.

What's the rationale for ice? Is there a problem with warm packs? Is it masking a problem?

plumrn, BSN, RN · Jan 12, 2005

I've seen nurses use warmth, and cold to the site. Just thinking the warm pack would dilate the vein, increasing blood flow, whereas the cold packs would constrict the vessel, causing decreased blood flow to the vein. So it seems maybe the warm pack is better? Dunno.

actioncat · Jan 12, 2005

Welll, that is what I thought. I assumed vasodilation would be better than vasoconstriction, but when I saw all these posts about ice, I meant to ask about warm packs.

plumrn, BSN, RN · Jan 12, 2005

I guess we all just go with what we've tried, that helped. Cold packs may numb the pain some. The warmth may make the 'burning' pain worse for some people.

scooterRN52 · Jan 12, 2005

I guess we all just go with what we've tried, that helped. Cold packs may numb the pain some. The warmth may make the 'burning' pain worse for some people.

I think it depends on the patient, but I have had good results w/ the warm packs and elevating the extremety when there has been an infiltration. :)