Potassium piggybacks

dazzle256 · Feb 20, 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.

I usually run saline to dilute the potasium with the NS at the lower port. Usually works pretty well if I run the K+ at 20 meq/hr. Good luck I know some places use lidocaine but I've never had to use it.

melons · Mar 4, 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.

In our hospital we have ready made iv bags of 1000ml/20mmol k. Run over prescribed time, usually 8 hours. Never had a problem with burning.

RNKPCE · Mar 4, 2005

On my floor most of the patients that need K replacement have CHF and this would be too much fluid to give. We sometimes slightly increase the primary rate or give lidocaine. Of the few patients in which this didn't resolve the problem I usually called the MD and got po replacement if this was appropriate. It seems in the late 90's all you saw was IV replacement on everyone who walked in. We now have both standard IV replacment and po replacement and most docs are ordering po unless contraindicated.

In our hospital we have ready made iv bags of 1000ml/20mmol k. Run over prescribed time, usually 8 hours. Never had a problem with burning.

scooterRN52 · Mar 5, 2005

In our hospital we have ready made iv bags of 1000ml/20mmol k. Run over prescribed time, usually 8 hours. Never had a problem with burning.

You won't have a problem w/ a large volume IV bag which 1000ml/ 1 liter

bag is. That is alot of dilution for 20 or 40 meq of potassium. IF you put that much 20 or 40 of K+ in a small bag of 100ml - 250 ml's it will definately cause burning and it will blow the line. We had acase on another unit the other night when they called me to see if I could start an other line on the patient, the nurse ran the K+ rider of 40 meq in a 100ml bag as a piggy back,causing the solution to run undiluted and burning the patient.

tiredfeetED · Mar 5, 2005

You won't have a problem w/ a large volume IV bag which 1000ml/ 1 liter
bag is. That is alot of dilution for 20 or 40 meq of potassium. IF you put that much 20 or 40 of K+ in a small bag of 100ml - 250 ml's it will definately cause burning and it will blow the line. We had acase on another unit the other night when they called me to see if I could start an other line on the patient, the nurse ran the K+ rider of 40 meq in a 100ml bag as a piggy back,causing the solution to run undiluted and burning the patient.

10 meq/ hr periphal, 20/hr meq central, havent seen 40 meq in 100 in along time....and your right 20 meq in a 1000 cc doesnt hurt, but your not going to bolus 1liter/hr unless they need fluids..cuz that can cause prob of its own

plumrn, BSN, RN · Mar 5, 2005

This is a long thread, and I admit I haven't read all of the posts, so forgive me if this has already been addressed.

We run the K-riders on another pump along with the primary solution to decrease the burning as someone said above. But, suppose your pts primary solution is NS w/40 meq KCL infusing at 40ml/hr, and you have an order for a k-rider. Do you continue to run the primary solution with the KCL in it PLUS the prescribed K-rider, or do you stop the primary and run only the K-rider? ... OR, do you run a plain NS solution @ 40ml/hr just for the time it takes to run the K-rider in, then return to the primary NS w/40meq KCL?

begalli · Mar 5, 2005

plum - is there an order to stop the primary solution from running during the administration of the k-rider?

Assuming your primary is a liter bag with 40 meq's of KCL in it, running it at 40 ml/hr gives the patient just 1.6 meq's of K/hr. Adding a k-rider that runs over an hour at the same time is not significant imo.

plumrn, BSN, RN · Mar 5, 2005

Of course! Too little to make a difference. I didn't stop to think it out like that. Thanks begalli!

danolden · Mar 6, 2005

Our kcl piggybacks come in two flavors; central line kcl, and peripheral. Peripheral KCL piggybacks have a smidgen of lidocaine. No problems

scooterRN52 · Mar 6, 2005

10 meq/ hr periphal, 20/hr meq central, havent seen 40 meq in 100 in along time....and your right 20 meq in a 1000 cc doesnt hurt, but your not going to bolus 1liter/hr unless they need fluids..cuz that can cause prob of its own

You are right, but the pharmacy in our hospital makes up K+ riders of 40meq in a100 cc bag of nss to run at 25cc/ hr. to be completed in 4 hr. for a pt. w/ a K+

Some pt.'s are on maintenance IVfluids w/ 20 or 40 of K+ in them. these

are run like that in peripheral and cental lines. If you run that concentration of K+ in small bag too fast they will end up in icu w/ cardiac rhythm changes, I've seen this happen when we had an agency nurse on the unit I work on, she ran it as a piggyback at 100cc/hr. The pt. went to icu. All of our patients have cancer along w/ other dx and they are pretty sick after their

surgery.

highland lass · Mar 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.

Hi, Interested in all these threads about potassium infusions. I work in an ITU in Scotland and we never give potassium peripherally. We would give 40mmols in 20mls normal saline over 4 hours (total 40mls volume) and the only time it would peripherally would be 40 mmols diluted in a 500ml bag.Your way of calculations etc is quite different from ours I think. Its so interesting to read all these things. So many of the names of things are so different.

scooterRN52 · Mar 9, 2005

Hi, Interested in all these threads about potassium infusions. I work in an ITU in Scotland and we never give potassium peripherally. We would give 40mmols in 20mls normal saline over 4 hours (total 40mls volume) and the only time it would peripherally would be 40 mmols diluted in a 500ml bag.Your way of calculations etc is quite different from ours I think. Its so interesting to read all these things. So many of the names of things are so different.

This website is great, isin't it? you can learn a lot, and your right, the names for things do vary, but here in the states we use the metric system for measurement of pharmacological drugs. We used to also use something called: apothacary which consisted of,grains, drams,minums, and fluidrams.

that was confusing, I guess that is why they stopped using it. :)