Potassium piggybacks

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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.

Because it's an ICU, our patients usually have central lines that we give our potassium through but occasionally we have just a peripheral line and so what we do is get an order for 1% or 2% lidocaine in 2 mls and add it to the potassium bag. This works! I sometimes further dilute the piggy back as well with about 40-50ml NS.

It seems like the lidocaine might cause cardiac problems, as potentially could the potassium. I wouldn't feel good about mixing it. But, on an ICU it's probably different since the patient can be more closely monitored.

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The amount of sodium bicarb in an amp is inconsequential, the doctor who orders it is also aware of the pt.'s labs, thus the purpose for ordering the potassium in the first place.

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Specializes in Critical Care/ICU.
It seems like the lidocaine might cause cardiac problems, as potentially could the potassium.

Unless it's done incorrectly, the amount of lido added to a bag is inconsequential to cardiac functioning. It's a miniscule amount.

The reason we're replacing the potassium is to avoid cardiac problems. Depleted potassium = ectopy = impaired cardiac functioning.

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Unless it's done incorrectly, the amount of lido added to a bag is inconsequential to cardiac functioning. It's a miniscule amount.

The reason we're replacing the potassium is to avoid cardiac problems. Depleted potassium = ectopy = impaired cardiac functioning.

Right. But, if the patient has too much potassium, or it's run too quickly, that will cause cardiac problems too. Correct?

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Specializes in Critical Care/ICU.

Well yes. But the original post in this thread was asking about potassium replacement and the burning associated with it, not how fast one should run potassium in and the subsequent problems it may cause.

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Well yes. But the original post in this thread was asking about potassium replacement and the burning associated with it, not how fast one should run potassium in and the subsequent problems it may cause.

Right. But I was just responding to your statement because I want to be sure I am on the right track. The subject got off track originally with the lidocaine side track.

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Specializes in Critical Care/ICU.
Well yes. But the original post in this thread was asking about potassium replacement and the burning associated with it, not how fast one should run potassium in and the subsequent problems it may cause.

However, the amount of time the K runs in, does have to do with burning as well.

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Specializes in Critical Care/ICU.
Right. But I was just responding to your statement because I want to be sure I am on the right track. The subject got off track originally with the lidocaine side track.

LIDOCAINE was in direct response to the OP's question. Not off track at all. Cardiac problems caused by giving potassium too fast is off track. :)

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Specializes in oncology, surgical stepdown, ACLS & OCN.
LIDOCAINE was in direct response to the OP's question. Not off track at all. Cardiac problems caused by giving potassium too fast is off track. :)

Bottom line: potassium K+ riders which we give in our hopital when the K+

is low should be given according to the dose and amount, we infuse 20 meq

riders quicker than 40 meq. If through central line there is no burning, but that doesn't mean you can run it in faster. A peripheral line is sensitive to the K+ and should never be infused as a piggyback, I have seen too many lines blown because of that. We run it concurrently with a large volume IV

so that it is diluted and does not burn the patient, we do it that way all the time, and we never need to use lidocaine which would mask the problem of burning veins. Also I have seen a patient transferred to ICU because a nurse infused it as a piggyback. The patient developed SVT. and had to be monitoured, this was quite a few years ago when we didn't have telemetry monitors on the unit. This unit is now a surgical stepdown. :)

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Bottom line: potassium K+ riders which we give in our hopital when the K+

is low should be given according to the dose and amount, we infuse 20 meq

riders quicker than 40 meq. If through central line there is no burning, but that doesn't mean you can run it in faster. A peripheral line is sensitive to the K+ and should never be infused as a piggyback, I have seen too many lines blown because of that. We run it concurrently with a large volume IV

so that it is diluted and does not burn the patient, we do it that way all the time, and we never need to use lidocaine which would mask the problem of burning veins. Also I have seen a patient transferred to ICU because a nurse infused it as a piggyback. The patient developed SVT. and had to be monitoured, this was quite a few years ago when we didn't have telemetry monitors on the unit. This unit is now a surgical stepdown. :)

When you say "large volume IV" do you mean 250 cc NS? That's what we usually run on our floor; 40 meq in 250. The pharmacy will send up a bag that says to infuse over 2 hours. I run it at 80 cc/hour. Is that okay? The other nurses have said it's okay to go at 125, but the IV team says to go slower, so I do what they say.

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Specializes in oncology, surgical stepdown, ACLS & OCN.
When you say "large volume IV" do you mean 250 cc NS? That's what we usually run on our floor; 40 meq in 250. The pharmacy will send up a bag that says to infuse over 2 hours. I run it at 80 cc/hour. Is that okay? The other nurses have said it's okay to go at 125, but the IV team says to go slower, so I do what they say.

Large volume means a 1 liter bag of fluid at 80 to 100cc an hr. with a K+ rider which is 40 meq. of kcl in a 100cc bag of nss, run k rider on separate

IV pump and connect to the tubing of the 1 liter bag below the pump at the lowest injection port. When you do it this way ,you will not have burning through a peripheral IV line and you are diluting the potassium so it doesn"t burn. Run the K+ rider at 25cc an hr. over 4 hrs. With 2 pumps you can run each bag at a different rate unless you have IV pumps that allow you to run fluids concurrently like we have, then you only need one pump that infuses both bags at same time at different rates.

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Large volume means a 1 liter bag of fluid at 80 to 100cc an hr. with a K+ rider which is 40 meq. of kcl in a 100cc bag of nss, run k rider on separate

IV pump and connect to the tubing of the 1 liter bag below the pump at the lowest injection port. When you do it this way ,you will not have burning through a peripheral IV line and you are diluting the potassium so it doesn"t burn. Run the K+ rider at 25cc an hr. over 4 hrs. With 2 pumps you can run each bag at a different rate unless you have IV pumps that allow you to run fluids concurrently like we have, then you only need one pump that infuses both bags at same time at different rates.

Wow. I didn't realize it had to be run that slow. That's scary, because I run it at about 80cc/hour and that is slower than the others run it on my floor. I like the idea of running the fluids with, but one problem we have on my floor is so many of the pts have CHF. What really sucks is that usually we run it through PIV because the docs don't often order PICCs placed.

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