Trouble running potassium

[garciadiego]

Aloha

I'm hoping someone can explain this problem to me.

A patient, 85 year old male with a hep lock to his right upper arm, with a potassium of 2.7. Doctor orders D5NS with 20 MEQ K+ to run at 125cc/hr. and K+ 40MEQ to be given over 4 hrs. A Picc line is not an option for another 2 days but the Hep Lock is in good shape.

Since the 40MEQ K+ was not available from pharmacy right away, I started the IVF D5NS with 20MEQ, about a half hr. later I stopped the IVF and started the first of 2 bags of K+, which comes in 100cc bags containing 20 MEQ each, I piggy backed the K+ into the IVF.

The first bag of K+ ran in smoothly at 50cc/hr, but not so with the 2nd bag. The pump showed that 30cc went in after about 45min but the IV bag seemed to have the entire 100cc contents in it. So I restarted it, watching it drip to make sure it was running OK.. The same thing happened again, the pump said X amount of fluid was infused but the bag looked almost entirely full.

A more experienced nurse came to my assistance. He got a second pump, attached it to the IV pole , now there are 2 pumps on the IV pole. He got seperate tubing and ran the K+ on the 2nd pump...but I don't understand how he did this....it looks like he piggy backed the K+ to a flush bag and attached the 2nd tubing to the closest port on the first tubing with 2nd tubing.....hope that makes sense...then he ran it and it ran without problem. I could not understand his explanation...he speaks broken english with a thick philippino accent.

So how did he actually run it? And why didn't the K+ not infuse in the first place?

Thanks.

[GilaRRT]

Common problem with piggybacking without a pump. Most likely, fluid from the primary bag was flowing and not fluid from the piggy back. With potassium containing fluids, both lines should be on a pump IMHO.

[flower75]

at my hospital we always run the small bags of KCl on a dedicated pump. The first pump is NS or whatever fluids the patient has ordered and is usually at a slow rate (20-25ml/hr). This line is attached directly to the HL. The 100ml bag of KCl is primed directly into a 60gtt/ml tubing (not piggybacked into another bag) and ran through a second pump. This line is attached to the most proximal port to the patient on the primary line running NS. this helps to dilute the KCl until the patient can get a PICC or CVL.

[garciadiego]

GilaRN, I was using a pump, thanks for your input though.

Flower75, let me see if I understand...the K+ on the second pump is running, attached to the closest por to the patient at the same time the NS is running at TKO in order to dilute the K+?

Can you explain why the K+ did not infuse in the first place? I don't see how the IVF could have backed up into the piggy backed K+ as I had every thing set up correctly...however I don't see another reason why the K+ did not infuse.

Thanks all for your help

[GilaRRT]

If you are piggybacking potassium into your primary fluid line, you run the risk of not having the piggyback flow properly unless BOTH lines are on a pump. This means each bag has it's own pump. I understood you only used one pump and did the typical piggyback setup through only one pump. This set's you up for problems with fluid flow as you do not have direct control of the flow from one of your bags.

[Virgo_RN, BSN, RN]

It sounds like the other nurse "Y sited" the K+ in, which is what I would have done as well, to dilute the K+ in order to decrease the chances of phlebitis. K+ can really hurt going in.

When you set up your piggyback, did you lower the primary bag? Did you watch the K+ drip chamber to see that it was flowing? Did you unroll the roller clamp on the piggyback tubing?

Another thought, sometimes I've spiked a bag, filled the drip chamber, and still the medication will not flow to prime the tubing (this is on mini bags of medications that I'm running in as a primary). Twisting the spike, or moving it in and out, or giving the bag a squeeze, can remedy this. Is it possible that when you spiked the K+ bag, you didn't get a good spike, so the fluid wasn't running?

If the piggyback isn't running for whatever reason, the pump will simply infuse the primary fluid, and it will read out as if the piggyback had infused.

This is why it's important, whenever hanging a piggyback, to watch the drip chamber and be sure the fluid is infusing before you leave the room.

[dragonflyRN]

Could they have been programmed to run at a slow rate concurrently, not the K+ as a piggyback.

From what I understand...your d5ns with K+ was on the pump, you then piggybacked the K+ on the same pump. Piggybacked, this would have stoped the ivf, piggyback would infuse, then pump would revert back to ivf. If the pump was set to concurrent, both would infuse at the same time.