Forum topic

 A mechanical flow control device such as Dial-a-Flo has the same accuracy rating as a regular roller clamp - +/- 25%. 

Do you know what the baseline serum potassium is before this infusion?

How much dilution for this 40 mEq?

Up to 40 mEq/100 mL can be given through a peripheral vein if regulated on an infusion pump. 

Max rate of 10 mEq per hour

This is coming from Gahart's Intravenous Medication book and they do not have any specific setting-based recommendations. 

Frankly, for most patients in need of this much KCl, it seems like close monitoring is needed, more close monitoring than can be provided in home care. You might need to base this on the primary and secondary medical diagnoses and the specific reason for why this dose is needed. 

Lynn

 In the hospital setting Kcl usually runs at 10mEq over an hour, you're talking about a faster potassium infusion than most facilites allow along with 2 liters of fluid.  A liter in my experience is 3-4 trips to the bathroom for the patient.  So, we have a patient with low potassium running back and forth to the potty about 6 or 7 times not on a monitor let alone the absence of an infusion pump.  Personally, I'd be ok with the dial-a-flo depending on who is there to monitor the infusion, but the rest of the situation, nope.

 Valorie,

You did the right thing saying no.  I have done home health care although not infusion.  Before changing to vascular access I was a Cardiac Care Nurse in many capacities both in and out of the hospital.  Both in home health and in a cardiologist's office for a total of 15 years and because I have family members with heart failure I keep up.  We did do some things in our cardiology office because we had everytthing we needed including a crash cart and all of the doctors and nurses necessary to run a code and rapid availability of EMS.  The doctors chose well who was a candidate for office stress testing, but we did code and revive a patient that went into flash pulmonary edema as a side effect of the stress medication.  That only happened once in 5 years but we still ran mock codes.  We never gave KCl IV in the office even though we could have kept them all day and had the monitors.  If the cardiologist felt that PO wouldn't be fast enough off to the hospital they went. 

There is not enough information about this particular patient.  But in general a patient with a K+ of 2.6 needs to be in a monitored bed.  High risks of v tach or v fib.  In our facility that patient would be moved from a regular floor bed to a monitored bed if not the ICU.  Giving 2 liters of fluid to someone with a K+ of 2.6 is likely going to dilute their K+ level even further.  80 mEq might not likely offset the dilution of 2 L unless you diuresed at the same time.  We might do that in the hospital along with an IV diuretic although I haven't seen that very often except in renal patients or heart failure patients that now have kidney issues and shouldn't have a bolus of KCl and then they are very closely monitored and might likely even have a foley in for the most accurate I/O. You are talking about giving someone a bolus of 2 L over 6 - 8 hours is 250 to 333 ml/hr which is a lot of fluid to give in an unmonitored location.  What would a HH nurse do when that patient went into flash pulmonary edema.  I am not the least bit concerned at the moment as to what kind of IV you have.  That is another issue.  This is a matter of general patient safety.  Do you carry an AED?  Do you carry emergency lasix?  Most home health nurses are not ACLS trained.  Mine didn't require it.  We didn't carry the meds.  I still had mine because of my past.  

I had doctors ask me to do dangerous things as a home health nurse.  I said no.  I didn't like the process of discharging and readmitting a Medicare pt from home care any more than the doctor did.  It might be easier now with computerized records than it was with everything in paper and add to it if they were Medicaid I had to do that paperwork in addition.  But you do what you have to for patient safety.  Fortunately I had superiors that backed up my position on patient safety.  And I explained my reasoning well to the doctor I was speaking to and rarely had any disagreement.

Remember the 5 rights of medication administration.  In the home care setting there should be number 6.  The appropriate location for treatment.  Not all treatment belongs in the home.  Again I will reiterate that there really isn't enough information about the patient.  But if they had renal issues or cardiac issues all the more reason for hospital care.  Talk to the medical director of your home care service about this situation.  S/he can give you much more direction on this particular patient than this forum can. 

Best wishes,

Mary Penn RN VA-BC

Hi Valorie,

I have been a home infusion nurse for 23 years and now head up a large home infusion program in Northern California.  We have made it a policy to never administer Potassium to a patient whose level is below 3.  Most lab works in home care aren't done STAT and even if they the results usually won't be called to you till hours later.  By the time you get the results, MD gives order and you get the infusion to the patient's home it is then really hard to know what the patient's Potassium level currently.  Also, if we do administer Potassium in the home we never give it faster than 10MEQ per hour with a maximum of 20MEQ in 1 liter per day.  We will use a dial-a-flow for this.

I did have a patient that an MD asked us to administer Potassium in the home and her level was 2.8.  I said no and by the time the patient got to the hospital and they rechecked her level it had gone down to 2.4 and she was having arrhythmias and she was admitted to Telemetry.