K+ given in the a Docs office?

Hi all, I have a question. I am a new nurse and I work in a rural doctors office. Recently we were asked to start fluids for a pt. that has cancer. This pt. has a porta-cath so no peripheral IV was needed. Pt. was low on K+ his level was 3.2 and the orders were to give 1L of NS with 10mEq of K+ over 1 hour. I work with nurses that have lots of experience and they refused to give this pt. fluid in the clinic. Their reasoning, because we have no policy on running K+ in the clinic as well as their skill level in using a porta-cath were not up to date. Was their reasoning justified? Why or why not. If I were to gain the skills with the porta-cath is this something that should be done in a doctor's office?

Thanks for your help in advance

Quote from melabonicHi all, I have a question. I am a new nurse and I work in a rural doctors office. Recently we were asked to start fluids for a pt. that has cancer. This pt. has a porta-cath so no peripheral IV was needed. Pt. was low on K+ his level was 3.2 and the orders were to give 1L of NS with 10mEq of K+ over 1 hour. I work with nurses that have lots of experience and they refused to give this pt. fluid in the clinic. Their reasoning, because we have no policy on running K+ in the clinic as well as their skill level in using a porta-cath were not up to date. Was their reasoning justified? Why or why not. If I were to gain the skills with the porta-cath is this something that should be done in a doctor’s office?Thanks for your help in advance

Was the port accessed? If the RNs would have to access it, then I would say that unfamiliarity is a good reason to not use it. If it already was accessed, then using it is basically no different from using any other central line (I'm guessing I will get burned on that statement) and I would not see why they can't infuse through that.As for the issue of the potassium: if there is no policy for administering IV K+ in the office, why is there infusions with K+ available to be used? I've never bolused with a liter of fluid with K+ in it--I've either given a liter of NSS or 10 meq of K+ over a hour, but not both in the same solution. Then again, I would not feel uncomfortable doing it. In the ED we give liters all the time. We also frequently give 10 of KCl to pts who are not on a monitor. So, I don't see the big problem with it, but I also agree with Esme that it would be a good idea to see if other offices have a policy on this type of infusion and what those policies are.

Quote from psu_213Was the port accessed? If the RNs would have to access it, then I would say that unfamiliarity is a good reason to not use it. If it already was accessed, then using it is basically no different from using any other central line (I'm guessing I will get burned on that statement) and I would not see why they can't infuse through that.As for the issue of the potassium: if there is no policy for administering IV K+ in the office, why is there infusions with K+ available to be used? I've never bolused with a liter of fluid with K+ in it--I've either given a liter of NSS or 10 meq of K+ over a hour, but not both in the same solution. Then again, I would not feel uncomfortable doing it. In the ED we give liters all the time. We also frequently give 10 of KCl to pts who are not on a monitor. So, I don't see the big problem with it, but I also agree with Esme that it would be a good idea to see if other offices have a policy on this type of infusion and what those policies are.

Quote from psu_213Was the port accessed? If the RNs would have to access it, then I would say that unfamiliarity is a good reason to not use it. If it already was accessed, then using it is basically no different from using any other central line (I'm guessing I will get burned on that statement) and I would not see why they can't infuse through that.

Quote from MomRN0913I won't burn you for that one. If it's accessed, you flush it and hook up the fluids...... even some patients are taught to do this at home. Flush it again when disconnected. However, you should obtain an order from the physician for the flushing.

I would be more concerned about the doctor's reasoning for giving K in that much fluid. I don't give healthy pts K in that much fluid. Typically it is diluted 10mEq replacement in 100ml

Quote from ChristineNI would be more concerned about the doctor's reasoning for giving K in that much fluid. I don't give healthy pts K in that much fluid. Typically it is diluted 10mEq replacement in 100ml

Well, do you have a pyxis code to get into the other areas and their pyxis, that would say something? Some offices give chemo, some offices eg rheumatology give infusions too.

Esme, you are right, the pt is dehydrated.Netglow, I work in a rural clinic, no pyxis available. We just have to call the pharmacy and they bring you what you need. We usually will run a bolus of fluids for pt. or medication like reclast as well. My main concern is the safety of the patient and the lack of a policy to cover me. With the K+ infusion.

Quote from Esme12This is a cancer patient with a port. As a NP to be, I am sure you are thinking along the same lines as I am........I am thinking dehydrated from hyperemsis and chemo needing K+ and fluids.

Quote from melabonicHi all, I have a question. I am a new nurse and I work in a rural doctors office. Recently we were asked to start fluids for a pt. that has cancer. This pt. has a porta-cath so no peripheral IV was needed. Pt. was low on K+ his level was 3.2 and the orders were to give 1L of NS with 10mEq of K+ over 1 hour. I work with nurses that have lots of experience and they refused to give this pt. fluid in the clinic. Their reasoning, because we have no policy on running K+ in the clinic as well as their skill level in using a porta-cath were not up to date. Was their reasoning justified? Why or why not. If I were to gain the skills with the porta-cath is this something that should be done in a doctor's office?Thanks for your help in advance

I bet the other nurses were afraid of it, knowing their skills were not up to date. They are right. Things can go wrong. Maybe attending a skills lab or having somone in to teach skills might help everyone feel more comfortable.