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Difficulty: HardPharmacological and Parenteral Therapies

A nurse is reviewing prescriptions for a client admitted with muscle weakness and a serum potassium level of 2.4 mEq/L. The healthcare provider has prescribed 40 mEq of intravenous potassium chloride (KCl) in 100 mL of 0.9% sodium chloride to be infused over 1 hour. The client currently has a 22-gauge peripheral intravenous (IV) catheter in the right forearm. Which action should the nurse take first?

  1. A
    Program the electronic infusion pump to deliver the medication at exactly 100 mL/hr to ensure accurate dosing.
  2. B
    Assess the client for a narrowing pulse pressure and tachycardia prior to initiating the infusion.
  3. Withhold the medication and contact the healthcare provider to clarify the unsafe infusion rate and route.Answer
  4. D
    Piggyback the potassium chloride into a primary normal saline infusion running at 150 mL/hr to reduce vein irritation.

Answer

Withhold the medication and contact the healthcare provider to clarify the unsafe infusion rate and route.
The correct action is to withhold the medication and contact the provider. Intravenous potassium chloride is a high-alert medication. The maximum safe infusion rate for a peripheral IV is typically 10 mEq/hr, and the maximum concentration is usually 10 mEq per 100 mL to prevent severe vein irritation and phlebitis. An infusion of 40 mEq over 1 hour via a peripheral line is highly dangerous and places the client at immediate risk for fatal cardiac arrhythmias and severe vascular damage.

Step-by-Step Solution

1
Analyze the prescribed medication order against safe administration guidelines for intravenous potassium chloride.
The order is 40 mEq over 1 hour via a peripheral IV.
Intravenous potassium is a high-alert medication that can cause fatal arrhythmias if administered too rapidly.
2
Evaluate the prescribed route and concentration against maximum limits.
The concentration is 40 mEq in 100 mL, and the route is a 22-gauge peripheral line.
Peripheral administration of potassium should generally not exceed 10 mEq/hr, and concentrations higher than 10 mEq/100 mL can cause severe chemical phlebitis.
3
Determine the priority nursing intervention.
The nurse must refuse to administer the unsafe order and contact the provider for a safer prescription.
Patient safety and advocacy require the nurse to challenge unsafe prescriptions before harm occurs.

Key Concept

Safe Administration of Intravenous Potassium Chloride
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Topics

Pharmacological and Parenteral Therapies

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