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Difficulty: HardPharmacological and Parenteral Therapies

A critically ill client admitted with diabetic ketoacidosis (DKA) has a serum potassium level of 2.82.8 mEq/L. The healthcare provider prescribes an intravenous infusion of 2020 mEq potassium chloride (KCl) in 100100 mL of 0.9%0.9\% sodium chloride to be administered over 11 hour. The client has a double-lumen central venous catheter (CVC) in the right internal jugular vein. A continuous regular insulin infusion is actively running through the distal lumen. Which of the following actions should the nurse take regarding the potassium chloride administration? (Select all that apply.)

  1. Administer the solution through the proximal CVC lumen using an electronic infusion pump.Answer
  2. Verify that the client has produced at least 3030 mL/hr of urine before initiating the infusion.Answer
  3. Ensure the client is connected to a continuous electrocardiogram (ECG) monitor during the infusion.Answer
  4. Aspirate the proximal CVC lumen for a brisk blood return prior to starting the infusion.Answer
  5. E
    Set the electronic infusion pump to deliver the potassium chloride solution at a rate of 5050 mL/hr.
  6. F
    Connect the potassium chloride tubing to the Y-site of the insulin line without checking a compatibility resource.

Answer

The correct actions include administering the solution through the available proximal lumen using an electronic pump, verifying adequate urine output, ensuring continuous ECG monitoring, and aspirating for a blood return.
Intravenous potassium chloride is a high-alert medication that requires strict adherence to safety protocols. Because the prescribed rate (2020 mEq/hr) exceeds the standard peripheral limit (1010 mEq/hr), continuous ECG monitoring is mandatory to detect potential cardiac arrhythmias. The nurse must also verify renal function (urine output of at least 3030 mL/hr) to ensure the client can excrete the potassium and avoid hyperkalemia. Furthermore, since potassium is a severe tissue irritant and vesicant, central line patency must be confirmed by aspirating for a brisk blood return before infusion. Finally, an electronic infusion pump is always required to guarantee precise delivery and prevent an accidental rapid bolus.

Step-by-Step Solution

1
Analyze the prescription and the client's current intravenous access.
The client requires a high-concentration potassium infusion (2020 mEq/hr) and has an available dedicated lumen on a central venous catheter.
Determining the rate and route is essential for identifying the required safety protocols for high-alert medications.
2
Identify the mandatory safety parameters for high-dose intravenous potassium.
Administration requires an electronic volumetric pump, continuous ECG monitoring (due to the rate >10> 10 mEq/hr), and verification of renal function (urine output ≥30\geq 30 mL/hr).
Potassium is primarily excreted by the kidneys and rapid administration can cause fatal cardiac arrhythmias.
3
Evaluate central line administration and medication compatibility principles.
The available proximal lumen should be used after confirming patency via blood aspiration. Connecting to the insulin line without checking compatibility is unsafe.
Potassium is a vesicant that can cause tissue necrosis if extravasated, and manipulating continuous high-alert infusions (like insulin) should be avoided.

Key Concept

Safe Administration of Parenteral Potassium Chloride and Central Line Management
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Topics

Pharmacological and Parenteral Therapies

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