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Difficulty: MediumPharmacological and Parenteral Therapies

The healthcare provider prescribes 40 mEq40\text{ mEq} of intravenous (IV) potassium chloride for a client whose morning laboratory results reveal a serum potassium level of 2.5 mEq/L2.5\text{ mEq/L}. The client currently has a continuous transfusion of packed red blood cells (PRBCs) running through a single-lumen peripheral IV catheter. Which of the following actions should the nurse take to safely administer the medication?

  1. Establish a new peripheral IV site and administer the potassium chloride via an infusion pump at a maximum rate of 10 mEq/hr10\text{ mEq/hr}.Answer
  2. B
    Administer the potassium chloride directly into the existing IV line as a slow push over 5 minutes to rapidly treat the hypokalemia.
  3. C
    Connect the potassium chloride infusion to the lowest Y-site on the blood administration set to allow simultaneous delivery.
  4. D
    Start the potassium infusion immediately through a new IV site without waiting to verify if the client has adequate urine output.

Answer

The correct action is to establish a new peripheral IV site and administer the potassium chloride via an infusion pump at a maximum rate of 10 mEq/hr10\text{ mEq/hr}.
Potassium chloride must be administered via an electronic infusion pump at a strictly controlled rate (maximum 10 mEq/hr10\text{ mEq/hr} for a peripheral line) to prevent cardiac toxicity and venous irritation. Furthermore, because the client's only IV access is actively being used for a PRBC transfusion—which is incompatible with all medications except normal saline—a dedicated secondary IV site must be established.

Step-by-Step Solution

1
Evaluate the current IV access and fluid compatibility.
The client has a single-lumen IV currently infusing PRBCs.
Blood products are only compatible with 0.9%0.9\% sodium chloride; mixing them with potassium or any other medication causes hemolysis and clot formation, requiring a new IV access.
2
Determine the correct administration method for IV potassium chloride.
IV potassium must be diluted and given via an electronic infusion pump.
Potassium is a high-alert medication. Rapid infusion or an IV push causes immediate, fatal cardiac arrhythmias.
3
Determine the safe maximum infusion rate.
The maximum safe rate for peripheral administration is 10 mEq/hr10\text{ mEq/hr}.
Rates exceeding this limit increase the risk of cardiac toxicity and severe venous irritation (phlebitis).
4
Identify prerequisite nursing safety assessments.
The nurse must verify adequate renal function (urine output ≥30 mL/hr\geq 30\text{ mL/hr}) prior to administration.
Because potassium is primarily excreted by the kidneys, administering it to an oliguric client can quickly result in life-threatening hyperkalemia.

Key Concept

Safe administration of intravenous potassium chloride requires an infusion pump, strict rate control (maximum 10 mEq/hr10\text{ mEq/hr} peripherally), verification of renal function, and ensuring line compatibility.
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Topics

Pharmacological and Parenteral Therapies

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