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Difficulty: MediumPharmacological and Parenteral Therapies

A client with severe hypokalemia is prescribed an intravenous (IV) infusion of 40 mEq40\text{ mEq} of potassium chloride (KCl) diluted in 100 mL100\text{ mL} of normal saline. Which of the following actions by the nurse is essential for the safe administration of this therapy?

  1. Program the intravenous pump to deliver the medication at a maximum rate of 10 mEq/hr10\text{ mEq/hr}.Answer
  2. B
    Calculate the drip rate to infuse the entire 100 mL100\text{ mL} volume over 15 minutes15\text{ minutes} using gravity tubing.
  3. C
    Connect the secondary medication tubing to the Y-site of an infusing total parenteral nutrition (TPN) line.
  4. D
    Delegate the hourly inspection of the intravenous insertion site for signs of infiltration to the unlicensed assistive personnel (UAP).

Answer

The correct action is to program the intravenous pump to deliver the medication at a maximum rate of 10 mEq/hr.
Intravenous potassium chloride is a high-alert medication that can cause fatal cardiac arrhythmias if administered too rapidly. The standard maximum safe rate for a peripheral IV line is 10 mEq/hr10\text{ mEq/hr}. It must always be administered using an electronic infusion pump to ensure precise rate control and prevent accidental boluses.

Step-by-Step Solution

1
Identify the high-alert status of the medication.
Recognize that intravenous potassium chloride (KCl) is a high-alert electrolyte.
Rapid or uncontrolled administration of potassium chloride can lead to fatal cardiac arrhythmias and cardiac arrest.
2
Determine safe administration protocols for the medication.
Identify that the medication must be diluted, administered via an electronic infusion pump, and infused at a strictly controlled rate.
Gravity tubing or rapid IV push methods are strictly contraindicated because they cannot guarantee a precise, slow delivery rate.
3
Establish the maximum safe infusion rate.
Determine that the standard maximum safe infusion rate for IV potassium chloride through a peripheral line is 10 mEq/hr.
Rates exceeding this limit significantly increase the risk of phlebitis, burning at the IV site, and systemic cardiac toxicity.
4
Evaluate the safety of the alternative actions provided.
Rule out the other options by recognizing that TPN requires a dedicated line and IV site assessment cannot be delegated to a UAP.
Maintaining fundamental safety principles for parenteral therapies ensures the correct action is solely focused on the safe infusion rate.

Key Concept

Safe administration of intravenous high-alert medications (Potassium Chloride)
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Topics

Pharmacological and Parenteral Therapies

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