| Contents | Previous | Next |
A nurse received an order to administer a liter of 5 % dextrose in water to keep her patient's vein open. Soon after the nurse started the infusion, the patient's laboratory report arrived, showing she had severe hypokalemia. The doctor then ordered 40 mEq of potassium chloride to be added to the hanging I.V. bag. He also increased the administration rate.
The nurse drew the potassium chloride into a syringe and injected it into the solution bag through the additive port. Almost immediately after restarting the infusion, the patient began to scream with pain. The shocked nurse stopped the infusion and called the doctor. But by the time he arrived, the nurse realized what had happened.
After she added the potassium chloride to the bag, she didn't mix it with the dextrose solution. As a result, the concentrated drug flowed directly into the patient's vein, causing intense, burning pain. Fortunately, the patient escaped serious injury-probably because the nurse was able to stop the infusion so quickly. Transient hyperkalemia from an infusion of concentrated potassium chloride has caused death for some patients.
Many drugs that are added to infusing I.V.s can cause vein inflammation or drug toxicity if they're not mixed well. This problem occurs most often with nonrigid containers (plastic bags), since the area surrounding their additive ports tends to retain some of the drug.
To prevent the drug from pooling at the bottom of the bag, squeeze the drug from the additive port, then invert the bag several times to mix the solution. Using a needle of at least 1 1/2 inches long to inject the drug, inject it over less than 5 seconds. Of course, you must mix well when using rigid containers (glass bottles), too.