University of Michigan Hospitals and Health Centers

Policy 07-01-020 
Intravenous Electrolyte Ordering and Administration in Adult Patients at UMHHC
(Formerly Policy 62-01-007) 
Issued: 7/2002 Last Reviewed: 7/2004 Last Revised: 7/2004 Posted: 9/2004 

I. POLICY STATEMENT

The University of Michigan Hospitals and Health Centers shall create and maintain Policy and Guidelines (Exhibit A) to provide standards for safe and effective ordering and administration of intravenous electrolytes including sodium, potassium, magnesium, calcium and phosphorus to adult patients.

II. POLICY PURPOSE

The purpose of this policy is to provide standards for the safe and effective ordering and administration of intravenous electrolytes including sodium, potassium, magnesium, calcium and phosphorus to adult patients. This policy addresses the ordering and administration of intravenous electrolytes for maintenance and replacement/supplementation. This policy is NOT meant to address the use of electrolytes in urgent or emergent situations, or in any other specific diseases or under specific clinical conditions that necessitate a deviation from these guidelines.

III. DEFINITIONS

IV PUSH: Any medication which is administered directly into a vein over a period of time less than or equal to 5 minutes.

INTERMITTENT INFUSION: Any medication that is administered directly into a vein over a prescribed limited time period. The medication is administered at set time intervals. The infusion rate is usually controlled by a mechanical infusion pump.

CONTINUOUS INFUSION: Any medication that is administered into a vein in an uninterrupted manner. The infusion rate is usually controlled by a mechanical infusion pump.

MAINTENANCE DOSE: Electrolytes provided on a daily basis to maintain normal balance - usually mixed in an intravenous hydration fluid or parenteral nutrition solution.

REPLACEMENT DOSE: Electrolytes provided to correct the serum deficit of a particular ion - usually infused over a limited time period. (NOTE: Replacement dose = total dose ordered over prescribed time period, not hourly dose.)

IV. POLICY STANDARDS

A. The absolute maximum concentrations and maximum rates of infusion listed in the guidelines shall not be exceeded without an order signed by an attending physician.

B. Concentrations listed in the guidelines represent final administration concentrations. Floor stock may require further dilution.

C. DO NOT give IV PUSH (except for magnesium and calcium).

D. Consider all sources of electrolytes when assessing electrolyte requirements and supplementation.

E. Physician orders for maintenance electrolytes must specify the name of the electrolyte, name of diluent, concentration, and infusion rate (e.g., D5 0.45 NS with 20mEqKCl/L @ 20 mL per hour).

1. If the prescriber does not specify a volume for a large volume maintenance solution, a standard volume of 1000 ml will be dispensed.

F. Physician orders for replacement electrolytes must specify the name of the electrolyte, amount, and number of doses to be given (e.g., 10 mEq of KCl IV x 1). The standard duration of infusion shall follow the Guidelines for infusion time and rate specified for each electrolyte.

1. If the prescriber does not specify an infusion rate, a standard infusion rate appropriate for the specific electrolyte will be recommended by Pharmacy.

G. Whenever possible give electrolyte replacements via a central venous catheter. If a peripheral vein is used, monitor the patient for signs that may indicate tissue irritation/infiltration.

H. Use an infusion device to administer all replacement electrolytes.

I. Equipment: Continuous infusion device, appropriate syringes, tubing, diluents, electrolyte injection solutions and labels.

J. All maintenance intravenous solutions should be appropriately labeled with the total amount of electrolytes from all sources and total volume of diluent (e.g., 40 mEq KCl per 1000 mL of D10W).

K. All replacement intravenous solutions should be appropriately labeled with the total amount of electrolyte, total volume of diluent, and rate of infusion (e.g., 10 mEq KCl in 100 mL of NS, infuse over 1 hour).

L. Documentation: Each dose administered will be charted on the Medication Administration Record (MAR).

M. Calcium chloride, potassium phosphate and concentrated potassium chloride (i.e. 2 mEq/mL) shall not be part of routine floor stock.

N. Contraindications/Precautions. See guidelines applicable to all electrolytes and individual electrolyte guidelines.

O. Preparation of patient. Encourage patient/family to notify nurse if there is pain, redness or swelling at the infusion site.

NOTES:

1. For more detailed information on the ordering and administration of the electrolytes covered under this policy, refer to the UMHHC Guidelines for Intravenous Electrolyte Ordering and Administration in Adult Patients (Exhibit A).
 
2. Deviation from this policy requires the order to be signed by an