Slow-Drip Delia — IV Potassium Safety: Never Push, Always Dilute, Always Pump
The order says potassium — and the single most dangerous thing a nurse can do with it is give it fast
A new nurse reaches for a potassium vial and a syringe. Delia stops her hand mid-air: this medication kills when it moves fast.
Delia is the nurse who slows everything down when potassium is on the medication list. IV potassium is NEVER given IV push or as a bolus — it causes fatal cardiac arrest. It must be diluted, infused on a pump, and generally run no faster than 10 mEq/hr on a general unit (higher rates only in critical care with continuous cardiac monitoring). Before infusing, confirm urine output of at least 30 mL/hr, because potassium is excreted by the kidneys. During infusion, watch for burning at the site — a sign of irritation or infiltration — and monitor the cardiac rhythm.
Read Slow-Drip Delia's full story →The story arc
The setup
A client's potassium is 2.9 and the provider orders IV potassium replacement.
The turn
Delia checks the kidneys before the drip: is this client making urine?
The crisis
A colleague asks whether the dose can be pushed to save time. The answer is never — an IV push of potassium stops the heart.
The save
The bag runs on a pump at 10 mEq/hr with cardiac monitoring. The client reports burning, so Delia assesses the site and slows the rate per policy.
NCLEX study section — IV Potassium Safety: Never Push, Always Dilute, Always Pump
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Endocrine & Metabolic
Take this chapter into practice questions on the same topic.