Download 6.9 Potassium Standing Order

Standing Order for Administration of potassium modifier (13g/50mL) into dialysis solution
Medication Standing
Order for Routine
Procedures
Document registration number:
Site(s) where Standing
Order applies
All Haemodialysis units within HNELHD
Administration of potassium modifier (13 g/50 mL) into dialysis solution
Drug:
Potassium modifier
Target audience
Nursing staff competent in dialysis treatment working in
dialysis units across HNELHD
To be used in conjunction with renal guidelines and
procedures. Only for patients receiving dialysis treatment in
HNELHD
Nephrology, Haemodialysis, Dialysis, Potassium, Dialysate
N/A
Description
Keywords
Replaces Existing Standing Order?
Document number and/ or name
of superseded document/s
Related Legislation (including OHS legislation), Australian Standards, NSW Health Policy or
Circular, other HNEH Documents, Professional Guidelines, Codes of Practice or Ethics:
- NSW Health Policy Directive PD2013_043 Medication Handling in NSW Public Health Facilities
Person responsible for compilation
Contact Details
Authorisation:
Signed (Nursing)
Ginger Chu Renal Clinical Nurse Consultant
(02) 49048815
<signature of responsible NUM or Service Manager in
Unit>
Date
Signed (Medical)
<signature of responsible MO in Unit>
Date
DTC or QUMC Approval
<signature of Chairman of HNE Quality Use of
Medicines Committee
Date
Revised
Review
N/A
<due date of next review (usually annually)>
Trim Number
Details: This Standing order is to be used in the absence of an authorised prescriber during
routine dialysis procedures. The HNELHD Quality Use of Medicines Committee has
determined that the authorised prescriber is not required to confirm the administration by
Version No.
Month/Year
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Standing Order for Administration of potassium modifier (13g/50mL) into dialysis solution
countersigning the record of the administration.
Presentation
Potassium Modifier (13 g/50 mL)
Indications for use
To balance serum potassium during haemodialysis treatment
Contraindications
Normal serum potassium level for haemodialysis population
Proposed Place in
Therapy
To be used in conjunction with dialysis solution and administered as requested prior
to each dialysis treatment.
Dosage
The addition of 50 mL of potassium modifier will increase the potassium level by 1
mmol/L after dilution in 5 litres of part A haemodialysis solution.
Pre-dialysis Serum potassium
< 3 mmol/L
3-4 mmol/L
>4 - 6 mmol/L
>6 mmol/L or patients on digoxin
Administration
Monitoring
requirements
Dialysate Concentration
K4
(2x50 mL potassium
modifier in K2 part A
solution)
K3
(1x 50 mL potassium
modifier in K2 part A
solution)
K2 Part A solution
K2 part A solution +
consultation with a medical
officer

Potassium modifier must be added to a full bottle of dialysis part A solution
and mixed well. It is for single patient use, and must be discarded at the
end of dialysis treatment.

Dialysis part A solution and potassium modifier must be prescribed on the
dialysis prescription

Dialysis part A solution and potassium modifier must be checked by two
nurses and counter signed on the label according to labelling policy.

For acutely unwell patients or patients with recent diarrhoea or bowel
surgery, potassium level needs to be monitored pre dialysis.

For new patients, potassium level needs to be monitored at each dialysis
session for 4-6 weeks until stabilise.

For chronic patients, potassium level needs to be monitored monthly and
prescription must be adjusted accordingly.
Management of
complications
Over use of potassium additive may cause hyperkalaemia and lead to cardiac
arrhythmia. For severe hyperkalaemia patients, extra dialysis sessions will need to
be arranged to remove excess potassium.
Adverse Drug
Reaction
N/A
Interactions
N/A
Documentation
This is a Standing Order for Routine Procedures and Programs as per
HNE2013_043 Section 7.4. It has been determined by the HNELHD QUMC
that the record of administration does not require countersigning by the
authorized prescriber.
Nursing staff administering the potassium modifier must record the dose,
route and administration time on the medication label. This should be
independently double checked by another nurse.
A periodic review of documentation should be undertaken by the Renal
leadership group annually or when matter raised under this document.
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Standing Order for Administration of potassium modifier (13g/50mL) into dialysis solution
Version No.
Month/Year
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