Download 6.7 CCLHD Standing Protocol-Potassium Additives

Standing protocol form
TITLE
Potassium Additive into Dialysate Fluid to Prevent Hypokalaemia in
Haemodialysis Patients
Ward / Department
GOSFORD IN-CENTRE, SATELLITE AND LAKEHAVEN RENAL UNITS
Drug
Potassium Modifier for concentrated haemodialysis solution. 50mLs contains Potassium
Chloride B.P. 13g/50mLs.
Potassium Modifier is ordered weekly through Fresenius Medical Care as part of the Price per
Treatment Contract.
Indication
To prevent and reduce the development of clinical manifestations of hypokalaemia.
Contraindications1
Hyperkalaemia
Dose1
Add potassium modifier to 5 Liters of Concentrated Haemodialysis Solution Part A (Potassium
2mmol/L) and mix thoroughly. Addition of 50mLs of Potassium Modifier will increase the
potassium level by 35mmol/L. For 35 fold Part A mixing ratio (Part A-1 part, Part B-1.225 parts,
Purified water- 32.775 parts) the potassium level will increase by 1mmol/L for every 50ml
Potassium modifier added after dilution.
Dose frequency1
As required per haemodialysis treatment.
Administration1

Serum K < 3mmol/L add 100mls (2 X 50mls) Potassium modifier to dialysate solution Part A. A 35 fold Part
A mixing ratio as described above will lead to a total of 4mmol/L Potassium Chloride .

Serum K 3-4mmol/L add 50mls (1 X 50mls) Potassium modifier to dialysate solution Part A. A 35 fold Part
A mixing ratio as described above will lead to a total of 3mmol/L Potassium Chloride.

All haemodialysis patients that are on digoxin therapy will have a dialysate with a total of 3mmol/Litre (add
50mls (1 X 50mls) Potassium modifier to dialysate solution (Part A). A 35 fold Part A mixing ratio as
described above will lead to a total of 3mmol/L Potassium Chloride),(Santoro et al, 2005).

Potassium Modifier must be checked by two nursing staff members, one of which must be a Registered Nurse.
The Potassium modifier is then added to a full bottle of dialysate Part A and mixed well.

An Additive label is applied to the dialysate Part A bottle, clearly displaying that Potassium Modifier has been
added including number of bottles added.

Ensure that the patient has been educated by the Renal Dietician. Arrange referral to Renal Dietician if
required.
Santoro, A. Mancini, E. Gaggi, R. Cavalanctie, S. Severi, S. Cagnoli, L. Badiali, F. Perrone, B. London, G. Fessy, L.
Mercadal, L. Grandi, F. (2005) Electrophysiological Response to Dialysis: The Role of Dialysate Potassium Content and
Profiling. Cardiovascular Disorders in Hemodialysis. 149, pp295-305.
Drug Interactions1
Nil
Monitoring requirements1
Assess patient’s serum potassium monthly or more often if required.
Record potassium concentrate required on haemodialysis flow chart.
Any changes to be discussed with Nephrologist, team leader and or primary nurse.
Nursing Accreditation
Requirements
Nil
Documentation
Document in patient’s progress notes and on Haemodialysis flow chart.
Nursing Manager
Signature
Print
Date
Signature
Print
Date
Signature
Print
Date
Nephrologist
Drug Committee Chair
Date for Review
1The
drug information provided is to act as a guide only, for further information reference should be made to the full manufacturers product
information <accessible via CIAP: http://www.ciap.health.nsw.gov.au/>
Standing protocol form
POLICY2

Standing protocols provide authorisation for nursing staff to administer medications routinely administered
at renal haemodialysis sessions.
An appropriately qualified and trained registered nurse must ensure the patient’s medical records are
checked to confirm there has been no previous adverse reaction to the medication before it is administered.

 Regular

2
medical review of haemodialysis patients must be performed
Nursing staff must keep a record of each patient’s medication according to such protocols
PD2007_077 - Medication Handling in NSW Public Hospitals -Section 6.4.7 – Renal Haemodialysis Medications
Notes
1. One copy of this Standing Protocol is to be kept in the ward or unit, one copy is to be kept on record in
the hospital Pharmacy, and one copy sent to the CCLHD Drug and Therapeutics Committee (DTC).
2. Upon DTC approval this standing protocol shall be returned to the submitting unit, which has
responsibility for its circulation.
3. This Standing Protocol MUST be reviewed annually. It is the responsibility of the Ward / Department
using the standing protocol to ensure that this happens
4. This Standing Protocol is valid for a period of 12 months only from the last date of authorisation by the
Drug Committee.
5. Any amendments to this document not endorsed by the Drug and Therapeutics Committee renders this
Standing Protocol invalid.