Darlene Malone, age 42, has been admitted to the emergency department with complaints of fatigue, extreme weakness, and heart palpitations. She says she has not seen a healthcare provider in nearly 10 years. Suddenly, she slumps and falls over. She is not breathing, has no pulse, and does not respond to verbal stimuli. She is resuscitated with CPR and IV epinephrine, and an endotracheal tube is placed. STAT lab results show a potassium level of 7.7 mEq/L, BUN of 102 mg/dL, and creatinine of 5 mg/dL. A physician diagnoses acute renal failure. Among other interventions, an IV is started to administer 10% calcium chloride solution, 1,000 mg, by slow IV push to counteract the toxic effects of hyperkalemia on the cell membranes. The nurse used a 20-gauge over-the-needle catheter in Ms. Malone’s right cephalic vein, about 5 cm (2 in.) above her wrist.
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