[newestlilnurse2b]

I just graduated in May and after a nice break, went straight to peds almost 2 months ago. We use the Baxter buritrol tubing, and I don't completely understand them. When running maintenance fluids, or when adding meds to the buritrol, I have problems knowing which clamps need to be open or closed. There is a roller clamp just above the buritrol which allows fluids from the bag into the buritrol, and an open/close valve to the buritrol itself. I've seen nurses leave them both open. I've seen the roller clamp open and the valve closed and vice versa. I would prefer to keep the minimal fluids in my buritrol especially for when I have to add a med, etc.

Can anyone clarify for me how these clamps/valves should be used, and what is the actual purpose of the open/close valve on the buritrol?
Thanks

[Jolie]

The purpose of a Buretrol is to control the amount of IV fluid that is "available" to be infused at any given time. As you know, pediatric patients can easily become fluid overloaded should there be a programming error or pump malfunction. The Buretrol is a safety device intended to prevent this serious complication by limiting the amount of fluid that the pump can deliver.

Anyone who leaves the roller clamp between the Buretrol and IV bag open is essentially disabling this safety mechanism by 'allowing' the pump to have access to the entire contents of the IV bag, creating a safety hazard for the patient. Please, do not ever do this!

Please read your unit's P&P regarding the use of Buretrols for pediatric IVs and follow it to the letter. Most facilities recommend that only 1-2 hour's worth of IVF be placed in the Buretrol at any given time, to minimize the risk of fluid overload in the event of pump malfunction or programming error. This also insures that the nurse will have to check the pump (and the IV site) every 1-2 hours, again minimizing the risk of complications of IV therapy.

As far as administering medications via the Buretrol, it can be done if the medication is compatible with the fluid that is running. The medication is added to the Buretrol with an appropriate amount of fluid and run at an appropriate rate. Again, check your facility's policy on this.

[janfrn]

I second Jolie's response. TO answer the otehr part of your question... the part about the clamps and such...

At the top of the set, between the bag spike and the buretrol there's a roller clamp. Close that clamp after you've decided how much fluid the pump should have access to and have programed the volume to be infused into the pump. On top of the buretrol, there will be either a pinch clamp on a short piece of tubing that ends in a small cap (filter over a vent) or a vent with a "switch" over it. If your roller clamp is closed, this vent must be open. Otherwise as the pump pulls fluid from the buretrol a vacuum is created and the sides of the buretrol get sucked toward each other risking cracks. Don't get the vent filter wet, because then it doesn't work. If you leave the roller clamp open to the bag, let's say for a fluid bolus in a septic patient, then you should close the vent, otherwise the fluid will just flow from the bag into the buretrol until it's full to the top, and your filter will be wet. Clamp open, vent closed; clamp closed, vent open. And be aware the volume markings on the buretrol aren't very accurate, usually out by about 10%. Between the buretrol and the patient there will be a roller clamp or a slide clamp or both. Once the pump is set up with the tubing in its drive path, any clamps you can see between the pump and the patient have to be open for the pump to work. The pump is designed to prevent free flow of fluid to the patient if the set is loaded in the pump properly. If you're really concerned about free flow while you're connecting everything, you can always use the slide clamp on the T-piece to your IV, if there is one. Just remember to open it back up before you start your infusion. The pump will remind you if you forget.

[newestlilnurse2b]

Thanks for the responses. I now have a better understanding. As suggested, I'm also going to review our P&P. (I have a HUGE list of clinical P&P's to finish before my 90 days, but I haven't gotten to this one yet!!!)