Why use Buretrols? - page 2

Hello all, I'm a pharmacy technician giving a lecture on Iv Administration. I have various opinions on the Buretrol's. Some say they are a must for peds patients, others say they are ancient... Read More

  1. by   Jolie
    Quote from Rxlover
    One more question-is it always used between the pump and patient or can you just hang it alone? In my 15 years as a tech, I've never had to put meds in one, so I'm very lost concerning them. Thanks again, rxlover
    Buretrols are used between the IV bag and the pump. They limit the amount of fluid available to the pump, to prevent accidental fluid overload due to programming error, pump malfunction, or inadvertent free-flow.

    A buretrol is an ADDITIONAL safety device, used in conjunction with an IV pump. It is never used alone in NICU or peds, as a pump is a necessity when administering IVs to children.
  2. by   unikuelady
    At my facility we use buretrols. When used correctly, you are only supposed to put a 1 hour amount of fluid into it, clamp the bag and set your pump. Every hour we are to check the iv site, re-set the pump for the next hours amount. Very tedious-but we have minimal infiltrates in our iv sites. We are a small unit and all the pumps are set for the same time on the hour. This keeps the noise to 1 time and everyone checks their iv sites. We run antibiotics and drips on syringe infusion pumps.
  3. by   justjenny
    I actually had to google the word buretrol to find out what you were talking about! We use Alaris IV pumps which have a "guardrail" program that prevents errors. We have tried many times to test it and punch in weird numbers (not connected to a patient) and it will not allow infusion rates above a certain amount, etc. We still have to have another RN check our rates/calculations for pressors, insulin, etc.

    Jenny
  4. by   NICU_3_RN
    Quote from Gompers
    We've recently stopped using them. I hear they've decided, after much research, that the IV pumps we use are safe enough to go without. It makes us a little uncomfortable, but to be honest I've never seen an "accident" where the patient got a huge bolus whether there was a buretrol or not. Our IV pump tubing has a safety mechanism on it - the tubing is clamped as it goes into the machine. That way, when you pull the tubing out of the machine, it is still clamped and nothing gets to the baby unless you take the extra step of unclamping it.

    What I wish we would do is eliminate IV pumps with hanging bags completely and run everything on syringe pumps. At least then you can see exactly how much is left in the syringe at all times, plus our "smart pumps" have parameters for things like rates/dosages and if you go outside of the normal limits it alarms to warn you before it'll let you override the system.
    I think it's scary that you've stopped using buretrols because IV pumps are "safe". I've seen way too much human error to ever feel comfortable with that. The pumps might be safe - but people are scary.
  5. by   BittyBabyGrower
    think it's scary that you've stopped using buretrols because IV pumps are "safe". I've seen way too much human error to ever feel comfortable with that. The pumps might be safe - but people are scary
    Is this a problem where you work? Like I said, we quit using them 15 years ago and we have not had any problems. If people in your unit are screwing up and they feel they need to use buretrols then they need to put a safe guard in place such as double checking all infusion rates with another nurse before starting them.
  6. by   NICU_3_RN
    honestly - it hasn't been a problem, that i know of - but there will always be human error. I'd rather have the buretrol... it's just one more safeguard.

    but yes - some of the people i work with are scary.
  7. by   Gompers
    I've never seen a big error in IV rates in my unit, like 5cc/hr instead of 0.5cc/hr. Some things are set everyday and we don't even touch the rate for 24 hours, just set the amount to be infused - like Intralipids, TKO heparinized saline, etc. Hyperals are ordered with a max rate which is usually within 2cc/hr of what we've calculated the baby to actually need, so we're always mindful of that rate. And all of our drips (narcotic, pressor, insulin) are run through syringes on Smart Pumps, plus we check those calculations with another nurse every shift and with every dosage change. I've never seen someone running an IV at an absolutely crazy rate, in all my eight years.

    We didn't really use the buretrols when we had them, anyways. they were just part of our IV tubing. We didn't fill them with a certain amount and clamp off the bag so only that much could be infused without refilling the chamber. We just let them fill naturally and left the bag unclamped. So they were kind of pointless.

    Maybe the reason we trust the pumps so much is that we've never seen them malfunction.
  8. by   lovemyjob
    We dont use them either, and I have only seen one error and it was with lipids...and, I dont think the nurse had checked the pump with each hour (it was a two hour error, so there is no way the pump was checked.) Otherwise, we run all other drips using the smart pumps.
  9. by   Mimi2RN
    We were told at work that an IV pump on another unit went crazy when a visitor used a cellphone near it. Supposedly, it dumped a lot of fluid into the patient. Believe it or not. If it did happen, it is a good reason to use a buratrol. I'm still not convinced it wasn't nurse error or more likely family member meddling.
  10. by   LilPeanut
    We use Alaris pumps too, though just fyi, we have notices hanging that there can be issues with alaris pumps double keying accidentally.

    All of our IVs are reset hourly, so hopefully, even if there is a problem, it couldn't go on for more than an hour.
  11. by   elizabells
    We don't use them. We use IV pumps (for TPN, IL, etc) that are programmed to prompt a confirmation if the rate is outside a certain range. For IV meds we use the syringe pumps, which are also programmed for NICU rates. I'm told we don't use buretrols because any meds would get "lost" in them. Frankly, I don't even know what that's supposed to mean and it sounds like an urban legend. But I'm still on orientation, so it's more than likely that I just don't understand.
  12. by   NotReady4PrimeTime
    Quote from elizabells
    I'm told we don't use buretrols because any meds would get "lost" in them. Frankly, I don't even know what that's supposed to mean and it sounds like an urban legend. But I'm still on orientation, so it's more than likely that I just don't understand.
    The dead space (tubing) in most buretrol sets is so huge that a neonate's volume might take a day and a half just to clear it. The Alaris Signature Gold pump that we use has a dead space of approximately 20 mL, with or without a buretrol attached. Putting a med into a buretrol for a child weighing 3 kg would seriously fluid overload them if run in a manner to allow the med to actually reach the child on the same day it was put in there. We use them for maintenance fluid and TPN, and whenever we add... let's say potassium... to the buretrol, we have to then run about 30 mL of fluid into the garbage to ensure that the K+ will reach the patient in a timely manner. I'd MUCH rather use a syringe pump for all infusions on kids less than 10 kg.
  13. by   elizabells
    Ahhhhh, thank you. It was a thing where at first I thought yeah, that make sense, and then so many ppl talk about using them in the NICU that I figured I must be missing something. Seems like syringe pumps, if a unit has enough available, are a much better choice.

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