Any buretrol advice???

melipeds · Aug 19, 2003

When I first saw the first message I thought maybe they were referring to a drug. Then I realised that you were all talking about what we call burettes! So now I can join in the discussion.... intelligently we hope!

Here, in a paediatric ward in a general Sydney hospital, we flush straight after giving antibiotics. We have a bright orange sticker which we apply to the burette when the meds are going through, and then we take it off the burette and attach it to the line when flushing. The sticker states what the med is, time etc, and has the signature of the two RN's that administered the drug. That way ANYONE walking in to the room can see if there are meds going through or being flushed. If the IV is left running TKVO then we don't flush before giving the next lot of meds. However, if we have capped the IV then, obviously, we do flush before the next lot of meds.

Sometimes, like when giving flucoxacillin, we'll double flush... so that no drug has remained in the burette to be mixed with the fluid that is flushing. We don't like to leave any flucox in the veins due to it's irritating tendencies.

cheers,

Mel

peds77 · Jan 28, 2007

The way to avoid bubbles is to Fill the buretrol wih say 10-20cc of fluid while keeping the tubing clamped...(so don't open the clamp between the burette and the bad while your priming the line) then open your clamp on the tubing and prime the line...also to avoid bubbles turn the clamp on the line upside down while your running the fluid through to prime(this is for alaris sets...and if u do get a bubble put a 5cc syringe onto the port distal to the bubble...then pinch the tubing or bend it right below the port..open the clamp in the line and pull back on the syringe slowly and it will such the bubble out will re priming the line sounds tricky but swear to god works wonders and i do it atleast twice a shift...

seeandwhy · Jan 28, 2007

Buretrol is the best because we mix our own IV meds and putting it in the buretrol saves time to prepare for piggyback! we use buretrol to all our patients in my floor - we cater to all ages. Just to give you an example : if you needed to give 40 mEq of KCl IV on your patient for a K level of 3.2, just get 4 10 mEq KCl bags (this is our stock) then get a secondary line and put all the KCl in the buretrol which then totals to 200 cc then program the pump to 50 cc rate and 200 for the volume then it will automatically infuse for 4 hours. This way, it is more convenient and saves time, you do not need to keep on changing the piggyback 4 times. Actually, benefits are too many to mention.....

Mags4711, RN · Jan 28, 2007

People still use them? We did away with them about 8 years ago. As the poster at the top of this page said, they are pretty inaccurate. and with the pumps we have today, what is the point of having them on? There are studies out there about IV drug incompatibility and Burette's(trols). You may put your med into it and run it in, but there is still a small coating of the med left on the wall of the device, then you are risking putting another med in that is incompatible. The other issue (which is really only an issue with little little folks) is the fluid limitations with tiny ones. If you are giving a med to a baby, it can be a looong time before it makes it though the tubing and gets into the patient, and that's a lot of fluid to flush it through.

Now that we use MedFusion syring pumps, I cannot imagine going back.

nurs4kids · Feb 4, 2007

Here is my buretrol pet peeve. Lipids always seem to clog the filter which allows to regulate pressure out, therefore creating a vacumn in the buretrol. Any suggestions to avoid this (the manufacturer thinks we are nuts)

Canadian,

We use the ones without a filter for lipids. I can not imagine how you ever get it to infuse or prime with lipids and a filter??

I know you guys are going to scream, but..

we use them on most every patient. Rarely, and I mean rarely, we use syringe pumps. For a healthy infant, non-fluid restricted, we use them. We do raise our rates to speed up the infusion time, keeping the 20cc in the tubing in mind when calculating our rate. I've been doing it for 13 years in the same hospital (and they've done it longer) and can not think of one time it has been a problem.

As for med incompatibilities, we have a few meds we KNOW are not going to like others. For those, we hang separate buretrol's. For the most part, we just drop in a flush, swish it around and we have no problems with precipitation. We do flush the med port on top of the buretrol with saline between multiple meds.

Our policy is only two hours worth of fluid in the buretrol and only two hours worth of time on the pump. We assess our IV's hourly, so I usually check my fluid hourly too.

I love them, can't imagine life without a buretrol!!

I'm curious now. How often do ya'll change yours? Ours are changed every 72 hrs for periperal, 24 for central and hyperal.

Pediatric Critical Care Columnist · Feb 11, 2007

We change our tubing q72 hours for most infusions except anything lipid-based which is then q 24 hours, and those where stability or adsorption might be a problem. That information is available to us in our PPDM monographs.

We don't use buretrols for any vasoactive drug and we don't generally like to run anything via buretrol into the same lumen that is infusing vasoactive drugs, due to the ebb-and-flow action of the pulse-driven pump. We've even seen problems with inconsistent delivery of vasoactives when there's something running via buretrol into another lumen of the line. I never noticed this dramatic variability with my favourite Baxter Colleagues.