buretrol for magnesium?

Jolie, BSN · Jul 10, 2006

I am new to this small facility. I informed the doctors that it would be safer to have pre-mixed bags of magnesium than the nurses mixing them. The bags that we are to get are 1000ml bags with 40gms of Magnesium. The doctors started talking about how concentrated this was and I had better write a procedure including the use of a buretrol to prevent overdose during the initial bolus. I was taken aback! The pre-mixed bags falls in line with their current protocol. I guess maybe they are having the nurses mix smaller bags for the bolus, however they don't have a policy stating this. I don't mind having the buretrol as an added safety feature, I was just surprised by the reaction. What is everyone else doing?

I've never worked anyplace that required Buretrols for Mg SO4, but have to say that I think it's a very good idea.

ragingmomster, BSN, MSN, RN · Jul 10, 2006

Okay...

Color me ignorant...What is buretrol?

Jolie, BSN · Jul 10, 2006

Okay...
Color me ignorant...What is buretrol?

A Buretrol (or Volutrol) is a cylindrical-shaped volume control device that is placed immediately below the IV bag, separated by a roller-clamp. It has a capacity of about 150cc's. Fluid is placed in the Buretrol, the roller clamp is closed, and the pump is set to deliver the amount in the Buretrol. It effectively limits the amount of fluid that could possibly "free-flow" to the patient. It is commonly used in NICU and peds.

htrn · Jul 10, 2006

We use syringe pumps for the loading dose then convert to 40G/1000ml bag of fluid for maintenance. My biggest fear is an accidental MgSO4 overdose. Sent a pre-eclamptic/pit induction back for crash section and taped the cartridge door closed and put a piece of tape over the dial on the IV pump - in addition to telling and showing EVERYONE in the OR that she was on mag, etc...

Everything came out fine, but I still worry someone will accidently open the mag instead of the pit - has happened b4.

SmilingBluEyes · Jul 11, 2006

I think the Buretrol is an EXCELLENT idea. We use these in our special care nursery.

Suebee6 · Jul 11, 2006

We have pre-mixed bolus bags and pre mixed maintenance bags, we used to have the 40 g in 1000 bags but now we have 20 in 500 bags. Our bolus bags are 4 grams in 100 ml.

Jolie, BSN · Jul 11, 2006

We have pre-mixed bolus bags and pre mixed maintenance bags, we used to have the 40 g in 1000 bags but now we have 20 in 500 bags. Our bolus bags are 4 grams in 100 ml.

Based on replies to recent threads, it seems like most hospitals are now using the system you describe. It is definitely better than the "olden days" of nurses mixing MgSO4 and using a single bag for bolus and maintainance doses. However, this still leaves the possibility of a patient receiving as much as 20g of MgSO4 with a pump malfunction, programming error, or inadvertent free flow.

I'm liking the Buretrol idea even better!

daisybaby, LPN · Jul 11, 2006

We don't use Buretrols at the hospital where I currently work, but we used them at my previous hospital. The peace of mind in knowing an accidental bolus won't occur is worth whatever they cost.

RNnL&D · Jul 12, 2006

We use premixed 500 ml bags and an infusion pump. We don't use seperate bolus bags, just change the IV volume and rate on the pump according to the bolus dose ordered.

judyblueeyes · Jul 15, 2006

We use 500 cc bags premixed from the pharmacy and a buretrol. We do not use a separate bag for the bolus. All mag initiations, rate changes and even bag changes are verified with a second nurse. Our policy does not allow more than 2 hours of mag in the buretrol which fits nicely with our assessment requirements.

enfermeraSG · Jul 15, 2006

Buretrol's and premixed bags definitely reduce the risk of accidental OD as much as possible. I know of three incidents over the years (two resulted in fatalities at other facilities) where the Mag infusion was mistakenly opened up. This is an avoidable tragedy, so I hope that the described protocol becomes more widespread. SG