Buretrols or Not

Pediatric Critical Care Columnist · Jan 5, 2010

We use them on all pediatric patients for all infusions except pressure lines on children >10 kg in weight. Then we use a pressure bag/transducer set-up. Age doesn't matter and weight doesn't matter. Our unit doesn't even stock 'straight' sets except for use with blood products that are infused via syringe pump or into an ECMO circuit.

noahsmama · Jan 7, 2010

I work at a pediatric hospital, and we do not use Buretrols at all. I don't know when we stopped -- this is my first job as a nurse, and we have not had Buretrols in the 14 months that I've been working as a nurse.

Music in My Heart · Jan 7, 2010

They're still used in the NICU in which I precepted.

Personally, I think they're redundant if you're using IV pumps. I'm curious if anybody's taken a good, hard look at their value (cost-benefit analysis) when used with pumps.

Mimi2RN, ASN, RN · Jan 7, 2010

Our Peds unit quit using buretrols when they changed to Alaris pumps. And we all hope the pumps behave. Meds could be mixed in the buretrol, and flushed through without adding extra fluid.

In the NICU we have Medfusion pumps so everything is in a syringe. The glorified version of buretrols. We used to fill the syringes with just 2 hours of fluid, now we have to use the biggest one so that we don't have to break the system to replace the syringe when it starts to stick.

All these changes are made by management, without a whole lot of feedback from the staff.

iluvivt, BSN, RN · Jan 7, 2010

The purpose of the volutrol in the pediatric population is to limit the potential for the inadvertent administration of IVFs and or medications into the pt. Many of the newer pumps are more reliable and the potential for free flow has been eliminated by design features of the pump and or its tubing. So you really need to look at all your IV systems and the type of pump you have. You may also want to check with the Institute for safe medical practice and see if they have any recommendations...Are you using a special pediatric pump?

ChrisF · Jan 7, 2010

Thanks everyone for your replies and input. We are currently using the Alaris pumps. Our rationale has also been to prevent inadvertant fluid overload in the younger population. The only problem we really have with our pumps is the discrepancy from the number of mls in the IV bags and number of mls the pump is reading/dispensing. This has caused 24 hour bags of chemo to run over 25 - 26 hours.

littleneoRN · Jan 13, 2010

We use the Alaris pumps, and I haven't experienced discrepancies with what the pump reads for volume infused vs. what seems to be gone from the bag. The only issue I've noticed is that when I program the syringe pump modules an amount, such as 1 mL, sometimes it will warn me that this is more than thhe waye volume in the container (it's not), but in the end, it still infuses my 1 mL properly. Anybody else have this problem?

Anyway, we don't use buretrols since we use the pumps, which are designed to prevent free flow.

FutureNurse2B · Feb 7, 2010

our hospital is currently in the process of ridding away of buretrols but simply for cost reasons.

vanlo001 · Feb 7, 2010

Well that's interesting about the discrepency. We use buretrols with any drip medications (heparin, lasix, dopamine) and chemotherapy drugs that infuse over 24 hours. We also find our chemo infusions lasting 25 to 26 hours which is a huge issue when you are involved in COG studies. We thought initially it was due to adding of the drug to iv bags and not accounting for the overfill. Now it looks as if the standard ivf bag contains a variable amount of ivf solution. This prompts us to have to adjust the infusionrate based on the amount left in the buretrol so if there's a 150cc left and it's running at 10cc/hr and it should be done in 12 hours we will take 150 divide by 12 and run the rest of infusion at 12.5cc/hr. Not optimal but what we must do to get the infusion in in the allotted time. Without the buretrol it would be hard to know the exact amount left in the bag.

Leecy · Feb 9, 2010

We also use Alaris pumps. Instead of Buretrols we use syring pumps which are part of the Alaris system. The syring pumps give you exacting controls. We also have a problem with overfill with chemotherapy. We ask pharmacy to send chemo in a syring if the volume is less than 60mls. If the chemo volume is greater than that it still comes in a bag with the tubing primed with saline from pharmacy. We infuse the first 20mls quickly as it is not chemo, the stop and program the pump for the proper volume. Still, sometimes it's clearly overfilled. What I have found is some nurse will stop the infusion at the ordered volume and flush even if there is 20ml still in the bag. When the chemo dose was mixed in the total amount of fluid, to get the whole dose of chemo, you have to infuse the whole bag regardless of volume. Personally I think the prefilled bags of NS or D5 pharmacy uses are overfilled my the manufacter. I've pulled 62mls from a supposed 50ml bag with a syring almost daily. I've brought this to pharmacy's attention, but no one thinks it is crucial enough to change anything. So bottom line, when I hang chemo I program the stated volume, and eyeball the bag during infusion to adjust the rate if needed if it's a chemo that will expire in 100 minutes or so.

Pediatric Critical Care Columnist · Jun 28, 2010

One reason that I can't see our unit ever completely eliminating Buretrols is that most of our patients have rapidly-chaning electrolyte requirements. We make many changes in the potassium concntration in our IV fluids and TPN on our cardiac kiddies; in one shift we could go from 0 to 60 and then back to 0. It's not cost-effective or sensible time management to be changing bags and tubing after every lab result; it's much easier to add some potassium to a Buretrol in a "known" volume of fluid then add either more K+ or more IV fluid after the next serum K level.