Any tips on using buretrols? Thank you for any advice!:kiss
Jun 5, '03
What in particular would u like to know about them???? Personally, I love them!!!!!
Jun 6, '03
Any tips or tidbits that you have found helpful. Due to an incredible shortage of nursing faculty in our area, I am conducting a clinical on a busy PEDS floor this summer. I am a former CICU nurse. To say I am not used to PEDS is an understatement.... But, on a positive note, I am very competent and love to learn new things. Have always enjoyed children and look forward to a great summer with my students. Have immensely enjoyed the clinicals so far.... it's just some of the equipment and devices that I haven't seen nor used in YEARS.
Jun 6, '03
Well, they are great for hanging various meds. What we do when we are giving a med is leave the syringe or iv bag still attached so that anyone walking into the room will know that there was a med in there that needs to be flushed (and also know not to bolus with it)
When giving the med you simply squeeze the buretrol and get the correct amount of NS into it, clamp the top off, open up the little flow valve up top (I guess that is what you call it), program the pump to go at the desired rate and the volume to be infused.... ie) 100 cc for a volume of 100. After the med is complete, we give a 20 cc flush from the buretrol again.... and then back to maintance fluids. When you are giving just maintence you need to unclamp, and shut the valve, and take off the syringe.
Jun 6, '03
Buratrols are used on all our babies and pedi patients. You have to watch the amt of fluid going in, so we don't always change the rate. Most meds can be given through the buratrol if the kids are bigger, but remember that there is IV fluid (frequently D5.2 NS) in the tubing. Our tubing hold 17cc from the tubing down, so if a med is given with an IV rate of 10cc/h, it should be give on a separate syringe pump, otherwise it won't get to the kid for 1.7 hours! Syringe pumps should be plugged in to the closest port, and always used on baby meds, up to about 6 mos, depending on the size of the baby. If you push a med...use the closest port to the pt.
It used to be that buratrols were used when we didn't have pumps, so we didn't give too much fluid if the flow rate was wrong. Now people put 2-4 hour of fluid in the buratrol, but the pump is doing the work, so less chance of overhydration.
I know that sounds simple, but you have to watch fluid volumes carefully on the little ones. If you do put meds in the buratrol, you must flush the tubing before starting your next med. Just think small amts on small people.
Hope this makes sense...
Jun 6, '03
Buretrols and infusion pumps are essential safety devices for IV therapy on kids. Most of my experience is in NICU where an excess of just a few cc's of IV fluid can have serious consequences for a micro-preemie or a child with chronic lung disease or heart problems.
ALL pediatric IVs must be run through infusion pumps. No exceptions to this rule, ever! But because pumps and nurses occasionally malfunction, Buretrols are important back-up safety devices.
When hanging an IV, fill the Buretrol with just enough IV fluid for 1-4 hours' worth of time. Set the pump to alarm just before the fluid is due to run out, so you can re-fill the Buretrol and re-set the volume limit for the next period of time. Smaller and sicker babies get just one hour's worth of fluid in the Buretrol. Bigger, healthier kids get up to 4 hours' worth. That way you know that if the pump should malfunction or if you should make a calculation error, the baby will receive only a limited amount of IV fluid, hopefully not enough to do any serious harm. IV site checks are to be done every hour.
Remember that many peds patients are on fluid restrictions, so be careful with piggyback meds and flushes. Sometimes it is better to run meds on a syringe pump so that smaller volumes can be used.
Good luck to you teaching an area so far from your usual practice! It can't be easy. Don't be afraid to ask the staff for help and suggestions.
Jun 6, '03
Interesting to read about the use of buretrols on little ones, makes sense....we always use them bc of our sick heart failure patients with EF's of 5-10 percent. Same concept... careful track of fluid.
Jun 10, '03
Be very careful when 'sqeezing' buretrols. They are hard plastic and can rupture easy...trust me...I sqeezed once and chemo exploded all over my arm and the kid!!!
Plus when you squeeze you allow air (only having gone through a sm filter I question the sterility espeially with high dextrose solutions) up into the IV bag. so just open the slide clamp and let the fluid drain into the buretrol....it is slow (especially at 3am) but way better for the kid.
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)
Jun 11, '03
i have always used buritrols on kids especially before we had pumps so that we didn't over hydrate little ones. now our unit uses them on kids under 5 yrs of age and only put in 2 hours worth of fluid. it forces you to go back every 2 hours miminum to check the iv site if you get too busy to check every hour and i have followed some nurses who have not checked a site for a long time and seen some bad infiltrates!!! plus some times the kids will dislodge the cath and leak the fluids all over the bed when they are sleeping. many of the staff complain about having to use them but to me (i have a lot of grey hair moments) it reminds me to check a site on a child especially when they are sleeping.
Jun 11, '03
i forgot to say we don't use buritrols for meds. we use syringe pumps attached closer to the iv site. it takes 25 cc to get from the buritrol to the patient and if you are giving it at a rate of 25 cc to a little one it can take up to 2 hours for the patient to receive an antibiotic. also if you are giving gent or vancomycin for which you are doing levels, you need to know exactly when you started infusing and the med ended to get correct levels.
Aug 16, '03
My one complaint about buretrols is that they are a very inaccurate way of measuring fluid volumes, the IVAC/Alaris ones in particular. The markings are out by up to 10ml. What looks like 100 ml according to the graduations will add up to more like 110 on the pump. I didn't notice quite as much discrepancy on the Baxter sets. (I prefer the Baxter triple channel pump over the Alaris double channel by a huge margin for accuracy and ease of use. The Alaris is not a great pump for fluid boluses and such because the cassette is impossible to prime quickly without filling it with microscopic bubbles that will delay your bolus by oh... at least five minutes while you try getting them out.
... I HATE THEM!!!!)
Aug 16, '03
I noticed that, too, Jan, about the bubbles. Very hard to prime the tubing. Ah, summer is over now... have moved on to the adult cardiac unit!!! Thank you for your advice and help!
Aug 19, '03
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.