setting VTBI - your hospital policy

[dansmum03]

I have been nursing for nine years , med-surg, onc, ccu, resp, burns, within the same large tertiary hospital. This morning after a long tricky night shift as I was walking out the door, a colleague mentioned that we are not allowed to clamp a burette and set VTBI from primary container for any longer than an hour at a time.....policy apparently! (haven't had a chance to check if it is or not!)

Example of what I do, always have, probably always will unless someone can show me it's "bad practice"

Pt has Normal saline 100ml/hr, AB's due at 2100, 2400, 0300, 0600 via peripheral IVC

1000ml NS bag connected to 150ml capacity burette, connected to pt via IMED pump. 2100 AB completes in 30 minutes so at 2130 I run a flush, then clamp the burette at the top and set the VTBI of 250ml at 100ml/hr from ie complete at 2400 at which time next AB is again put through burette. I only do this with Normal saline, never KCl (reset pump hourly)

I check the PIVC site and rate at commencement of shift, before AB goes through, tell AOx3 pt to call me if IV gives any pain, I check site afterwards when running flush, I check rate and site at 2200, 0200 and 0600 when doing obs.

Am I wrong to set VTBI through burette for more than an hour at a time???

If pt is not on AB, has no burette, just straight normal saline 100ml/hr, I set VTBI @ 950ml and still check rate and IV site frequently throughout night. Is that wrong too!!??

If I don't have an IMED available, I'll use a gravity line, set the drip rate to 100ml/hr and still check rate and site during night.

I don't have IMED's beeping continously, I don't have IVC's tissuing cos I check them, pts get much needed sleep!

Tell me if what I've been doing the last nine years is wrong!! I'm beginning to doubt myself.

Do you have a policy on VTBI at your hosp? Is it more to remind us to check IV sites and rates or as a measure to prevent too rapid infusion, in which case checking hourly is a moot point cos machine will beep when infusion COMPLETE in an hour anyway, damage done!

Sorry if I'm not making sense, night duty delerium!

[BinkieRN, BSN, RN]

Our protocol is Q8 for a KVO rate, Q4 for KVO to 200cc/hr and Q1 for anything over 200cc/hr. None of these include antibiotics. Drips such as Lasix and dopamine are Q1hour. I know for a fact this is not always followed particularly the Q1 hour drips. I always follow protocol because I know the patient can go downhill too quickly for that reason and a host of other reasons.

[iluvivt, BSN, RN]

The use of burette.volutrol or solusets are very popular in the pediatric and ICU settings. The main purpose of these is to prevent inadvertent administration of IV fluids or medications. This is extremely important in the pediatric population. In the ICU setting where fluid and electrolyte balance have to be closely monitored,it basically gives you an added layer of protection and a means to easily flush with multiple meds being given. So,unless you are in a peds ICU I see absolutely nothing wrong with what you are doing. Perhaps their idea (other then to drive you crazy with alarms) is to have you checking the IV every hour. In addition,the IV pumps we have now are far superior than those used years ago. We never even use these anymore unless the pt is in ICU or is a pediatric pt. We hang all kinds of medications and large volume parenterals without them. Most pumps will allow you to set a bolus dose,ramp up and down,multi-step and other so we do not need them as much. Also the Infusion Nurses Society recomendations does not have this as a recommendation,though they do advocate their use in pediatrics if needed to keep total available volume limits acceptable