Why use Buretrols?

Pediatric Critical Care Columnist · Sep 18, 2006

I'm told we don't use buretrols because any meds would get "lost" in them. Frankly, I don't even know what that's supposed to mean and it sounds like an urban legend. But I'm still on orientation, so it's more than likely that I just don't understand.

The dead space (tubing) in most buretrol sets is so huge that a neonate's volume might take a day and a half just to clear it. The Alaris Signature Gold pump that we use has a dead space of approximately 20 mL, with or without a buretrol attached. Putting a med into a buretrol for a child weighing 3 kg would seriously fluid overload them if run in a manner to allow the med to actually reach the child on the same day it was put in there. We use them for maintenance fluid and TPN, and whenever we add... let's say potassium... to the buretrol, we have to then run about 30 mL of fluid into the garbage to ensure that the K+ will reach the patient in a timely manner. I'd MUCH rather use a syringe pump for all infusions on kids less than 10 kg.

elizabells, BSN, RN · Sep 19, 2006

Ahhhhh, thank you. It was a thing where at first I thought yeah, that make sense, and then so many ppl talk about using them in the NICU that I figured I must be missing something. Seems like syringe pumps, if a unit has enough available, are a much better choice.

kitty29 · Sep 20, 2006

We've recently stopped using them. I hear they've decided, after much research, that the IV pumps we use are safe enough to go without. It makes us a little uncomfortable, but to be honest I've never seen an "accident" where the patient got a huge bolus whether there was a buretrol or not. Our IV pump tubing has a safety mechanism on it - the tubing is clamped as it goes into the machine. That way, when you pull the tubing out of the machine, it is still clamped and nothing gets to the baby unless you take the extra step of unclamping it.
What I wish we would do is eliminate IV pumps with hanging bags completely and run everything on syringe pumps. At least then you can see exactly how much is left in the syringe at all times, plus our "smart pumps" have parameters for things like rates/dosages and if you go outside of the normal limits it alarms to warn you before it'll let you override the system.

We haven't used them for several years as you say in you comments.