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Maurine Clark
Maximum IV bag volumes for peds/NICU
We are evaluating our policies around maximum IV bag volumes of 250 mls & 500mls for pediatric/neonatal patients under 10kgs & 20 kgs respectively.  We are also questioning the need for buretrols/solu-sets and/or setting a 1-2 hr VTBI with electronic infusion pumps on these smaller patients.  Feedback on any of these issues would be helpful.
mary ann ferrannini
What are you considering
What are you considering hanging....a liter bag? A 250 ml bag for 10 kg or under and a 500 mg for 10-20 kg. You absolutely should have a pump that prevents free-flow when it is opened in this vulnerable population. If you do not use a solu-set you have no-back up if something should go wrong as in pump malfunction or if someone inputs an incorrect flow rate. The solu-set will at least minimize an error which can be life saving in this population. Are you currently using the solu-set for any intermittent medication administration,as this would be another thing to consider. Also consider the ways in which you administer piggybacks and secondaries and if losing your solu-set would increase your chance of other medication errors. Also consider the standard of care and make sure any changes you make meet that standard.
Angela Lee
Many pediatric facilities

Many pediatric facilities have reduced or eliminated the use of solusets.  We have hung on to ours but are trying to phase them out --at least in most of the hospital.  Certain areas such as OR and our one day surgery unit do not use them already.  We are going to minibags and syringes for med administration.  We have also put a new pump in the hospital so we are having a lot of experimentation with the delivery process while we develop P&P. 

I would not hang liter bags on neonatal or small pediatric patients and definitely you want to set a limit on volume to be infused at one time.  This necessitates frequent patient checks which will allow problems to be caught earlier rather than later.

It's likely that we will continue to use solusets on neonates or in our NICU for now.

Maurine Clark
I have checked the FDA

I have checked the FDA Adverse Event Report for malfunctions of our specific types of electronic infusion pumps over the last 8 years and found no reported incidence of overinfusion.  We record volume infusioned and infusion rates every hour with our site checks.  I discourage the use of VTBI set for each hour to "call" the nurse in the room to check the site & the volume infused.  It is our standard to check the site & rate we should not need a beeping pump to do that and our infusions should not stop every hour while it waits for the nurse to reset the pump & resume the infusion. 

So I'm having a hard time justifying the use of buretrols and maximum bag volumes of 250ml for patients under 10kg etc.  We also use the lock-out option on the back of the pump if tampering  is a risk.   

we have always used infusion
we have always used infusion pumps in our pediatric population and have never had a problem. the NICU uses smaller bags but doesnt use buretrols and the peds and picu hang litre bags. the picu programs a 2 hur limit but not on peds ( we do hourly rounds). i can tell you as a parent if you set the pump to alarm every 2 hours i would be ready to strangle someone its hard enough to get any rest in the hospital (im talking about the patient)
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