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.
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.
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.