[USA987]

Our guidelines were recently updated stating amnioinfusions must be on a pump. Just curious as to what everyone else is doing????

[sirI]

Originally Posted by USA987

Our guidelines were recently updated stating amnioinfusions must be on a pump. Just curious as to what everyone else is doing????

Yes, always infuse by volume controlled infusion pump.

[sbic56]

Originally Posted by USA987

Our guidelines were recently updated stating amnioinfusions must be on a pump. Just curious as to what everyone else is doing????

As Siri said. Rationale is to infuse at a controlled rate to avoid cord prolapse and causing trauma to an existing scar from previous surgery.

[SmilingBluEyes]

Actually, yes, you DO use a pump to control the rate, like the others said. And you do I/O's on the amount infused and its return----noting how saturated and how many chux you use.

Heating the solution is no longer recommended, except in cases of very premature cases, however. This is a relatively new recommendation.

[JaneyW]

I'm glad this came up. I just changed jobs from a community hospital to a large high risk teaching facility. At the community hospital we had to use a pump. At the teaching hospital their P&P says NO pump with the rationale being that you don't want to force fluids into the uterus at any time. Makes sense.

The first time I did one at the new place, they were in a hurry so I didn't consult the P&P first and just did it as my old place had with a 600cc bolus per pump. My charge nurse came in and took it off the pump and told me NO NO! It was interesting because the travelers and registry people around had only done it per pump as well.

Both rationales make sense (closely control rate and don't force fluids). Anyone else a no pump place?

[RNLaborNurse4U]

Our policy is very open to the MD orders. Pump vs gravity. Warmed or room temp. LR or NSS. Rates vary too.

I heat all fluids (unless MD insists on room temp) for amnioinfusions now, due to a poor mom/baby outcome from a room temp amnioinfusion where mom's temp was 33.8 in the OR, and baby was 33.7 on delivery after c/s. (C/S was called for non reassuring FHT's/lates, about 30 minutes after start of amnioinfusion - given for thick mec)

Yes, I rechecked temps multiple times on the baby. But she was COLD coming out of the uterus too. Needless to say, a NICU admit for resp distress too.

Jen

[rpbear]

We run the bolus to gravity then put it on a pump, we record fluid return hourly. We don't warm fluids, never knew about that. I can see how it would help in a bolus, but the fluid is going to become room temp within an hour or so anyway, unless you guys are talking about running it on a warmer set up, like a blood warmer.

[sirI]

Originally Posted by rpbear

We run the bolus to gravity then put it on a pump, we record fluid return hourly. We don't warm fluids, never knew about that. I can see how it would help in a bolus, but the fluid is going to become room temp within an hour or so anyway, unless you guys are talking about running it on a warmer set up, like a blood warmer.

Yes, you use a standard blood warming unit. The solution should be warmed for preterm gestations prior to and during infusion. The fluid can be at room temperature for term gestations. The fluid must remain at room temperature for storage (and never in the baby blanket warmer).

Now, there was discussion regarding the use of a infusion controller. The initial bolus is, of course, not on a pump, but, the infusion is normally on a pump. I have not seen amnioinfusion without this device.

But, there is literature survey that states infusion pumps and warmers do not prove beneficial. So, it is up to the OB provider.

[SmilingBluEyes]

The current literature indicates warming fluids for term fetuses is not beneficial.

[sirI]

Originally Posted by SmilingBluEyes

The current literature indicates warming fluids for term fetuses is not beneficial.

Exactly correct. Thus, should be at room temp. Has shown to produce tachy arrythmias in the term infant.