[SheaOBRN]

1st time posting a thread so bear with me...

I am in a labor focus group in my unit and am involved in a project concerning the use of bedside sonos by the nurses. We occasionally do this to determine presenting part if we are unsure from the vag exam. I work nights so no doc I know will come in for this and will just want the pit started, we can't do this if we are unsure of what the presenting part is. The other question is using it when we are unable to find heart tones. Personally, if I can't find heart tones, I will not look myself with the ultrasound, I leave that to the doctor...

So the questions are:
What are your opinions on the use of ultrasound by the nurses?
Are there restrictions to what we all have to check, like perform a BPP if we even look for presenting part?
Are we allowed to do this under the nurse practice act?
Is there training or a competency we should set for this?

Any feed back would be appreciated! Thanks!
Shea

[ragingmomster]

Unsure about the nurse practice act, you would have to check with your state BON.

We do not perform bedside sono's, worst case scenario, what would you do if you saw a severe anomaly that had not been picked up earlier?

Leopold's suffices for us, if we were trained to use a sonosite I am sure the private OB's would be asking us to do that before we called them to be sure of presenting part.

[Suebee6]

Just an aside, but our policy states our doc must be in the hospital in order to start pit on a patient anyway...is that not a standard in most hospitals? Just curious...

I was wondering the same thing about US too...they ask us to do them before a section to comfirm breech LOL..but they will come down to do them if we arent comfortable. We have a nurse who used to be a US tech so I always have her or the charge nurse document, or make the doc do it.

[JaneyW]

There is an LVN at my facility that does routine testing including BPPs. I don't consider it a license issue as much as a training issue. I am at a teaching hospital now, so the residents do it, but at my old place it was part of our protocol to confirm presentation by SVE or US prior to placing Cytotec, Cervidil, or starting pit. And no, the doc did not have to be in house before strting pit. They relied on the nurse assessment to order over the phone. I've never been good at Leopolds, but I find it pretty easy to determine a head in even a poor quality US (we had an ancient bedside one!).

[tdr61]

I would definitely check with your BON on this one. If you are one of the nurses who is performing a bedside US for whatever reason, make sure you have a documented competency showing that you have been trained to perform that duty and make sure your policy covers it. Otherwise you're setting yourself up for problems. Personally, while I am capable of doing them and have in the past...I don't any longer and wouldn't do so without attending an OB US certification class. If I can locate the literature from AWHONN about RN's performing bedside US's I'll pass it on.

[mitchsmom]

We don't have to have a doc to start pit (lol, they'd barely ever be able to leave if so!) & we don't do bedside u/s. If someone needs it, an u/s tech comes up from radiology to do it.

[OBNurseryRN2006]

Like the others have said - documentation of special training should be present before RN's should be allowed to do this routinely . IMO anyways. We (RN's) in my unit do not use the sonosite - unless we are messing around with it on ourselves/pregnant coworkers . LOL. And that's probably not really the best idea either! I work in a small facility - approx 20-40 births/month - the docs DO NOT have to be in house for Pit administration and often if we question presenting part we have radiology do a flat plat of abd, our hospital doesn't have 24/7 u/s techs in house either.

[klone]

The only thing we're allowed to use the sono for is to determine appropriate placement of the EFM when we're unable to find FHTs with the EFM or doppler alone.

A couple weeks ago, a mom came in for a scheduled c/s and the OB called and wanted me to do a sono to ascertain the baby was still breech before she would come in to the hospital to do the section. Sorry, no can do.

[SheaOBRN]

thank you so much for the replies, but I work nights, half the time the kid has to be half out for the docs to come to hospital, I just wonder what the attitude would be if we asked to come for an US. these replies have helped though...we are trying to put together training and competency so a few nurses on all shifts are capable. Thanks again!

[SmilingBluEyes]

beeeeeeeeeeeeeeeeeeeeeeeeee careful!

make sure your are within your scope per your State Practice Acts and yes, do have DOCUMENTED and thorough training IF you elect to do this as bedside nurses!