Cervidil--Talk to me!

  1. We do cervidils here(antepartum) very often. Too often, but that's besides the point.

    Our protocol is a reactive 20min strip within two hours prior to placement. IV placement, T&S/CBC sent, and they're supposed to sono for presentation (though CNMs just do leopolds). Bishops score no higher than 8.

    Then once the cervidil is placed, CONTINUOUS FETAL MONITORING/TOCO, Q HOUR VITALS (except temp, which is q4), labor progress sheet filled out (even if no ctx). NPOx2hours after placement, sometimes clear liquids after mn. (CNMs allow clears all the time, sometimes light snacks) All until 30 min after cervidil is pulled--pt remains in house the whole time. This seems excessive to me (especially having the BP cuff go off every hour while the Pt is trying to get some very important rest).

    What is your policy like?
    •  
  2. 9 Comments

  3. by   kirsnikity
    At my facility: 20 minute reactive strip; known vertex presentation (with either vag exam or sono); bedrest and continuous efm for two hours after insertion, then ambulation ad lib depending on the Dr. IV once active labor begins. VS q hour, which I also think is excessive since most of these inductions are started at midnight. I think we do too many cervidil inductions also, especially with primips....who seem to end up with c/s 75% of the time after cervidil induction.
  4. by   babyktchr
    Ok....you MUST continuously monitor patients with cerividil. MUST. This is a time release prostiglandin and is considered INDUCTION, even though it is cerivical ripening. There is no defense for you if you do not continuosly monitor. Yes it seems excessive, but you have medication that can cause hyperstim and subsequently may cause some fetal issues. Be very careful if you policy does not include this. There are a handful of obscene multi-million dollar lawsuits involving cervidil and no monitoring.

    We have a similar policy, but no q1 hour VS (why?). There is no evidence based practice for such frequent VS when using cerividil or pitocin. Its just more work. We do chart, but q30mins, unless there is something going on...labor starts, hyperstim or some other variant. We do allow clear liquids and I take that cervidil out and let them get up and shower, and I advise a nice walk, because they will be lashed to the bed for the rest of the day.

    Cervidil is one of those things that if it isn't placed correctly, it does nothing. Too many time the doc comes in and just pushes it up there, and you know it is no where NEAR that posterior fornix. It is a waste of time and money if you ask me. I rather like the foley bulb...patients can ambulate and not be monitored as much, and actually get rest the night before the pitocin.
  5. by   htrn
    We've had enough incidents with cervidil that our policy requires NS lock prior to insertion. BR for 2 hours after insertion. Policy says intermitent monitoring, but we've had enuf trouble that many of us insist on continuous monitoring throughout the night. I do VS at beginning of shift then when they get up to void sometime closer to morning.

    We remove cervidil if fetal distress, SROM (if the doctor actually believes you when you call her and tell her the pt had SROM :angryfire ) or active labor begins.
  6. by   PattonD
    This is quite an interesting thread! Can you help me out with some of the acronyms.....like what is SCROM, BR, VS, NS lock.....??
  7. by   SmilingBluEyes
    SROM is spontaneous rupture of membranes
    BR is bathroom
    VS means vital signs
    NS means normal saline
    Lock refers to a saline lock, which is established IV access (with no fluids running at the time)

    We don't use cervidil either place I work, so I am sorry, I can't help the OP. Good answers here I see. Good luck.
  8. by   nrse4evr
    First of all Cervidil MUST be refridgerated until right before placement. We obtain baseline nst, confirm vertex presentation, either cx check, leopolds, or sono. Then after cervidil placement NPO x 2 hrs then may eat until MN. Most of our cervidils come in at 5pm or 7-8 pm. We place the cervidil, monitor x 2 hrs, feed them, then NPO after Mn with continuous EFM VS not q1h but at least q4 or more often if something is going on. We find that alot of our Pts deliver on the night shift 7P-7A. It is a good induction tool if the pt is a good candidate. As are most induction tools.
    Some Dr will let their pt be off the monitor 2 hr post cervidil, but untimately it's up to the L and D nurse who is caring for that pt
    Hope this helps.
  9. by   KellNY
    Quote from SmilingBluEyes
    BR is bathroom
    .
    ooh, for me, when I say/write BR I mean Bed Rest. (BRP would be bathroom privs)
  10. by   SmilingBluEyes
    I guess this is why JCAHO and many others are getting excited about abbreviations. One acronym has several meanings, oftentimes.
  11. by   LDRNMOMMY
    Our policy doesn't really differ from what others already stated. We do have a few docs who will order intermittent monitoring with cervidil, most don't though. However, more often than not it ends up being continuous monitoring.
    Last edit by LDRNMOMMY on Feb 5, '07

close