OB Nurses....Question For Ya

BETSRN · Feb 26, 2005, 07:46 AM

Originally Posted by SmilingBluEyes

Phenergan....a drug used here for nausea and in some cases, as an adjunct for pain control. I dont like it much, it snows people usually (think super-benedryl) and it is VERY painful to inject, whether IV or IM due to it's extremely LOW pH. I much prefer Zofran or Anzemet for nausea and we don't use it for pain control at all where I work.

We use Phenergan in conjunction with Stadol pretty regularly. If you go slow IV push (from a higher up port) there is NO complaint about vein burning or irritation. As far as the comment about snowing people....it is SUPPOSED to snow them for a nap. That's the whole point and if they are at all nauseous, it takes care of that as well.
We never use Zofran in labor: only post-op. Isn't it funny how things are so different everywhere?

*SmilingBluEyes* · Feb 26, 2005, 08:04 AM

Yep it is different everywhere. Great opportunity to learn here, isn't there? And you are right about Zofran, as a rule we don't use it in labor, either. But I do hate the side effects of phenergan. I really think it's a bad drug, from what I have seen it do to people.

ldnurse7581 · Feb 26, 2005, 09:34 AM

where i work, anyone w/epidural has a foley. we deflate the balloon prior to pushing and if the pt is still really numb after delivery, we reinsert a foley. we have one doctor who wants it kept inflated during pushing and one doctor who doesnt want it reinserted post delivery even if the pt is still really numb. as far as getting up to the br, the nurses usually wait 4 hrs from the time the pt gets to pp floor (usually 5 hrs post delivery total) to get them up to the br and if they do ok getting up to the br (no sx syncope, no fever,etc) then they d/c their iv. pp floor protocol is d5lr 1000cc w/ 20 units of pitocin at 125cc/hr x 4hrs after delivery. it really is amazing of the vast differences in each hospital!!

BETSRN · Feb 26, 2005, 10:15 AM

Originally Posted by ldnurse7581

where i work, anyone w/epidural has a foley. we deflate the balloon prior to pushing and if the pt is still really numb after delivery, we reinsert a foley. we have one doctor who wants it kept inflated during pushing and one doctor who doesnt want it reinserted post delivery even if the pt is still really numb. as far as getting up to the br, the nurses usually wait 4 hrs from the time the pt gets to pp floor (usually 5 hrs post delivery total) to get them up to the br and if they do ok getting up to the br (no sx syncope, no fever,etc) then they d/c their iv. pp floor protocol is d5lr 1000cc w/ 20 units of pitocin at 125cc/hr x 4hrs after delivery. it really is amazing of the vast differences in each hospital!!

Our heaviness of epidurals varies (of course) from doc to doc and from patient to patient. Most of our patients are more than able to get up and out of bed in the hour to hour and a half after delivery. By that time, we get rid of most of the IV's as well.

It would seem to me that you guys would all have less work (especially in PP) if you got people up and d/c'd the IV's sooner. I often d/c my IV even if the patient cannot void: if she has a good firm uterus. If you're uncomfortable with that idea, d/c the IV and convert her to a hep lock until she voids. Most don't need all that extra fluid anyway. It just leads to more breast engorgement as well. Some Motrin (600-800 mg. is best), some food, and a couple of extra hours relaxing usually helps with the voiding issue and by then, the legs usually work fine.

Maybe we are really laid back at my place but it seems to work because we rarely have any kind of a PP hemorrhage.

BETSRN · Feb 26, 2005, 10:17 AM

Originally Posted by ldnurse7581

where i work, anyone w/epidural has a foley. we deflate the balloon prior to pushing and if the pt is still really numb after delivery, we reinsert a foley. we have one doctor who wants it kept inflated during pushing and one doctor who doesnt want it reinserted post delivery even if the pt is still really numb. as far as getting up to the br, the nurses usually wait 4 hrs from the time the pt gets to pp floor (usually 5 hrs post delivery total) to get them up to the br and if they do ok getting up to the br (no sx syncope, no fever,etc) then they d/c their iv. pp floor protocol is d5lr 1000cc w/ 20 units of pitocin at 125cc/hr x 4hrs after delivery. it really is amazing of the vast differences in each hospital!!

Another thing we differ on is that we have one group (our all woman group) who doesn't even put any pit in post-op IV's after a c/section either. It's not always necessary. We always have the option of adding pitocin to an IV if we think it is necessary.

Of course, not all of our patients even have IV's, nor do all of them need pit.

passionate · Jul 22, 2007, 02:47 PM

Re: OB Nurses....Question For Ya

At the time of a section and we see red of any color in the foley bag we assume we have nicked the bladder and rectify that. During labor blood vessels in the bladder can break and there you have it, blood.

passionate · Jul 22, 2007, 02:49 PM

Re: OB Nurses....Question For Ya

Zofran is great but if you use it once and no relief doesn't do any good to remedicate. I hate the phenergan side effects too. Fluid is still one of the best anitemetics around.!!!!!!!

mitchsmom · Jul 22, 2007, 04:47 PM

Re: OB Nurses....Question For Ya

I don't remember ever seeing frank blood w/ a foley, but I've only been doing this for a year so it's probably just a matter of time.

With our current epidural infusion mix (naropin & fentanyl) I find that about maybe 1/2 of my pts need a foley & 1/2 can still pee on their own.
Usually if I have to cath, I just go ahead & do a foley b/c we tend to give a lot of fluids and pts therefore have to pee a lot. Our MD's break water ASAP -> resulting in more pain and more urgency for delivery -> so more Pit -> and so more epidurals early on, ... combined with a primip + a lot of fluids that would be a lot of straight cathing in some cases.

Foley comes out for pushing but SBE's routine of deflating it & keeping in place sounds good to me.
If it's the end of labor or maybe a quick moving labor, I'll just straight cath. It depends on the individual case.

*SmilingBluEyes* · Jul 23, 2007, 08:15 AM

Re: OB Nurses....Question For Ya

In very short labors, a foley surely is not necessary. Also, in many cases, the mom will void at delivery, solving the problem of a full bladder. Unfortunately, when I was not paying close attention, I got caught with my proverbial pants down.....

had a natural labor pt the other day who had voided in labor, but not at delivery. She had a PP tubal ligation about 1 1/2 hours after her birth. Well, when I moved her to the OR table, I noted a lot of blood. Massaged a very boggy and displaced-to-the-right fundus for several clots and lots of blood. And there I was, DUH----I had forgotten the cardinal rule: CHECK BLADDER STATUS. Cathed her after her spinal, for over 550ml of urine. Shame on me......

Funny how things have a way of reminding me, I sure do not know everything and I had better pay attention to the little, yet obvious ones.

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OB Nurses....Question For Ya

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