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- by guamba Sep 13, '12I wondered what people's opinions were regarding VE's prior to epidural placement. I don't have a standard practice. If I feel like things are moving quickly and a mom is requesting an epidural then I'll check her. However, if she's a primip, ruptured, not at high risk for precipitous delivery, and was in early labor upon her most recent exam a few hours prior, I may not check her. What are people's thoughts? Any unit policies you have in place?
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- Sep 14, '12 by FyreflieIf she can sit still...she can have one!! That's the policy everywhere I've worked. They don't always make it but we try I will usually only check right before if it's a primip who is still early and I want to be sure or if I start having dips and think the head is sitting right there. My last two patients both had late epidurals and had no problems sitting for them--checked both right after and they were ten
I do more checking if we're discussing other pain options (morphine IM vs IV vs Fentanyl or gas)-- to help choose the most effective pain relief.
- Sep 15, '12 by MKPRNI typically VE my patients before and after epidural placement. I probably wouldn't check if my last exam was less than 1-2 hours prior. If my patient is hurting I want to know where they are and how fast they are moving. I check right after just to do a better exam and see if sitting up caused any change. I have had a primip go from 4-10 just while sitting up and getting an epidural.
- Sep 15, '12 by guambaEven if they're ruptured!? I hate chorio so I try to stay away from ve's on ruptured patient as much as possible. I just feel like if you've worked on labor and delivery for a while you get a gut sense about when to check your patients. I told my manager the other day I don't always VE prior to epidurals and she counseled me on how I should always VE prior.......I always VE prior to fentanyl....not an epidural though.......
- Sep 15, '12 by FyreflieQuote from guambaI'm with you, I use my gut. I try to minimize exams with ruptured pts too and in general on pts who don't have an epidural but more than anything on my instincts and paying real attention to what my patient is telling me/body cues.Even if they're ruptured!? I hate chorio so I try to stay away from ve's on ruptured patient as much as possible. I just feel like if you've worked on labor and delivery for a while you get a gut sense about when to check your patients. I told my manager the other day I don't always VE prior to epidurals and she counseled me on how I should always VE prior.......I always VE prior to fentanyl....not an epidural though.......
I recently had a pt, multip, who had an epi at 4 cm and was feeling some pressure during and after but was still only 4-5 when examined, not contracting super regularly but with ruptured membranes. An hour later she was feeling more pressure but not contracting much more. Her OB happened to be around and declined to examine her, stating that she wasn't contracting enough to have changed. When he left the room I asked her if she felt like anything had changed and she said yes--the way she was acting tickled my spidey-senses so I checked her anyway and she was 8, head at spines. We never got around to starting that pitot in and she delivered within an hour. So yeah--I rely in my gut more than anything it's saved my ass a few times!!
- Sep 17, '12 by LLLovelyWe don't have a policy on it, so it depends on the patient. If she is giving me signs that she is progressing quickly, I might do one before only to help the CRNA determine if perhaps an intrathecal would be more appropriate.
We tend to do them after patients are comfortable following epidural administration. Often that is when providers want to AROM someone or place internals.
Like guamba, I don't check ruptured patients unless there is a compelling reason or unless told to do so by the provider. Sometimes, the look on their face is a compelling reason. Gut is important for sure.