Version Protocols

  1. I'm interested in learning about the protocols and policies in place at various facilities re: versions. Anyone care to share info?

    We are a pretty new facility, and really have a pretty lax policy re: versions. Most of the nurses go above our policy and do what they feel is right during the procedure. I'm used to doing versions on the OR table, with the pt prepped for c/s, and everyone present to do a possible emergent c/s delivery if needed.

    We just had an incident with a recent version, which caused us to go back and read our policy. Although everything was done properly (actually, more appropriately than our policy), we are definitely interested in re-writing the current policy.

    Where do you guys do your versions? Who must be in house, and who must be at the bedside? What type of preparation is necessary? Etc...

    Thanks in advance for your help!
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  2. 6 Comments

  3. by   at your cervix
    We do our versions in our birthing rooms, the OR is just across the hall. Although our policy does not state that anesthesia must be present, I always call them and give them a heads up that we are doing a version. I also make sure that we have everything pulled in the OR, we don't open, just have it ready. Our policy says that we must start and IV so I always draw labs off of the IV start and hold to send to lab if needed. We usually give 0.25 mg sq terbutaline just prior to the procedure. Our policy also states that we must have a reactive NST prior to the procedure and must monitor x 1 hour after. We have 1 MD that will often have epidural placed prior to the procedure. I love that! The pt is much more comfortable, thus resulting in a higher success rate and if something goes wrong, we are ready for c-section and already have anesthesia there. We only do this however, if pt is going to deliver that day-not for versions that we do and send home. I hope this helps.
  4. by   luv l&d
    we do a cap, labs drawn not sent, 30 min strip that is reactive prior and 30 minutes after. no scheduled cases during a version and everyone is up to speed.
  5. by   HazeK
    Originally posted by luv l&d
    we do a cap, labs drawn not sent, 30 min strip that is reactive prior and 30 minutes after. no scheduled cases during a version and everyone is up to speed.
    also, a signed, WELL EXPLAINED, consent for
    " External Cephalic Version and possible Emergency Cesarean Section"
    we require patients to be NPO x 6 hours also...to ward off evil C/S spirits!
    Usually have u/s at b/s for before and after scan (although we do have one Perinatologist with 'Xray' hands who is fabulous at palpating fetal positon...but even he checks FHR w/ US afterwards.)

    Haze
    Las Vegas
  6. by   rdhdnrs
    The problem with doing an epidural for a version is that it can mask symptoms of abruption.
  7. by   mother/babyRN
    Our Or is across the hall too, and we do them in our delivery recovery area or, depending upon the doc, in a birthing room, also across the hall from the OR. I haven't actually seen a policy, but when they come in, we start an IV, and the OR team has to be there along with anesthesia (for standby). Lately, anesthesia puts in an epidural first, which increases the rate of success, at least around our parts...
  8. by   OB4ME
    Originally posted by rdhdnrs
    The problem with doing an epidural for a version is that it can mask symptoms of abruption.
    That's definitely an interesting point. Although...Each of the patients with abruptions that I have seen had pretty severe pain despite epidurals.

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