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Determining between a variable and a decel?

Ob/Gyn   (6,211 Views 18 Comments)

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So I say it's a decel and co-worker says variable. Baseline is 140 and it shoots down to 80 and goes back up. From beginning of decent to baseline is approx 30 second. Sits at 80 for about 5-10 seconds. It DOES have shoulders, but I'm not comfortable with it going so low! (She's on pitocin). What do you say? And how do you tell the difference? Keep in mind I am new and WAY panicky about the babies. However, I've called decels and she's called variables and I've been right (or so the dr has said) so sometimes my caution I feel is warranted.

How do you tell the difference?

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Fyreflie has 4 years experience.

189 Posts; 4,094 Profile Views

A decel and a variable are the same thing. If it's less than 15 seconds long it doesn't count as any kind of decel. If the onset to lowest point takes less than thirty seconds (ie up to 29 seconds) it falls under a variable deceleration as long as it meets the 15 x 15 rule.

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1,029 Posts; 15,812 Profile Views

If the onset to lowest point takes less than thirty seconds (ie up to 29 seconds) it falls under a variable deceleration as long as it meets the 15 x 15 rule.

Why couldn't ONE person give me this definition?????? Thank you!!!!!

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Fyreflie has 4 years experience.

189 Posts; 4,094 Profile Views

Why couldn't ONE person give me this definition?????? Thank you!!!!!

I would hope that you would have gotten that training from your facility before being turned loose to figure it out on your own!! If they haven't put you through a basic FHR monitoring course you'd best find one and take it. Working without knowing standard definitions is dangerous both for your patients and for your license.

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1,029 Posts; 15,812 Profile Views

I would hope that you would have gotten that training from your facility before being turned loose to figure it out on your own!! If they haven't put you through a basic FHR monitoring course you'd best find one and take it. Working without knowing standard definitions is dangerous both for your patients and for your license.

I have had the FHM class, and am still on orientation. However, it seems one of my coworkers never wants to deal with late or prolonged decels and always brushes them off as variables. Even the FHM class didn't give a simple quick definition and then build off that.

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Fyreflie has 4 years experience.

189 Posts; 4,094 Profile Views

I have had the FHM class, and am still on orientation. However, it seems one of my coworkers never wants to deal with late or prolonged decels and always brushes them off as variables. Even the FHM class didn't give a simple quick definition and then build off that.

I would just revisit your definitions, know them by heart and stick to your guns then. AWHONN has a good document on classification. I'm baffled that a basic FHR course wouldn't teach those definitions!

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1,029 Posts; 15,812 Profile Views

I would just revisit your definitions, know them by heart and stick to your guns then. AWHONN has a good document on classification. I'm baffled that a basic FHR course wouldn't teach those definitions!

It is entirely possible that she DID just not in so simple to break down methods. They were described as carrot sticks, and what I saw wasn't a carrot stick but a giant carrot stick!!! An then down the road an hour later guess what popped up? Lates. And of course I was teased about the "variables" that were on the board. Um. No. Now they are lates. And nothing was done.

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klone has 13 years experience as a MSN, RN and specializes in Women's Health/OB Leadership.

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A variable is a type of decel. There are early decels, variable decels and late decels. What defines it as a variable decel is that it drops and raises quickly (that's not the textbook definition but that's the gist).

So I guess you're both right. Or both wrong, depending on how you want to look at it. I agree with Fyreflie, I'm surprised this wasn't taught to you and your coworkers. This is basic stuff.

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1,029 Posts; 15,812 Profile Views

A variable is a type of decel. There are early decels, variable decels and late decels. What defines it as a variable decel is that it drops and raises quickly (that's not the textbook definition but that's the gist).

So I guess you're both right. Or both wrong, depending on how you want to look at it. I agree with Fyreflie, I'm surprised this wasn't taught to you and your coworkers. This is basic stuff.

That's how it was defined, but "quickly" didn't come with a time frame. Whenever I call late decels or don't feel comfortable about the nature of a decel one coworker will usually say yes, the doctor agrees and we deal with it. Three others will tease me about it, and it may or may not turn into something else. I think my big deal with this one was that it was deep and depth was never mentioned, and I've only ever seen deep decels when pushing with the patients and the head is coming out. This one though was a deep decel and was no where near coming out, so I spazzed. It's to the pint with some coworkers that I don't even wanna ask what they think about it because I get teased, and in one case I was harassed all day about asking and there was a very negative outcome. The next day another doc pointed to the same decels I was asking about saying "Look, these are subtle decels". So it's all still quite confusing, class or not. I get the feeling that some just see what they want when they look at the strip.

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Fyreflie has 4 years experience.

189 Posts; 4,094 Profile Views

Again--just learn your definitions and go by those when you describe or chart. It's your legal backup and if you are the only person who calls it, and you call your doc to review and keep communicating even though they don't seem as worried, when it comes down to it you'll be the only one who is protected. What your colleagues do is their business, practice, and liability.

If you're not 100% sure of all your deceration definitions, make it your business to learn! In the end you are professionally accountable for your learning and it can only make you a better nurse.

Now if I had an isolated variable deceleration that went from 140 to 80 for 15-30 seconds I probably wouldn't be that fussed. Repetitive decels like that would make me worry. 1 on its own very rarely means anything at all, especially if the rest of your strip is good.

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1,029 Posts; 15,812 Profile Views

Thank you everyone for the replies!!!!!! I really mean it! It's nice to get the facts and explanation without the teasing. Thank you!

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dariah has 3 years experience and specializes in OB/GYN.

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Whether its a late or a variable, it's still a category 2 tracing and if the decels are recurrent they should be managed the same way. It bugs me sometimes when people ignore variables because lates are not always ominous and variables are not always benign.

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