IV fluids after C/S, am I wrong???

Specialties Ob/Gyn

Published

I am new to the hospital I am working at and they seem to run IV fluids for 24 hrs regardless how the pt is tolerating fluids. When I get a fresh C/S, the pt is on slow pit and IV fluids. If the pt is tolerating fluids well, not nauseated or throwing up, great bowel sounds, doing exceptionally well, I cut off the fluids about mid-day and continue with liquids to full liquids...etc. When I give report to the night nurse, they seem absolutely appalled. I explain to them that they are taking fluids PO and tolerating very well ...give them the whole above scenario but I can tell they are not happy or don't agree with what I did.

Finally I asked one day shift nurse and she said that it is anasthesia's order to continue IV fluids for 24 hours. We look at the orders and I point out the part that says "discontinue IV if tolerating PO". She then points to another section that says, "keep IV access for 24 hrs" and says, "see that means keep fluids for 24 hrs." I do not agree with her translation of that order.

What is the rational for keeping fluids going for 24 hrs if they are drinking fluids fine and output if fine...perfect scenerio basically.

The entire unit practices like this so it makes me second guess what I am doing. 20 nurses vs 1. :(

Advice/opinions please! Thanks!

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Specializes in ICU, Med-Surg, Float.

I would interpret "keep IV access for 24 hrs" as "make sure the cannula is patent for 24 hours" as a just in case there's a PPH or something. That just means 4-6 hrly flushes. As long as their BP is stable and they are tolerating fluids then you are the one following the order correctly. Discontinue IV if tolerating PO is a clear order - and you are doing just that.

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Yes, I did interpret the IV access as "keep the IV in and patent!" not "keep the fluids running"! I'm curious if other postpartum floors are running IV fluids as long as these nurses are. The night shift nurses give me such appalled looks when I tell them I saline locked them. It makes me feel like I'm doing something wrong!

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Specializes in Emergency Department.

I'm not an OB/Gyn nurse and if I read "Discontinue IV if tolerating PO" along with "maintain IV access for 24 hours" I would interpret that to mean the very same thing you did. The way I interpret that order is to discontinue IV fluids if the patient is tolerating PO fluids and maintain patent IV access (flushing q6-q8 hours) via saline lock. If you have a question about this, why not find, and ask, the Anesthesiologist or the attending OB if the way you interpret the order is the way they actually want things done.

Just be a bit careful as you're starting to swim against unit culture and practice on this, as you probably know.

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I actually did. My nurse friend (different hospital), her husband is the anesthesiologist at my hospital. I asked her the same question and she ran it by her husband. And they both agreed with me. I guess I needed more validation. LOL :)

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Specializes in Reproductive & Public Health.

There's no benefit to keep fluid going that long when mom is hydrating PO, and definitely potential for harm. What is their rationale for keeping fluids running (besides just pointing to an order, I mean)?

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This is more than a misinterpretation of the orders, this is an ingrained unit culture. While I agree with all of the previous posters, are you sure that this is the hill you want to charge?

If it were me, I would continue what you are doing and discontinue fluids on your patients when they are tolerating PO fluids.

Best wishes in whichever you choose.

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I know c/s patients at my hospital head over to PP with NS and pit running. However, I know most of our PP nurses take the NS down when the patient has shown that they are tolerating PO fluids/solids (usually about an hour or so after). We do maintain IV access for a certain number of hours after delivery, but it is saline locked and removed as fast as safely possible, as per our protocol.

Pitocin, both intrapartum and postpartum, can cause water retention that can lead to swelling and breast engorgement and may interfere with mom's function and breastfeeding in the postpartum stage. Personally, I'd have no problem stopping the NS and maintaining a saline lock as long as mom is tolerating PO.

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Specializes in OB.

I think you're thinking critically and practicing completely sensibly. Unfortunately, a lot of nurses in some institutions are really stuck in their "because that's the way we've always done it" ways.

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All posters are so correct.....it is just be the ingrained culture and "is this the hill you want to charge."

I completely agree with what you are doing and I would probably start out by trying to do the same. Sometimes you just have to "detach" yourself...(that is my new favorite word when I feel myself getting annoyed or eye rolling over something really that isn't worth getting annoyed over).

You could ask twenty OB's, postpartum RN's, anesthesiologist, etc., their opinion and get 30 answers!

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Why don't you ask the provider who wrote the orders?

:blink:

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Specializes in Reproductive & Public Health.
Why don't you ask the provider who wrote the orders?

:blink:

The order is written to d/c fluid when PO is tolerated- the unit nurses are just interpreting the order to maintain access for 24 hours as an order to keep fluid running the whole time.

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