IV fluids during labor

I think it varies by hospital culture. I try to keep my fluid on the pump OR be very careful how fast I am running it by gravity. Sometimes if I have to open it up in a hurry one of our more senior staff will roll their eyes at me but really, it takes maybe 5 seconds to yank the tubing out of the pump and open the clamp. And I have seen women come back in for diuretics after developing congestive heart failure related to fluid in labour--it's not just bad practice not to keep your fluids tightly controlled, it can also be life threatening. There was a case in the paper recently about a booked c/s who had a little too much fluid on the table (low BP after spinal etc) who came back to ER after discharge from hospital and coded, then died in ICU--underlying heart issues never diagnosed, but fluid was the kicker. We assume these women are completely healthy and can handle it but that's not always true.

There is research coming out to say that large volumes of fluid also go to baby, skew their birthweight (making them at risk for more intervention) and interfere with Breastfeeding (edema in the breast makes it difficult to latch). Next time someone bugs you about it, tell them you're practicing in an evidence based manner and protecting your license.

we dont routinely give women fluid in labor unless they are a pit induction or plan on getting an epidural at some point. We dont even require IV access (saline lock) unless they are GBS pos. If we have to establish access in labor, then we do that at that point in time.

The only time we use OR tubing is when we have to go back. So if she has pump tubing, we switch it out then.

We always give fluids. It depends on who is working if they have a pump (125/hr) or its open slightly to gravity.

Hello All,

I am new here and was hoping to get a general consensus as to your practices wherever you may be :) This may sound like a crazy question but could you tell me if your hospital uses the pump for all IV fluids during labor...including the mainline IV of LR?

My hospital uses OR tubing (even for vag deliveries) and I have found it to be extremely easy to not only lose track of I&Os but also to give extra fluids..(IV starts..open wide, late decels...open wide....epidural bolus...open wide) Anyway, I just joined the practice council and wanted to help....Personally I want it all to be on pump and I believe we stepped out of this practice due to grief given by certain anesthesiologists (though we do use 18 gauge)....

Any info given is appreciated!!!

thanks :)

We hang all mainline fluids on a straight set. I do NOT want my LR on a pump. If there is a decel or if mom is hypotensive I don't want to rely on the pump, I want to be able to turn it wide open and let it run. I know you can set a pump on a really high rate, but I don't like that either, because then if it infiltrates you can pump fluid in the tissues. And our pump sets won't run as fast as our pump sets, even when the pump sets are "open."

I'm new (4months into orientation) to L&D. Coming from a short stint in med/surg (everything on a pump) and psych (what are iv's?) I was kind of in shock to see everyone running stuff to gravity. Most people even piggyback abx to the LR and skip the pump (of course pit, mag, etc. always go on a pump).

At this point though, I'm immune to it, and have been doing it the way everyone else does, but I just want to say THANK YOU for bringing this idea of fluid overload to my attention. I hadn't really thought through the consequences (and am embarrassed to say that). I do carefully titrate fluids before an epidural, because I don't want to make moms uncomfortable with needing to get up frequently to urinate. But I admittedly am less careful once that foley is in. (this is not to say that I leave LR running wide open at all times, but I am just less conscientious).

I will add, that my current hospital also uses pump tubing (when a pump is in use) but this was also a shock. My hospital where I did med/surg used smart pumps that did not require pump tubing. That was really nice in retrospect. I hate priming pump tubing.

I work at a very busy hospital in Texas, we put everything on a pump! We have patients who range from vanilla/granola to high risk. As far as being able to bolus we simply put a piggy back and attach it to the port below the pump. This allows us to bolus for epidurals and decels. I love the pump!

At my hospital in Australia we don't routinely put fluids up or have IV access unless its a GBS pos mum or an induction. If an epidural is going to be put in we'll whip a IV in, give a stat bolus of fluids and call the anesthetist. But we encourage mothers to drink during labour and only use pumps for synt (pit in the US), insulin infusions or mag sulph. All other fluids are gravity sets.

We run LR @ 125ml/hr on all low-risk laboring patients unless the patient has specifically requested no IV or IV lock only. IV fluids run on the pump. Luckily our pump tubing is also gravity/OR tubing--there's simply a clamp instead of a special cassette. I generally bolus for an epidural or C/S off the pump and let it run by gravity. After bolus is finished for epidural I use the pump again. Bolus for decels I usually keep the tubing on the pump.

I think it's generally not a good idea to routinely let the IV run on gravity. It's too easy to fluid overload (or occasionally, under hydrate) a patient.

Thank you for your responses! I appreciate the feedback!

Jen

Hello! I've been reading the research that you mentioned - large volumes of IV fluids leading to water weight in newborns and breast edema in the mom. Would it be possible for a mom to drink enough in labor to also experience these overload complications? Or are they happening because the IV fluids go directly to the bloodstream, putting mom/baby at risk of swelling, when the same volume of oral fluids over the same length of time wouldn't have the same effect?