IV policy

michforoffice · Sep 19, 2008

What kind of medication would you give to a multipara who was administered Demerol and shortly after begins to hemorrhage and is about to have a stat c-section? I'm in nursing school and trying to get some feedback. Thanks for any help!

HappyNurse2005, RN · Sep 22, 2008

We do require 18 gauges. Techincally, i think the orders say LR at 150ml/hr for labor, but, i've routinely told people they can have only a heplock, esp if they are going natural.

Tolle_lege · Sep 22, 2008

The hospital I delivered at (St. Elizabeth's) has a waterbirth tub and you cannot have even a saline lock or any pain drugs if doing a waterbirth, at least that is my understanding. Incidently they gave me cytotec po after my birth I assume for bleeding? (I'm just a nursing student :) Their sister hospital 30 miles north insists on an iv access standard when you walk through the door. I am not sure why the difference in policy, they are both CHW hospitals, but I know I picked the one I delivered at because there was a more natural approach.

asher315 · Sep 22, 2008

I attended a delivery just a few weeks ago where the pt had doula and wanted to go as natural as possible. She was GBS positive and had an IV for antibiotics. During labor her IV came out and as she was close to delivery the OB said leave the IV out but only if she agreed to pitocin Im following placental delivery. She agreed and everything was cool. The delivery went great, she did great but after the placenta delivered, you guessed it, she began to hemorrhage. The patient's mother was present and was a nurse, when she saw the bleeding, she asked the OB if the pt needed an IV. The OB said yes if she'd let us. The pt's mom said, she'll let you and the charge nurse got one in the ac. While all this was going on, there is fundal massaging, IM methergine and lady partsl Cytotec. All's well that's ends well and it was a great labor and delivery (natural as opposed to numbed and up in stirrups, draped, etc). Alot of interventions we do in L&D are just for our convenience but I think IV access (saline lock or running IVF) is always a good idea.

HappyNurse2005, RN · Sep 23, 2008

I attended a delivery just a few weeks ago where the pt had doula and wanted to go as natural as possible. She was GBS positive and had an IV for antibiotics. During labor her IV came out and as she was close to delivery the OB said leave the IV out but only if she agreed to pitocin Im following placental delivery. She agreed and everything was cool. The delivery went great, she did great but after the placenta delivered, you guessed it, she began to hemorrhage. The patient's mother was present and was a nurse, when she saw the bleeding, she asked the OB if the pt needed an IV. The OB said yes if she'd let us. The pt's mom said, she'll let you and the charge nurse got one in the ac. While all this was going on, there is fundal massaging, IM methergine and lady partsl Cytotec. All's well that's ends well and it was a great labor and delivery (natural as opposed to numbed and up in stirrups, draped, etc). Alot of interventions we do in L&D are just for our convenience but I think IV access (saline lock or running IVF) is always a good idea.

The patients MOTHER gave consent for her? Was the patient not married? Unconscious?

elanddeenrs · Sep 23, 2008

Our CNM pts who want to go all natural can refuse if they want, but most our pts get epidurals, so it's kind of a given.

OzMW · Sep 26, 2008

Does everyone get an IV where you work? I remember from nursing school my OB instructor saying "Always make sure you have a patent IV" Is this pretty standard or is for only mom's being induced/with epidurals/on mag/needing abx?
Thanks!

Nope. I'm in Australia and only high women get them, a cannula that is. There is no evidence to support cannulating a birthing woman just because shes birthing/labouring! And we don't have women dropping dead from PPHs etc. You just put one in when needed! Never had an issue with that way of doing things! We don't starve our low risk women either. :redpinkhe

OzMW · Sep 26, 2008

All it takes is for a really bad hemorrhage to wake me up. And I have seen a couple. Had to start a second line on one, and it was hard as hell. I would rather not have to gain IV access under such dire (if rare) conditions and/or situations. No thanks. Saline lock works for me. And almost all the patients have no issue with this, either.

I've seen nasty PPHs too - although more commonly in women who have had lots of intervention and thus more likely to have an IVC. Still have had no problem getting iv access - one just needs to be on ones toes and act before the woman has a BP in her boots.