Labor guidelines and policies

fourbirds4me · Sep 28, 2003

1.) rn's placing iupc's? --- we do not

2.) rn's placing fetal scalp electrodes? -- we do... usually dr does it we do it if we need to be assured of fht's

3.) how often you document fht's during active labor; every 5 or every 15 minutes? we document q30min unless the patient is on pit in active labor

4.) how often you are required to do bp's on pt's with epidurals that are stable, after placement? after stable q30... although if there has been a problem i do it more frequently

5.) protocols for a newborn's intital blood glucose of 25? not real sure about this one since i'm not in the nursery but i believe low bs requires blood glucose and cbc. 1oz of formula and q 30min accucheks

SmilingBluEyes · Sep 28, 2003

Originally posted by DeniseLDRN
I was wondering what your facilities policy is on:

1.) RN's placing IUPC's?

We RN's do place these after documented competence by a preceptor.

2.) RN's placing Fetal Scalp electrodes?

We do this also, after documented competence.

3.) How often you document FHT's during active labor; every 5 or every 15 minutes?

This is a complicated question really, as variables exist that can change things. In active labor --low-risk--- every 30 minutes, high risk every 15 minutes. For anesthesia initiation, every 3x5, every 5x5, every 15 while drip is still on....other "risk" situations warranting more frequent vital signs may include pit and mag drips running and maternal conditions warranting frequent vital signs.

4.) How often you are required to do BP's on pt's with Epidurals that are stable, after placement?

As above, once stable and in place, after initial "recovery" VS, every 15 minutes as long as epidural is running. FHM is constant.

5.) Protocols for a newborn's intital blood glucose of 25?

If we get initial glucose on our machines less than 40mg/dl, we have to repeat. If still below 40, we draw and RUSH TO LAB for STAT CONFIRMATION....then we have a glucose protocol. -----usually early feeding or IV, if unable to feed for some reason. If glucose as low as your 25---well, that kid has BOUGHT an IV, period, and a D-10 bolus, followed by maintenance dosing, based on weight, regardless of feeding capability. All this is done as we are talking to the pediatrician on the phone. It's pretty much automatic.

If anyone knows the standards set forth by ACOG or AWONN for the above, would you please let me know.

I don't KNOW them, but we have referred to them in our protocols at work. Are you an AWHONN member? You can visit their site: http://www.awhonn.org

GOOD LUCK!

Thanks--

(your are welcome)

Deniseldrn

:kiss

acuteobrn · Sep 28, 2003

1.) rn's placing iupc's? we do not, but i do know that there are some facilities that will supply the training and credentialling, i think in ca.

2.) rn's placing fetal scalp electrodes? we do in the event of an emergency, often times, though the house ob will do it as they are there for 24 hour coverage.

3.) how often you document fht's during active labor; every 5 or every 15 minutes?

early low risk we chart q 30. active, on pitocin or high risk we chart q 15. i used to work somewhere where they would chart q 5 for 2nd stage.

4.) how often you are required to do bp's on pt's with epidurals that are stable, after placement? obtain and chart bps q 2 after bolus, q 5 after continuous set up until stable then q 15.

5.) protocols for a newborn's intital blood glucose of 25? we don't do routine accuchecks on all infants. we do them on any symptomatic neonate (jittery, cold...), infants of gdm mothers, traumatic delivery, evidence of fetal compramise inutero, and based on weights 8lbs 5 oz. that is based on a neonatology standard/awhonn guidlines. if less then 40 they get serum glucose, cbc and some formula. i don't know exactly what they do under 25 because at that point they brought themselves an obs admit to nicu, i do know that under a certain value, can't remember the exact value they mix 1/2 high cal formula w/ 1/2 glucose water (10% i believe). that would be a good one to post on the nicu site.

i do believe these are acog standards that we follow as we are part of a teaching hospital system. and awhonn, and acog follow basically the same standards. you can check out the awhonn website for where you can find more.

L&D_RN_OH · Sep 28, 2003

Originally posted by DeniseLDRN
I was wondering what your facilities policy is on:

1.) RN's placing IUPC's?
Only those credentialed to do it can. And some of those choose not to.

2.) RN's placing Fetal Scalp electrodes?
We do.

3.) How often you document FHT's during active labor; every 5 or every 15 minutes?
q 30 for 1st stage, q 15 if high risk, and q 5 during 2nd stage.

4.) How often you are required to do BP's on pt's with Epidurals that are stable, after placement?
q 30 min

5.) Protocols for a newborn's intital blood glucose of 25?
I'm not in the NSY, but I believe with it that low, an IV bolus of D10 is given, plus a feed.

at your cervix · Oct 6, 2003

Check with your state board of nursing. Some states allow nurses to place IUPC's and FSE's, others do not. Remember, however, that even if your state allows nurses to place IUPC's and FSE's, you facility may elect to not allow it. A facility can always restrict nursing practice, but cannot expand it.

PegRNBSN · Oct 7, 2003

IUPC placement no

FSE placement Yes after training and certification

FHTs: All is based upon risk status high vs. low ( and that can change during the labor)

Low 30" during 1st stage and 15" during 2nd

High( including Pitocin administration) 15" during 1st stage and 5"during 2nd stage

Epidurals

q 2" for 30" after bolus and q 15" for the rest of labor

FHT charting is based upon AWOHNN standards

Epidurals: we are trying to get our anesthesia department to change. So far we have found no evidenced based recommendations for frequency of BPs ( if anyone knows of any we'd love to hear from you)