Magnesium Sulfate Policy in your hospital

Mrs.S · Feb 22, 2006

we do vitals including SpO2, reflexes, auscultate lung sounds, & I/O q2h, and continuous EFM. usually Mag level after 12h and prn if symptomatic

Mississippi_RN · Feb 22, 2006

When we start mag for PIH or PTL, the patient will usually get a 4 gm loading bolus.. then, usually they will be on 2-3 gm/hr maintenance in 1000 cc LR. We monitor 02 sats, temp, reflexes, etc q 4h (or prn). But we monitor EFM continously and urine output every hour. Also... for PIH BP are every 15 minutes (we have to chart them on flow sheet with FHT every 15 minutes).

It is **supposed** to be 1-on-1 nursing care with patients on either Mag or Pit, but they sometimes (ok...a lot of time) doesn't happen. We also do mag levels every 6 hours and you really have to stay on lab to make sure it is drawn on time (or even within 2 hours). Have to make sure it stays between 7-9 ( i think right off top of my head )

camay1221_RN · Feb 22, 2006

When we start mag for PIH or PTL, the patient will usually get a 4 gm loading bolus.. then, usually they will be on 2-3 gm/hr maintenance in 1000 cc LR. We monitor 02 sats, temp, reflexes, etc q 4h (or prn). But we monitor EFM continously and urine output every hour. Also... for PIH BP are every 15 minutes (we have to chart them on flow sheet with FHT every 15 minutes).
It is **supposed** to be 1-on-1 nursing care with patients on either Mag or Pit, but they sometimes (ok...a lot of time) doesn't happen. We also do mag levels every 6 hours and you really have to stay on lab to make sure it is drawn on time (or even within 2 hours). Have to make sure it stays between 7-9 ( i think right off top of my head )

Our policy is very similar to yours.

We do our own blood draws, so we don't have to depend on lab getting them done in a timely manner.

RaeT,RN · Feb 22, 2006

Our Mag load is usually 4gm, but I have also seen 6gm loads given; it's really at the discretion of the MD. That is usually followed by 2 or 3 gm an hour; I've also seen 4gm/hr in extreme cases.

During the load, P/R/BP's are taken every 15 min; then hourly checks are started for u/o, reflexes, P/R/BP, breath sounds. Mag levels are drawn for s/s of Mag toxicity (absent reflexes, change in LOC, decreased u/o.) Depending on how sick the pt is and how they're tolerating the Mag, some physicians will change to q 2 hr monitoring of bp's, etc. If they're still with us, they're usually on continuous EFM. Antepartum they may be monitored q shift or whatever the MD wants.

LuvofNursing, BSN, MSN, RN · Aug 9, 2010

I was glad to find this thread, because there has been some discussion as to what is considered standard of care for Magnesium patients.

I work in a mother/baby unit, and our mag patients are considered the same as all other patients, so they are 1:8 ratio. We do VS (including BP, RR and O2), Urine output, dip for protein, lung sounds, DTRs and level of sedation every hour, which can be quite time consuming. Once they come to us, they are generally at 2gm/hour for at least 24 hours post delivery. Mag levels are generally every 6 hours.

For those of you who do BP every 15 minutes, are you in L&D? It seems as though there is so many differences between policies. Does anyone know if there is an AWHONN or ACOG policy?

thanks

SmilingBluEyes · Aug 9, 2010

Our Mag load is usually 4gm, but I have also seen 6gm loads given; it's really at the discretion of the MD. That is usually followed by 2 or 3 gm an hour; I've also seen 4gm/hr in extreme cases.
During the load, P/R/BP's are taken every 15 min; then hourly checks are started for u/o, reflexes, P/R/BP, breath sounds. Mag levels are drawn for s/s of Mag toxicity (absent reflexes, change in LOC, decreased u/o.) Depending on how sick the pt is and how they're tolerating the Mag, some physicians will change to q 2 hr monitoring of bp's, etc. If they're still with us, they're usually on continuous EFM. Antepartum they may be monitored q shift or whatever the MD wants.

This sounds about like our policy.

SmilingBluEyes · Aug 9, 2010

Yes, the q 15 minute monitoring is generally the requirement for mag bolusing or loading doses and in L/D. After that, q 2 hours is what the policy has been in all 4 hospitals at which I have worked.

L&DRN03 · Aug 10, 2010

We usually do 4gm loading doses for PIH and 6gm for PTL then going to a maintenance does of 2gm/hr. Vital signs including pulse ox Q1hr and mag/neuro checks Q4hr. Mag level drawn Q6hrs until mg d/c'd. While the pt is still pregnant continous EFM so they do not leave L&D. If they are PP they either go to AP or PP with a 1:2 or 1:3pt ratio with the other pts being low acuity. Oh and forgot hourly I&O's too.

ragingmomster, BSN, MSN, RN · Aug 11, 2010

Hi, everyone!
I've only been working in L&D for about 6 months, have been an RN for about 1 1/2 years. I've been recruited as a member of our unit's clinical research & policies committee. We meet next week and the policy we're reviewing/updating is the use of magnesium sulfate for ptl and pih. I found a couple of old threads regarding this issue, they're several years old. Was just wondering what the general consensus was regarding assessment protocol, ie monitoring blood pressures, checking for reflexes, etc. Any input would be much appreciated!
Stephanie:)

We no longer use Magnesium Sulfate for pre-term labor.

PIH and Pre-e goes as follows

4 g load over 20-30 minutes with VS q 5 minutes during load.

Then 2g/hour with VS q 15 x 2 then hourly VS, I/O and neuro checks (LOC, clonus, DTR's).

Mag levels only for symptoms.

Mag continues through delivery and 12-48 hours post delivery, continues until diuresis is well established.