How much is to MUCH

OBNURSEHEATHER · Sep 15, 2002

Well, maybe the units/nurses/docs thoughts were that she may eventually end up wanting an epidural, so we better bolus her anyways....

But yes, I think the patients are over-bolused. It got to be such an issue at my hospital that one of the MFM docs did a mandatory 3 CEU inservice about Pulmonary Edema in the Laboring Woman. Very interesting indeed.

Heather

fergus51 · Sep 15, 2002

Unless a woman is going to get an epidural we keep the IV rate at 125/hr. There is no reason for someone to get over 700/hr IV. I mean do you drink that much? Plus who wants to be changing the bag every hour?!

NurseyNursey · Sep 15, 2002

Ditto Fergus' post at my hospital!

indynurse · Sep 15, 2002

We do not do that routinely at my hospital. Except for bolusing a pt receiving an epidural, we run the fluid at 125 cc/hr.

About 5 years ago we had a nurse on orientation in L&D who gave 7 liters to a patient in a shift (8 hours). A couple of weeks later she gave 7 liters to a pt in about 6 1/2 hours. The second pt already had mild PIH. Thank goodness that neither patient suffered any adverse effects from FVO, but after the second time she did this, that nurse was history.

semstr · Sep 16, 2002

A woman only gets an iv when necessary, it is not routine to put in an iv.

mark_LD_RN · Sep 17, 2002

i think part of the problem here is that most of the nurses here only put pitocin and mag on the pump rest they hang to gravity just adjusting the drip rate. eyeballing the drops per minute. also they find lots of reasons to bolus pt, ie devels,variables etc. and no general size of blous to be given is stated any where.

sleepy247 · Sep 18, 2002

This is sometimes a problem where I work, too. We hang one bag on anesthesia tubing w/ no pump. That bag stays turned off unless pt getting a bolus for a specific reason. (Our pump tubing does not allow you to run fluids fast enough for boluses or emergencies) Then we piggyback a bag which runs on the pump at 125/hr. It is kind of cumbersome to set up, but does help one keep track of fluids easier. What is also a problem is not keeping up w/ output, especially when large amts of fluid are going in. You have family members emptying bedpans, for example, and any number of reasons why output is not measured and no one notices until there is a problem.

OB4ME · Sep 20, 2002

Here we bolus alot, but I think it is because basically all of our patients here are dehydrated (in Phoenix). It is pretty standard to start an IV and give like 500 right away, then turn it down to 125/hr (on gravity tubing, unless PIH is present/suspected or similar higher risk for fluid overload). Then, our patients get boluses as part of fetal in utero resusitation. We also routinely give 1-2L boluses immediately before epidurals.

I trained at a tertiary care center, with a very well known and respected perinatology group. They were very big on IV fluid bolusing (again, unless PIH present/suspected). And, we were all very cognizant about the risks and s/s of pulmonary edema. We rarely saw it, and when we did, it was usually either a sick mama (not getting big boluses anyways), or someone with some underlying problem that was previously unknown. But, we measure urine output on anyone with an IV and routinely evaluate cardio/pulmonary status if indicated.

I'm totally comfortable with that.

I worked a travel assignment at a tertiary care center in NY, where they did things very differently from most everyone else. They didn't give boluses, even before epidurals! And, most every patient ended up having late decels needing ephedrine after the epidural placement. Drove me nuts!

But 4500ccs in 6 hours on a stable labor patient, without a bad strip...that seems like quite alot, though! I could see that if the suspected a bad strip was due to hypovolemia or poor placental perfusion. But your average labor patient? yikes!

mark_LD_RN · Sep 20, 2002

my feelings exactlyOB4Me!ibolus patients when needed but really don't liketo just give a labor pt the amounts of fluid ihave been seeing given.

obtnt · Oct 3, 2002

This is entirely too much fluid to be routinely done!!! We are a high risk unit and that changes things a bit but still!!! We bolus the CE pt just prior to placement with 1000 cc and prior to that it's 125/hr unless specified otherwise. A nurse should be inserviced upfront on this as Pulmonary edema has very serious consequences--look them up! This is something you don't want to see happen, especially if you could be responsible for it!! Anesthesia should have standing orders for potential epidural pts on the unit too. Then, if there is an exception, i.e. dehydrated pt, the nurse knows to inquire as to the specific orders for that pt. Remember the importance of this when training students or nurses new to L&D.