I work mainly L&D and have worked as a traveler in 3 different facilities in the last 8 mos. Prior to that I worked in 1 facility for 1.5 years. Here are the things Im wondering about and have seen it differently every where I go, any input on evidence-based research , as well as your own experiences regarding these issues would be appreciated.
Fluid bolus/IV hydration prior to epidural - to do or not to do, how strict are your anesthesia personnel, how much 500, 1000? Also Platelet counts, must they know prior to giving an epidural or is one ok during the pregnancy good enough?
my personal opinion - with a normal, uncomplicated pre-natal course, one would expect the platelet count to be normal unless you have a reason to believe otherwise, ie; complications, PIH, etc. why delay giving an epidural because you dont have a CBC on the chart?
Bolus's - not entirely necessary, if someone is going to drop their pressures they usually do it regardless of a bolus, I realize this also depends on how hydrated they are in the first place.
Placing epidurals based on cervical dilation- is 1cm too soon? is 8cm too late, again lots of depends on factors, but where i work now, they are adamant about not placing them after 8cm and wrinkle their noses placing them before 3cm, strictly referring to anesthesia here.
mainline IV choice - D5LR? LR? the first place I worked it was always LR, hardly ever used D5, occasionally ppl would mix their pit in D5 - since I've been traveling everyone used D5, then when you have to bolus (for epidural or any other reason) you have to switch to LR, also used Isolyte at another place.
i personally think using straight LR is less complicated and doesn't make a bit of difference, and I've heard, (tho haven't seen any evidence to back this up) that accidently bolusing D5 like 200 or 300, or just having too fast of a rate, caused hypoglycemia in the infants after delivery.
Ok, so lets hear everyone's thoughts on this mess, thanks so much! SHelley