OB Nurses....Question For Ya

Specialties Ob/Gyn

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I no nothin' about OB (work in ICU) and was just curious about something. Is it normal to have frank red blood in a Foley during a lady partsl delivery?

What's phenergan?

One thing I've learned moving from hospital to hospital is that everyone does things differently and almost universally are convinced that their way is the right way. I am the reed bending with the wind....ohm.....ohm.....

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Phenergan....a drug used here for nausea and in some cases, as an adjunct for pain control. I dont like it much, it snows people usually (think super-benedryl) and it is VERY painful to inject, whether IV or IM due to it's extremely LOW pH. I much prefer Zofran or Anzemet for nausea and we don't use it for pain control at all where I work.

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I've never seen it. Course, I know some people thought I was crazy when I said we had used nitrous in labor!:D

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I am not getting defensive. (rofl or I am in denial and am)..... :rotfl:

I guess I went there cause you said "foley's in epidurals are never warranted". >>

Where did I or anyone say that foleys are NEVER warranted?

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What's phenergan?

One thing I've learned moving from hospital to hospital is that everyone does things differently and almost universally are convinced that their way is the right way. I am the reed bending with the wind....ohm.....ohm.....

That is so true Fergus . . . one of our nurses recently left and moved to the big city and is working in a large ER. I saw her today and she told me that they do so many thing different there. As an example, the triage nurse of course triages the pts for order in which to be seen. Then each nurse has four beds. They wait until the doctor is actually assessing the patient before taking vitals or a history. At our ER we take vitals, take a history, I do an assessment and then I call the doc. Unless it is an emergency - then I call him but we still start vitals, draw blood, start an EKG, etc. It is just funny how a nurse will wait to do vitals and assessment until the doc arrives.

I'll wager to bet we would be amazed at the differences in practice.

steph

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
That is so true Fergus . . . one of our nurses recently left and moved to the big city and is working in a large ER. I saw her today and she told me that they do so many thing different there. As an example, the triage nurse of course triages the pts for order in which to be seen. Then each nurse has four beds. They wait until the doctor is actually assessing the patient before taking vitals or a history. At our ER we take vitals, take a history, I do an assessment and then I call the doc. Unless it is an emergency - then I call him but we still start vitals, draw blood, start an EKG, etc. It is just funny how a nurse will wait to do vitals and assessment until the doc arrives.

I'll wager to bet we would be amazed at the differences in practice.

steph

I already AM amazed. :)

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Phenergan....a drug used here for nausea and in some cases, as an adjunct for pain control. I dont like it much, it snows people usually (think super-benedryl) and it is VERY painful to inject, whether IV or IM due to it's extremely LOW pH. I much prefer Zofran or Anzemet for nausea and we don't use it for pain control at all where I work.

We use Phenergan in conjunction with Stadol pretty regularly. If you go slow IV push (from a higher up port) there is NO complaint about vein burning or irritation. As far as the comment about snowing people....it is SUPPOSED to snow them for a nap. That's the whole point and if they are at all nauseous, it takes care of that as well.

We never use Zofran in labor: only post-op. Isn't it funny how things are so different everywhere?

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Yep it is different everywhere. Great opportunity to learn here, isn't there? And you are right about Zofran, as a rule we don't use it in labor, either. But I do hate the side effects of phenergan. I really think it's a bad drug, from what I have seen it do to people.

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where i work, anyone w/epidural has a foley. we deflate the balloon prior to pushing and if the pt is still really numb after delivery, we reinsert a foley. we have one doctor who wants it kept inflated during pushing and one doctor who doesnt want it reinserted post delivery even if the pt is still really numb. as far as getting up to the br, the nurses usually wait 4 hrs from the time the pt gets to pp floor (usually 5 hrs post delivery total) to get them up to the br and if they do ok getting up to the br (no sx syncope, no fever,etc) then they d/c their iv. pp floor protocol is d5lr 1000cc w/ 20 units of pitocin at 125cc/hr x 4hrs after delivery. it really is amazing of the vast differences in each hospital!!

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where i work, anyone w/epidural has a foley. we deflate the balloon prior to pushing and if the pt is still really numb after delivery, we reinsert a foley. we have one doctor who wants it kept inflated during pushing and one doctor who doesnt want it reinserted post delivery even if the pt is still really numb. as far as getting up to the br, the nurses usually wait 4 hrs from the time the pt gets to pp floor (usually 5 hrs post delivery total) to get them up to the br and if they do ok getting up to the br (no sx syncope, no fever,etc) then they d/c their iv. pp floor protocol is d5lr 1000cc w/ 20 units of pitocin at 125cc/hr x 4hrs after delivery. it really is amazing of the vast differences in each hospital!!

Our heaviness of epidurals varies (of course) from doc to doc and from patient to patient. Most of our patients are more than able to get up and out of bed in the hour to hour and a half after delivery. By that time, we get rid of most of the IV's as well.

It would seem to me that you guys would all have less work (especially in PP) if you got people up and d/c'd the IV's sooner. I often d/c my IV even if the patient cannot void: if she has a good firm uterus. If you're uncomfortable with that idea, d/c the IV and convert her to a hep lock until she voids. Most don't need all that extra fluid anyway. It just leads to more breast engorgement as well. Some Motrin (600-800 mg. is best), some food, and a couple of extra hours relaxing usually helps with the voiding issue and by then, the legs usually work fine.

Maybe we are really laid back at my place but it seems to work because we rarely have any kind of a PP hemorrhage.

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where i work, anyone w/epidural has a foley. we deflate the balloon prior to pushing and if the pt is still really numb after delivery, we reinsert a foley. we have one doctor who wants it kept inflated during pushing and one doctor who doesnt want it reinserted post delivery even if the pt is still really numb. as far as getting up to the br, the nurses usually wait 4 hrs from the time the pt gets to pp floor (usually 5 hrs post delivery total) to get them up to the br and if they do ok getting up to the br (no sx syncope, no fever,etc) then they d/c their iv. pp floor protocol is d5lr 1000cc w/ 20 units of pitocin at 125cc/hr x 4hrs after delivery. it really is amazing of the vast differences in each hospital!!

Another thing we differ on is that we have one group (our all woman group) who doesn't even put any pit in post-op IV's after a c/section either. It's not always necessary. We always have the option of adding pitocin to an IV if we think it is necessary.

Of course, not all of our patients even have IV's, nor do all of them need pit.

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At the time of a section and we see red of any color in the foley bag we assume we have nicked the bladder and rectify that. During labor blood vessels in the bladder can break and there you have it, blood.

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