Just wondering what kind of "Old School" practices are your units still stuck on.
Take my hospital for example:
Sanitary belts for c/s, which of course lands right across the vertical incision line that they all seem to use (for no really good reason other than it may be easier). Persoanlly I prefer the lovely "Victoria Secret" mesh panites we use on the NSVDs instead.
Still doing losts of good ole soap suds enemas...always fun trying to run to the bathroom 9 months pregnant and hooked up to an IV, BP machine(which is not part of the monitor) and of course the monitor.
Continous FHT monitoring on a 26 wkr here for 3 days of GDM teaching?!?!?
Not getting pt's out of bed no matter what. Even using a bed pan for someone who is 2 cm Intact and on pit, just because they are on pit.
Starting all IVs in the hand w/ and 18g angio not to mention the pain but these puppies don't infuse well especially when it comes time to push (pt's use their hands too much to start it here).
23 Observation for ALL!!! No matter what the complaint (maby I am exatruating, but it sure seems like it sometimes)
Ah, there are more, just can't think of them right now. Wish some things could change as this place is just not progressive in thought. Don't get me wrong I like where I work, but sometimes I just wonder....
Maybe I'm just crazy, but when I was in labor, I was GLAD for the foley! Especially when I got into active labor. I don't know how in the world I would have gotten up to pee, and I ALWAYS had to pee!
How can you not do a Foley with a epidural? Do you strait cath?
Also, heard an old school story for a patient the other day. Her husband says "really I can stay while they put in the epidural?" I say "sure in fact it's your job to hold her hand". He tells me that at the last hospital they went to, the nurse told him he wasn't allowed to stay because its so painful to get an epidural. I wasn't too surprised by them sending him out I figured they were afraid of him passing out or something. I explained to them that it shouldn't be painful except for the lidocain shot they use for local. What the patient said next did shock me though. She said that the anesthesiologist didn't use any local befor poking her in the back and that he then told her that it was unreasonable for her to expect to get out of all the pain of labor. So he pokes her in the back she screams and still remembers it as the most painful thing that has ever happened to her. Couldn't believe that one.
Then she tells me that the nurse had to push the last baby out for her. I wasn't too surprised by that I mean she was 38 so I guess it could have been like 15-20 years ago but then she says it was 2 years ago and again I was shocked. I know that was done a long time ago but have heard too many stories of complications for doing it so I thought it was stopped at least 10 years ago.
I have a pretty good game face but I think my jaw hit the floor while she was telling me this stuff. I asked where they delivered assuming it was like Cambodia or somewhere deep in the appilations or something. Nope it was a major metropolitan city.
Needless to say I feel she got much better care this time. She was really surprised that the epidural didn't hurt.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I believe it is better to have an indwelling urinary catheter rather than to straight cath a person (unless you will do this ONLY Once).
It is likely a patient will need MORE than one straight-cathing IF she has an epidural drip for several hours. With fluid boluses in prep for epidural anesthesia, in addition to hourly IV fluid intake, how does that bladder stay empty and OUT OF THE WAY of the baby's descent???? They cannot urinate on their own, after all.
REPEATED straight-caths are more likely to cause infection than a one-time insertion of an indwelling catheter. And, you CAN remove this catheter for pushing, if desired. I cannot see how you can get by without a foley catheter if you plan to have an patient on an epidural drip more than about 2-3 hours, really. It just does not make sense to me!
how does that bladder stay empty and OUT OF THE WAY of the baby's descent???? They cannot urinate on their own, after all.
Acrually some pts can urinate on their own with an epidural. I have put several on a bedpan. Otherwise, they are up to empty their bladder right before placement, then straight cathed once if needed. I have never really had a pt who needed more than one cath. during labor. Most of our pts don't get epidurals until 4-5 cm, and the fluid bolus seems to hit the bladder all at once, IME. How much fluid are you bolusing? Our pts get 500-1000 ml, depending on the anesthesist.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Originally posted by L&D_RN_OH
Acrually some pts can urinate on their own with an epidural. I have put several on a bedpan. Otherwise, they are up to empty their bladder right before placement, then straight cathed once if needed. I have never really had a pt who needed more than one cath. during labor. Most of our pts don't get epidurals until 4-5 cm, and the fluid bolus seems to hit the bladder all at once, IME. How much fluid are you bolusing? Our pts get 500-1000 ml, depending on the anesthesist.
we bolus no more than 500cc unless they are dehydrated. and it must be the type block they get here cause i have NEVER EVER seen ONE patient would could urinate once blocked. Usually they get their blocks AFTER dilated to 4 cm. hope this helps. I will err on the side of safety and cath them.They don't mind anyhow; it lets them rest and saves them the aggravation of using a bedpan. It works where i am, anyhow.
and it must be the type block they get here cause i have NEVER EVER seen ONE patient would could urinate once blocked.
It must be. I remember when I got an epidural with my second son. I couldn't feel anything, let alone lift my legs. But most pts here are able to move around the bed and even lift up to get on a bedpan.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Originally posted by L&D_RN_OH
Forgot to mention, most ask for the bedpan first, because they don't want to be cathed.
funny, ours DO. they like the idea of having not to scootch up to use these things, even if they can. a few can; but none can urinate. I have even tried peppermint/wintergreen oils to see if they can. nope.
I guess part of it is fear of pain, even thought they can't really feel their nether regions. This is an example of how anatomically stupid I was when I was younger. When I was told I would need a straight cath, I freaked. I was not aware that the urethra was seperate from um, er another part of the female anatomy and all I could think of was about this huge tube going in that little place.
And no, I'm not talking about a lady parts. :chuckle
Sad to see them go, too..... 
When I was told I would need a straight cath, I freaked. I was not aware that the urethra was seperate from um, er another part of the female anatomy and all I could think of was about this huge tube going in that little place. 
L&D_RN_OH
288 Posts
Same here. Sometimes we skip the saline lock too. Oh, and no foleys. The only pts with foleys are csections.