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When you identify these contractions as biphasic and triphasic are you including the duration of the contraction as the entire length? And then is that considered tachysystole at your institution? (any contraction lasting greater than 120 seconds is tachy at our institution) Thanks, Sharon

Hello, We have been experiencing so many changes with our documentation in labor that all of us 20 year veterans feel like we no longer know what we are doing!! My question is how do you chart your contraction pattern when you have coupling or tripling of contractions?? Some chart this as one prolonged contraction that doesn't return to baseline the entire length of the couplet so the length of the contraction could be 3 minutes long.....others are charting this as 2 or 3 seperate contractions and noting that they don't relax between them??? So much information available on the new NICHD charting for FHR but not as much on documentation of contractions. Please advise and resources where you have found information. THanks so much! Sharon

Thanks for all your responses. It sounds like everyone is charting something. Several of my co-workers want to chart "per MD" in all the spaces on computerized charting and I don't think that is enough. We are still responsible to chart how long it is on, how many pop offs, how many attempts, etc. even if we can't see the amount of pressure, right? If anyone can find a standard on this, I would really appreciate it! Thanks again!

Can anyone tell me what their policy is on charting for vacuum assisted deliveries? We are going to computerized charting and there is a place to chart # attempts, amount of suction, time of suction etc. Some feel this is the Dr.'s responsibility to fill this info in and others feel it is the nurses responsibility. Can anyone shed some light on this topic for us? thanks so much!

OK, I think with the help of your figures, I have it. However, when we add 20units to 1000 ml, 3ml/hr=1 mu/min. (Your calculation came up with 2). We USED to add only 10 units to 1000ml and then each 1mu/min = 6 ml's/hr....so here is where I am getting it from: 20 units= 20000 milliunits add this to 1000ml means that each 1ml=20 mu So if you run at 1ml/hr=20mu/hr but we talk in terms of mu/min when inducing. I can actually figure backwards easier.....say you want your pit at 5 mu/min take that times 60 to get mu/hr which is 300mu/hr and we know that 20 mu=1ml so 15 ml/hr would equal 5 mu/min. OK do I have everyone confused?? Anyway, I have it in my head now, just need to put it on paper so I can show new hires how to calculate. WOW that was way to taxing! Just hate to not be able to explain it to someone. Thanks, SHaron

OK, fellow RN's, I need your help. I have been running pitocin for 18 years and now when I try to calculate it, I can't find the right formula to make it work. So please show me how to show the math for 10 units or 20 units pitocin added to 1000 ml LR and why 1 milliunit equals 6 ml/hr or 3 ml/hr respectively. Thanks for your help. This is driving me nuts!! SHaron

This response was just a humerous one that shows some patients will tell us anything.......on admission we ask all the normal questions including when they ate or drank last in case we have to go to a c/s. Anyway, this particular nurse asked "When was the last time you had oral intake?" And the sweet patient responded, "Oh, about 3 months ago." WOW way too much information!!! The nurse was able to keep a straight face and ask the question again later in a more descriptive manner! And got the answer she was looking for that time! haha They do feel vulnerable when they come in to the hospital and can't even hardly remember their birthdate when we are shooting so many questions at them. Sharon

I like to work up to the due date as much as possible. I think the activity is good for you and baby, as long as you are having a healthy pregnancy. However, with you being due around the holidays, it would be nice to be home during that time also. I never had enough paid time off to take that many weeks before and 12 weeks after. Actually, with my last child, I worked 3-11 in OB and then contracted off and on thru the night and delivered at 7 AM. Boy, was my labor patient surprised the next morning when she saw me in a patient gown in the halls!!! I felt better when I kept active, but all pregnancies are different. Good luck!

WE don't meet with the cardiologist until December so we will find out then. I still haven't found any research on this online. Our Dr's have received the recommendations from the vascular surgeons and cardiologists at our regional hospital and will make their decision based on that. I will let you know after his appointment. Thanks for the responses and concern. Sharon

Hello, I work in Obstetrics and typically post on that site, but have a personal question for all the ICU nurses. My dad has an aortic dissecting aneurysm and also is in atrial fib. We have some Dr.'s that are recommending that he take coumadin for his atrial fib and other dr.'s that feel it is too risky with his aneurysm. Have any of you had experience with this or know of a web site where I could find information? Do any of your cardiologists have any input on this?? Any help would be greatly appreciated. We are trying to determine who's advice to follow and need some backup information to help us make that decision. Thanks so much, SHaron

My patient never had any itching and did actually receive good pain relief. The other problem I ran in to was if she had needed other pain meds, the anestesiologist refused to order since "he wasn't the primary" and the primary physician refused to order any since "the patient received duramorph". That was very frustrating also. Like I said, she had excellent pain relief so luckily I didn't have to worry about that. Thanks for all your help.

My patient never had any itching and did actually receive good pain relief. The other problem I ran in to was if she had needed other pain meds, the anestesiologist refused to order since "he wasn't the primary" and the primary physician refused to order any since "the patient received duramorph". That was very frustrating also. Like I said, she had excellent pain relief so luckily I didn't have to worry about that. Thanks for all your help.

We have a new group of anestesiologists that are starting to use Astromorph or duramorph for our C/S. Does anyone have a policy regarding care of these patients post-op?? We are looking for information regarding frequency of vitals, need for pulse ox, narcotic orders or other pain meds etc. Any help you can give would be greatly appreciated. I remember when we used to do this about 15 years ago and we did respirations every 15 minutes for about 12 hours!!! It seemed ridiculous. Thanks in advance. Sharon

Thanks everyone for all your input.....it sounds like the larger hospitals are doing them because they have the staff for that and the smaller hospitals are still utilizing an OR staff. I am sure this will be an ongoing argument til the end of time at our institution. Our C/S rate is climbing by the minute. Seems like we induce everyone too early and then have to C/S for failure to progress. I would guess we are at 15% on average which somedays seems like it is triple that. OUr anesthesiologists are not in house and we do very few VBAC's and have the OR staff and anesthesiologists in house for those. Just wondering what everyone else was doing regarding the C/S's and how feasible it is for us. Thanks for all the responses. Sharon

We are a small rural unit that does approximately 45 deliveries a month on average. Of course, we have crazy months that we do 65 and really slow months that we only do 35, but on average about 40-45. Anyway, we are constantly bombarded by the OR crew that the OB staff should be doing their own C/S's on the unit. Currently, if we have a stat C/S the OR team gets called in to do them. I understand the reasoning that with a 30 minute from decision to incision time that it would be better for in-house staff to do them, but we do so few per year that our skills just wouldn't be up to par and we don't currently have the staff available for that. And the expenses involved in training all 30 of us to learn this skill would be incredible and to keep up the skill would also involve extensive training, not to mention more staff to fill the area also. Being a small unit, we would have to train everyone because of days off, on call, etc. We confront this problem all the time and get frustrated. Mother and baby are of utmost priority and we do start opening the room and have the patient in the room sometimes prior to OR arriving, and then they take over and we concentrate on baby. (the labor nurse assists with the baby at this point). Do any small hospitals our size staff their own C/S and how does it work?? Our experience is that only larger hospitals are doing this and it would not work in a small hospital. Thanks for your help. Sharon