RN use of ultrasound in fetal demise cases

[April Tyler]

Are you as the RN and the Nurse in Charge that evening legally okay to use an ultrasound to reassure a patient that her baby's heart beat is no longer present? My Patient was not shown her demise at all on ultrasound and the doctor would not come in from home. The ultrasound tech at the hospital did not show her a picture of her baby either. They were still wanting me to give her the cytotec to induce labor; however the pt did not believe that her baby had passed without visual confirmation. No one would come a show her, therefor she thought htat she was terminating a wanted pregnancy. I put the ulrasound on her belly of 15 weeks and confirmed to her that her baby had passed. All the pt wanted was visual confirmation. I as a pt advocate did what I thought was correct and moral. The hospital suspeneded me for a week. Who is right ...the hospital or me for giving the patient and her family peace of mind and visual confirmation of no heartbeat? :confused:

Thanks,

April T.

[Catherinebt CNM]

A very difficult siuation..........

But you must always consider your scope of practice.

As an RN or CNM we must remain within our scope of practice.

Unless you are trained to use a piece of equipment, in this case an ultrasound scan..............then you should not use it.

I sympathize with you, as I understand how you wanted to be open and honest with the patient. But it is ridiculous that the technician performing the ultrasound didn't say to the mother:-

" I am very sorry, butI cannot see the baby's heartbeat.....your doctor we be here shortly to confirm what I suspect".

If it is policy that the technician doesn't report to the patient (which is ridiculous) then i think that it would have been OK for you to tell you patient

" I am very sorry, but the technician cannot see your baby's heart beating..........the doctor will come in now and confirm what she suspects and explain what will happen next".

The physician should be the one to confirm the diagnosis and get consent for treatment from the patient, not the nurse.

The doctor should have attended, if he refused to attend then you should have called you superviser and initiated the "chain of command".

No way should you begin to terminate a pregancy without the doctor physically being present, confirming the diagnosis, ordering the treatment and obtaining patient consent.

The doctor should also have been disciplined for failing to attend......though i doubt that he was?!

Don't be too hard on yourself..........you are undoubtably a nurse who really cares for her patients. But learn and grow from this.

I can assure you that there is not one nurse reading this that hasn't made a clinical error or made a bad clinical decision.........we are only human!

But the difference between a good nurse and a bad one....is that the good nurse recognises her weaknesses and grows from it!

[tewdles, RN]

It is my experience that an ultrasound tech would not be at liberty to say anything to the patient about possible fetal demise...of course I am older than dirt but I would be surprised if that has changed too much. Because nurses and techs cannot diagnose we cannot really provide the initial interpretation of tests to our patients...so it is best for us to keep silent until the MD diagnoses fetal demise and then we nurse the heck out of our sad young patients.