Routine Acoustic Stim Use

SmilingBluEyes · Jul 12, 2005

We never do it. If the baby fails a basic NST, it's on to a BPP (where gentle stimulation may be used to "awaken" a sleepy baby). We do not use vibroacoustic stim as nurses on OB. The use of acoustic stim is rather controversial at this point. Most places I worked had not used it in YEARS.

SmilingBluEyes · Jul 12, 2005

let me do some digging. I have read articles in the past arguing AGAINST routine use of acoustic stim in OB units. I just need to do some looking back in my journals.

RNnL&D · Jul 12, 2005

I have only used acoustic stim once. And that was as a last resort, after turning Mom on her side, giving her juice, then feeding her. Baby had variability, but no true accels. Even that stim barely got an accel.

I think it should be used as a last resort, not routinely. Are they just trying to hurry along their NST's?

SmilingBluEyes · Jul 12, 2005

Well, see that is the rub. If a baby is already failing an NST, feeding mom and moving her all about may help. Even THIS is controversial, now. Non-response to these interventions is an indication for a more comprehensive evaluation than wasting time trying to acoustically-stimulate a baby can provide.

RNnL&D · Jul 12, 2005

Well, see that is the rub. If a baby is already failing an NST, feeding mom and moving her all about may help. Even THIS is controversial, now. Non-response to these interventions is an indication for a more comprehensive evaluation than wasting time trying to acoustically-stimulate a baby can provide.

Yeah, but if baby's have sleep cycles, then it makes sense to try to wake them up, rather than run a BPP on everyone.

SmilingBluEyes · Jul 12, 2005

In most situations, it makes sense to me, anyhow, to let the baby finish the sleep cycle---they tend to be rather short.

That is why we typically give them 1 hour (or just a little more) to pass the NST, as most fetal sleep cycles last anywhere from 20-40 minutes before they begin some movements that count. Also, if the strip looks otherwise "ok"----(no decels and in the normal baseline range)---- we tend to take a wait and see approach.

After an hour or so, it seems prudent to investigate further. Also, maternal history and her report of lack of fetal movement for a certain length of time, are rather important considerations as to whether further intervention is needed sooner. By the time you get to having to stimulate them, you might be thinking it's time for a BPP.

We just did one yesterday for a mom reporting 2 days of little to no fetal movement and yes, baby failed NST. ( this was an otherwise benign strip and benign maternal history)---- Well, she went for BPP after about 75 minutes of waiting. Funny thing was, baby was just beginning to have some minor accels right before U/S personnel transported her. We were thinking "oh great, we jumped the gun and started all this for nothing".....(you never know for sure) :)

No matter, the BPP score was only 4. No amount of feeding mom or using acoustic stim was going to change that result, I am afraid. We were left with no choice but to discuss delivery w/mom-----I have to go to work today for a meeting, so I will be able to see how it all went. I do know a trial of labor was being considered as her AFI was normal.

babyktchr, BSN, RN · Jul 12, 2005

Accoustic stimulation can be used as part of the interventions needed to elicit a reactive strip...ie....change position. It cannot harm the baby, but should not be used solely to perk up a kid after 80 mins have gone by. By then, a BPP is appropriate. Are your residents using the stim to elicit responses on a flat strip, or are they impatient and just buzzing the baby to get the NST over? Just wondering.

Please please please..DO NOT FEED your patients if the NST is non reactive. Give only clear fluids if you have to, stick to water if you can. There is no evidence based information supporting the increase of maternal blood sugar and fetal movement. If this baby needs out, and you have fed the mom, and she later aspirates, you can be held negligent. Just don't do it.

In the summer I know I see more not so perky fetal strips and its cause even pregant bellies need sun, and well...if I drink a lot then I have to pee...and yada yada yada. Start an IV if you have to...sometimes that is all that poor baby needs.

JaneyW · Jul 13, 2005

Accoustic stimulation can be used as part of the interventions needed to elicit a reactive strip...ie....change position. It cannot harm the baby, but should not be used solely to perk up a kid after 80 mins have gone by. By then, a BPP is appropriate. Are your residents using the stim to elicit responses on a flat strip, or are they impatient and just buzzing the baby to get the NST over? Just wondering.
Please please please..DO NOT FEED your patients if the NST is non reactive. Give only clear fluids if you have to, stick to water if you can. There is no evidence based information supporting the increase of maternal blood sugar and fetal movement. If this baby needs out, and you have fed the mom, and she later aspirates, you can be held negligent. Just don't do it.
In the summer I know I see more not so perky fetal strips and its cause even pregant bellies need sun, and well...if I drink a lot then I have to pee...and yada yada yada. Start an IV if you have to...sometimes that is all that poor baby needs.

Thanks. I think the buzzing was just for reassurance--and maybe to get the strip to look it's best so the attending won't question their evaluation, etc. I have a lot to learn about the way it all works at a teaching facility!

I have also heard not to feed them. I have read that cold water works best. I think I was just worrying that the startle elicited from the acoustic stim was maybe not the best thing to do to an already stressed fetus. Most pts coming in for NSTs have other things going on as well.

Dayray, RN · Jul 13, 2005

I have used it in the past but now that I know more about NST's and babies I rarely find need of acustic stem.

If the baby is'nt reactive then I'll turn mom and give it time, while I investiaget her hydration and bloodsugar. If it still isent reactive after 30min - 1 hour and I've hydrated and am satisfied that she has eaten ralativly recently. Ill gently move moms belly around a littel. if the baby still is'nt reactive get her a BPP. It depends on what I think the problem is and what I think the course is going to end up being for the patient.

If I'm tryign to get a reactive strip before sending her home and think that the baby is really okay then ill just feed her.

If Iam concerned and think that the patient is going to need to be induced or C/S Ill get the resisdent to do a BPP.

I'm not sure why someone would hesitate to do a BPP they are fairly easy and a good indicator of fetal well being and most paitients enjoy a chance to see the baby on ultrasound.

As for feeding the patient, it is true that there are'nt any studies that suport this. However many times it works. Just becuse somethign isent "evidence based" does not mean it is'nt valid. I can see the argument agisnt feeding a mom that may need a c/s but if you use good judgment you will rarely run into that problem.

I don't use stem very offten becuse I don't think it helps much. If a strip is so flat that I feel inclined to use it then 1 accel caused by stem isent going to reasure me. If a strip stays flat for 60 min I'm goign to be reluctant to send a mom home reguardless of what the stem does.

babyktchr, BSN, RN · Jul 13, 2005

I have used it in the past but now that I know more about NST's and babies I rarely find need of acustic stem.
If the baby is'nt reactive then I'll turn mom and give it time, while I investiaget her hydration and bloodsugar. If it still isent reactive after 30min - 1 hour and I've hydrated and am satisfied that she has eaten ralativly recently. Ill gently move moms belly around a littel. if the baby still is'nt reactive get her a BPP. It depends on what I think the problem is and what I think the course is going to end up being for the patient.
If I'm tryign to get a reactive strip before sending her home and think that the baby is really okay then ill just feed her.
If Iam concerned and think that the patient is going to need to be induced or C/S Ill get the resisdent to do a BPP.
I'm not sure why someone would hesitate to do a BPP they are fairly easy and a good indicator of fetal well being and most paitients enjoy a chance to see the baby on ultrasound.
As for feeding the patient, it is true that there are'nt any studies that suport this. However many times it works. Just becuse somethign isent "evidence based" does not mean it is'nt valid. I can see the argument agisnt feeding a mom that may need a c/s but if you use good judgment you will rarely run into that problem.
I don't use stem very offten becuse I don't think it helps much. If a strip is so flat that I feel inclined to use it then 1 accel caused by stem isent going to reasure me. If a strip stays flat for 60 min I'm goign to be reluctant to send a mom home reguardless of what the stem does.

There is a problem with not using evidence based practice. What will you stand on if there is a problem? The reason why feeding a mom works is that the fetus is stimulated by the sound the food makes when it hits the belly....and so giving the mom water would be just the same. There is no evidence that maternal blood sugar has anything to do with fetal movement. Be careful when you think that just because something is tried and true, doesn't always make it the right thing to do...or valid. Just cause it works doesn't make it right. In court you will be asked why and how you know, and where you get your info. Hopefully you have a policy, and know the standards of care, because believe me, the lawyers will.

I agree with you totally, the big picture needs to be looked at. Mostly flat baby and one accel..hmm...she's gonna hang out for a while. I really don't know why BPP's aren't done as often. I know in my little institution, the reason is, in the middle of the night, someone has to be called in, and so........what's your point? Hospitals were open 24 hours, right? I call them in anyhoo.

Dayray, RN · Jul 13, 2005

I'll agree with the point made about non-evidence based interventions being a problem in court. I don't worry too much about it in this case however because it won't really come into question if used appropriately. If a mom came in with giant late's and no veriablity and I choose to give her milk and cookies I'm sure I would hang in court. That is why I only use it in cases where it is appropriate. Sure there is a question about moms aspirating should they need a C/S but I'm not talking about those patients. For a baby that just appears a little sleepy some fluid and sugar often does the trick. So I guess the deciding factor is again judgment (something we are being allowed to exercise less and less in our field).

I'm kinda surprised to hear that the sounds from the digestive tract will wake a baby up. Can you post a source for that info? I had thought that the digestive tract was always moving and would have assumed that a baby who doesn't respond to position changes wouldn't notice a little extra noise in the digestive track. Guess I learned something new, I'll be interested to see that info in an evidence based study.

The reason I sometimes choose to give them a snack is that I have seen it work. Usually I'll give them a Popsicle or sometimes a little D5 LR. Not to a patient with an awful strip but to a patient with a strip that is just short of the mark for going home.