Sterile Speculum exams for ?ROM

[LizzyL&DRN]

This might be a silly question but anyway.....

When you do a sterile speculum exam to determine if a pt has pooling of fluid in the lady parts, and to obtain a sample for ferning do you use KY gel? I was always taught, no gel in this situation. If the pt is indeed ruptured, its not usually a problem. But have you ever had those pts, (who I think are secretly just trying to get a cervical exam to see if they've changed) come in and say they think their water broke and you just can't get that darn spec in because they are so dry. I had one the other night that I just couldn't get the spec in and I had to use a little bit of gel. Did I do wrong???

[RNnL&D]

We do our own specs, no gel. And after watching some residents, I wish the nurses did them all. :uhoh21:

[Littlewonder]

I have been at several facilities where nursing is not allowed to do sterile spec exams and the physicians are not in house. We would simply do a SVE (without goo, ouch) and then brush the gloved fingers over the slide. We had great ferning results when ROM with this technique and no huge spec to try to get to go anywhere semi dry.

[LizzyL&DRN]

Littlewonder- Do you use the same technique for PPROM? We employ a "hands out" policy if they are preterm unless of course they are laboring.

[texas-rn-fnp]

I have never had a problem with inserting a speculum without gel. I have seen people have more problems if they try separating the labia from the anterior aspect. Seems to hurt like heck. Separating the labia from the posterior aspect seems to eliminate any discomfort. Appropriate size and type of speculum help, along with a gentle touch.

Anmiosure is just a nitrizine impregnated sterile swab. It can be used quite easily and quickly, bu is subject to the same limitations that nitrazine paper.

In my experience there have been enough patients that were certain that their water had broken and then were found to have the contrary, that it would be prudent to be certain about the diagnosis as it can significantly alter the plan of care in some patients.

I do a four way exam, check for pooling, valsalva, nitrazine, and ferning. Our docs say pooling is the most accurate for srom check. not sure if that is authoratative or opinion though.

Depending on your local situation there may not be any docs available. I have moonlighted in underserved areas where if the nurse did not do it then it did not happen. So they had to do it all. Kind of interesting re: scope of practice and authority differences based on locality.

[ragingmomster, BSN, MSN, RN]

Slightly off topic but...

I hvae also seen some speculum exams that I think I could have done better (and it would be the first time I've ever done one!)

When we get new residents in July there will be a sudden increase in the use of disposable plastic speculums when I am around.