Who draws up medication during C-section?

[pickledpepperRN]

I have to ask because I'm neither an OB-GYN nurse nor a surgical nurse.

I am on a committee at my hospital where the demands of a new physician were discussed.

He does not want medications drawn up, labeled, an ready on the sterile field as is the practice. A circulatine RN will obtain medications not already there and assist in ensuring the integrity of the sterile field.

This doctor wants the unlicensed scrub tech to draw up medications.

In my state only certain licensed professionals including LVNs and RNs may draw up medication and hand it to the doctor to administer to the patient.

Is there a professional organization position statement regarding this?

What is the practice at your facility?

Please excuse my ignorance, I havent done L&D since I was a student. Even then I didn't see a C-section.

[Marie_LPN, RN, LPN, RN]

www.aorn.org

We really haven't had much of an issue with medications being on a sterile fields, since it's the MDA who usually does all the medicating. The only time we have something on the field would be if we had to do a section with local (emergent) and that would be with Lidocaine. But if the case is done with local, then two nurses (no tec) would be scrubbed on the case, so who's drawing it up isn't a problem.

What is this surgeon's response to the state law about scrub techs not drawing up meds?

[pickledpepperRN]

www.aorn.org

We really haven't had much of an issue with medications being on a sterile fields, since it's the MDA who usually does all the medicating. The only time we have something on the field would be if we had to do a section with local (emergent) and that would be with Lidocaine. But if the case is done with local, then two nurses (no tec) would be scrubbed on the case, so who's drawing it up isn't a problem.

What is this surgeon's response to the state law about scrub techs not drawing up meds?

Thank you! I am getting the advice of an experienced expert.

Actually I like his response, but management does not. He says he wants a nurse scrubbing. It sounds good to me.

They do the C-sections in an OR in L&D.

The regular operating rooms are on another floor. The L&D nurses recover the patients.

I don't even know what medications they are discussing.

Just because they have done it a certain way doesn't mean there can't be improvements.

I'm just trying to find some organization with a policy & procedure.

I'm showing my ignorance now. What is an MDA?

[Marie_LPN, RN, LPN, RN]

MDA--another way of saying anesthesiologist MD.

[Marie_LPN, RN, LPN, RN]

Are the scrub techs there CSTs?

[SmilingBluEyes]

Depends, some meds are drawn up and given per the MDA; others by the circulating nurse (like methergine/hemabate.) Marie answered it well, too.

[SmilingBluEyes]

MDA: Medical Doctor of Anesthesia (your friendly anesthesiologist)

[pickledpepperRN]

MDA: Medical Doctor of Anesthesia (your friendly anesthesiologist)

Thank you both.

They are used to having the circulating nurse draw up medications.

Our anesthesiologists are friendly. The "on call for OB" person also helps us with emergency intubations in ICU.

[ragingmomster, BSN, MSN, RN]

We have lidocaine on the field in a sterile fashion for the privates who like to use it in their incisions during closing. It is drawn up by the ST.

Hemabate for injection into the uterine muscle is held by the circulating RN and drawn up in a sterile fashion by the ST with the MD waiting for the med to be handed over.

As for having an RN scrub in... we are a crazy busy unit and I would hate to think about the pt an RN would have to leave in order to scrub into a section.

I know that the problem could be avoided by having an RN dedicated to scrubbing for the day, but from experience I am sure she would be asked to take a pt or two, "maybe just a q 4 hour antepartum pt" or "we have these 2 PP pts waiting for beds on the PP floor, they won't be too much trouble".

Our ST's have tons of experience and if drawing up meds is the issue, IMHO I think there are other ways around the issue.

How would the circulating RN draw up meds in a sterile fashion? Open a drape, drop meds and needles onto field, apply sterile gloves, draw up meds, hand off to MD? Sounds like this process would be too slow.

[SmilingBluEyes]

I forgot:

Our L/D RNs do NOT scrub in---we circulate. We have 24/7 scrub tech presence and the dr's secure their assistants at the time a decision to do a c/sect is made. I can see where it would be handy to have the RN scrub in, but staffing won't allow it---nor it seems, is there time to train us all to do this.

[Marie_LPN, RN, LPN, RN]

How would the circulating RN draw up meds in a sterile fashion? Open a drape, drop meds and needles onto field, apply sterile gloves, draw up meds, hand off to MD? Sounds like this process would be too slow.

Coming from a vial, you could use a 'vial decanter' to transfer the med sterile to the table:

Or you could use a syringe and a blunt needle, draw up the med, take the blunt needle off w/o touching the tip of the syringle, then squirt the med onto the sterile field.

[pickledpepperRN]

In the main OR we have an LVN scrub nurse who can draw up medication.

The MD and circulating RN may not allow an unlicensed person to draw up medication.

I'm making a copy of this thread for a friend in L&D. We need to plan alternatives before meeting with management.

Apparantly nursing is getting a lot of scrutiny because a tray with sharps and medications was left on an overbed table in the hallway. The nursing staff is certain an anesthesiologist left them there. He is the person who removed the meds from the Pyxis.

Thank you all for your comments and information!

Thank you Marie. I will ask if that is how the circulating nurse does it now.