Who is using amnisure??

[shortstuff31117]

Just curious what people think of it. We started using it a few months ago and I'm not too sure what I think of it. Last night I had a pt. come in, c/o leaking x 24 hours. No visible fluid, did an amnisure and got 2 faint lines. Usually the control line is really dark so I repeated it and got the same result. Wondered if it was a faulty batch, so I went ahead and did a speculum to be sure, which showed no fluid, no ferns. I still worry that she was ruptured because there WERE 2 lines on the amnisure, but ran it all by the doc who said d/c her.

My other issue is that it's supposed to be a positive even if the second line is faint, but I've had another case where there was a faint second line, but no clinical signs of rupture, and my coworkers just said "oh that line is faint so it's negative"

Any input on this, anybody??

[redbeads]

My gut reaction is don't use a test that you're not going to trust....but, I will talk to the practitioners that use this on our floor and get back to you. I know that it is quite expensive and we usually first do spec exams, then if that is questionable and the patient has a convincing story, we go to the amnisure kit.

[Sandwitch883RN]

We use amnisure at my facility. The amnisure literature states that ANY line, no matter how faint indicates a positive result. However, recent intercourse can cause a positive result so it's important to know the last time of intercourse. If intercourse has occured less than 48 hours before performing amnisure it may not be accurate. Even in the absence of positive ferning, valsalva, pooling we still tx a positive amnisure as spontaneous rupture. I'm curious to see how other facilities interpret amnisure. We've been using it about a year now. It's an expensive test though.

[redbeads]

I spoke with one of our practitioners who works in our triage unit where we do many r/o ruptures every day. She said that she rarely uses the amnisure, but when she does, she treats any positive test like the pt. is ruptured. I'm thinking that sending someone home who has had a positive amnisure might not stand up well in a court of law if there was a bad outcome r/t this later on.

[klone, MSN, RN]

Did she say why she rarely uses it?

[shortstuff31117]

If intercourse has occured less than 48 hours before performing amnisure it may not be accurate.

I have never heard that intercourse can interfere with amnisure. This is what I found on the amnisure website

"Therefore, during the development

of AmniSure® and during clinical trials, there was no

interference of sperm factor in the results".

Is there some new info I'm not aware of??

Couple weeks ago, my coworker had a pt. with a negative amnisure, but when she checked her cervix, she got back a handful of thick mec. It does say that amnisure may not work in the presence of mec, so I'm just wondering if there are too many limitations to the test. I'm thinking maybe I will avoid using it, although I hate to do speculum exams....

[ducknurse]

Our physician did not like them in trials and we went back to Nitrazine and ferns

[redbeads]

Did she say why she rarely uses it?

Yes, she said that she gets good results with spec exams and simply doesn't feel that amnisure is often, if ever, necessary to r/o rupture. Although she didn't mention the cost factor, others have. Another reason was exactly what has been discussed here....when nothing else shows rupture of membranes, but someone does the amnisure and gets a positive result, then you have to proceed as if membranes are indeed ruptured. She felt that, similar to fetal fibronectin, amnisure results can have many false positives.

[JenTheRN]

Any two lines is considered a postitive, no matter how faint. I hope that patient has delivered by now. If not, she needs to come in! I agree with the above poster: that is just asking for a lawsuit!