Re: Amnioinfusion
From: Myer S. Bornstein (mborn@massmed.org)
Mon Oct 31 16:37:40 2005
Again
The inmates are running the show. A little knowledge is Bad. Passive
should be less problem than a pump, although we used a pump and all the
literature says continuous flow. This nurse needs to be re-educated
Myer
--
Myer S. Bornstein, MD, MMM, FACOG, FACPE
_____
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Lynn D.
Montgomery, M.D.
Sent: Monday, October 31, 2005 6:26 PM
To: Multiple recipients of list OB-GYN-L
Subject: Amnioinfusion
Listers,
I eagerly await your collective comments on the following that occurred to
me today.
Had a patient in labor at 5 cm, who began to have fairly significant
variable decels. An IUPC was placed and an amnioinfusion ordered. My
practice has always been to hang room temperature normal saline and allow it
to infuse via PASSIVE infusion (not on a pump) and have continuous infusion.
I have done this in my current facility for 7 years and overall for 17
years. In this case, the amnioinfusion was started and the variables
resolved.
However, the new nursing director of Labor instructed the nurses to
discontinue the amnioinfusion because the continuous infusion was dangerous
and not covered by the hospital policy. The variables recurred shortly
thereafter. I called her and asked her why she had given such instructions.
She stated that she had been involved with amnioinfusions for years and
never seen it provided as a continuous infusion and she considered it
unsafe. I advised that with passive infusion, there was no way it increased
risk and there was no data to support this. She replied by saying that she
could understand why this wouldn't increase the risk, but she was still
uncomfortable and would not allow "her nurses" to engage in this activity.
Fortunately, during the exchange, the patient went to complete and delivered
shortly thereafter.
I have never felt quite so helpless in my career.
Lynn
Lynn D. Montgomery, M.D.
Maternal-Fetal Medicine, OB/GYN
Rocky Mountain Women's Health
2835 Fort Missoula Rd., Suite 304
Missoula, Montana, 59804
406-549-0978
fax 406-549-0987
e-mail: apgar10@montanadsl.net
