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AmnioinfusionFrom: Lynn D. Montgomery, M.D. (apgar10@montanadsl.net)Mon Oct 31 16:25:05 2005
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
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