Fetal heart tones during placement of labor epidural

[narcusprince]

When placing the labor epidural does your practice require continuous fetal heart rate monitoring?

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[Wiscoblue]

Nope. The belt gets in my way. They can put it back as soon as I'm done sticking down my catheter. It's only 5 minutes anyway.


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[twoliter]

When placing the labor epidural does your practice require continuous fetal heart rate monitoring?

Nope

 

[teeva]

Same as wiscoblue

 

[jwk]

Nope - much ado about nothing.

 

[Gas]

I move the strap underneath patient's bottom - pretty much have her sitting on it, so no fetal heart tones. When I'm done with the epidural, I place tegaderm and silk tape over the catheter, and then move the strap back up over the tape.

 

[GA8314]

When placing the labor epidural does your practice require continuous fetal heart rate monitoring?

I notice a lot of our docs and residents are doing them. I personally do not document but do document Sp02. But, not FHR.....

 

[Wiscoblue]

I move the strap underneath patient's bottom - pretty much have her sitting on it, so no fetal heart tones. When I'm done with the epidural, I place tegaderm and silk tape over the catheter, and then move the strap back up over the tape.

I used to do this until once it snapped up into the field. So now I insist that the nurse remove it and replace it after I'm done. If they insist that they need to monitor during the epidural, they can hold the transducer or use a stethoscope or whatever.


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[d9sccr]

Granted I'm still in residency but we always monitor through placement (yes placement can take the new CA-1s some time). Just use some tape and tape the strap up. Once you have the epidural in place and the tegaderm secured, just release the tape and take it off to tape it up the back.

 

[anbuitachi]

I used to do this until once it snapped up into the field. So now I insist that the nurse remove it and replace it after I'm done. If they insist that they need to monitor during the epidural, they can hold the transducer or use a stethoscope or whatever.


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got to realy shove it underneath their butt so that its no longer visible to you.

Granted I'm still in residency but we always monitor through placement (yes placement can take the new CA-1s some time). Just use some tape and tape the strap up. Once you have the epidural in place and the tegaderm secured, just release the tape and take it off to tape it up the back.

Not just CA1s, anyone i feel like. we live in a fat country and some of them are just blobs with no palpable landmarks. Some of them you need to use longer than a 10cm needle cause it wont reach their space.. There's been like 2-3 wet taps per week here. Attending spent 30 min on 1 epidural last week, ended up with wet tap. I retried in a hour, no visible wet tap, felt good, catheter went in easily, completely neg lidocaine test, but on aspiration, got out a ton of csf in syringe lol

 

[pjl]

If you pull the straps up, and tuck the gown into it right it holds the straps up and also keeps their gown from falling down and exposing them.
Hard to explain in words, but get just a little pinch of gown from a few inches above where straps end up and tuck it in from the bottom side of the straps.


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[d9sccr]

If you pull the straps up, and tuck the gown into it right it holds the straps up and also keeps their gown from falling down and exposing them.
Hard to explain in words, but get just a little pinch of gown from a few inches above where straps end up and tuck it in from the bottom side of the straps.


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Sounds like a nice hack...will have to try that next time I'm on OB

 

[sigrhoillusion]

got to realy shove it underneath their butt so that its no longer visible to you.



Not just CA1s, anyone i feel like. we live in a fat country and some of them are just blobs with no palpable landmarks. Some of them you need to use longer than a 10cm needle cause it wont reach their space.. There's been like 2-3 wet taps per week here. Attending spent 30 min on 1 epidural last week, ended up with wet tap. I retried in a hour, no visible wet tap, felt good, catheter went in easily, completely neg lidocaine test, but on aspiration, got out a ton of csf in syringe lol

"There's been like 2-3 wet taps per week here. Attending spent 30 min on 1 epidural last week, ended up with wet tap. I retried in a hour, no visible wet tap, felt good, catheter went in easily, completely neg lidocaine test, but on aspiration, got out a ton of csf in syringe lol"

So wait... the attending struggled for 30 minutes on an epidural and then wet tapped, and then said... "**** it!" and just left...? Then he sent you up there an hour later to have you struggle and then wet tap again anyway? This is the kind of patient where I'd place the spinal catheter, label it, tell OB and nurses no to touch it and inform patient of PDPH symptoms.

Also, seems like a lot of wet taps in general.

 

[deleted162650]

If you pull the straps up, and tuck the gown into it right it holds the straps up and also keeps their gown from falling down and exposing them.
Hard to explain in words, but get just a little pinch of gown from a few inches above where straps end up and tuck it in from the bottom side of the straps.

Then all that crap is still in your way when you go to tape the catheter. Easier to just stuff it under their butt or have the nurse undo them altogether.

 

[Consigliere]

Stupidity

 

[anbuitachi]

"There's been like 2-3 wet taps per week here. Attending spent 30 min on 1 epidural last week, ended up with wet tap. I retried in a hour, no visible wet tap, felt good, catheter went in easily, completely neg lidocaine test, but on aspiration, got out a ton of csf in syringe lol"

So wait... the attending struggled for 30 minutes on an epidural and then wet tapped, and then said... "**** it!" and just left...? Then he sent you up there an hour later to have you struggle and then wet tap again anyway? This is the kind of patient where I'd place the spinal catheter, label it, tell OB and nurses no to touch it and inform patient of PDPH symptoms.

Also, seems like a lot of wet taps in general.

Oh no, the patient needed a break. i shortened the story. a hr later we went back to check and she agreed to retry epidural, but i did it instead of attending. new pair of hands!

 

[pjl]

Then all that crap is still in your way when you go to tape the catheter. Easier to just stuff it under their butt or have the nurse undo them altogether.

Nah, you tape the insertion part then move bands back down and tape the last part up their back, takes almost no time.


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[Noyac]

I have the husband glove and gown up so as to feel like they are a part of the "most" important part of the delivery of their baby, the epidural. I instruct the husband that in no circumstances is he to "pass out" or else all **** will hit the fan. Then I instruct him to hold the fetal monitor in place or else his child may suffer a terrible outcome. Then I ask the nurse to go get me a cup of freshly brewed coffee. Not anything that has been in the pot for more than 15 seconds.

I have never had a fetal monitor get in my way since adopting this approach.