Pregnancy test

[rmh149]

Question to all of you as to your standard proving negative pregnancy in your young female patients.

Example:

ASA-1 22yo female (obviously)
scheduled for Diagnostic laparoscopy at 0730
Serum pregnancy 7 days prior negative.
States that there is no way possible she can be pregnant (right).
Cannot provide urine sample because she just voided. It is 725 am

Your thoughts.

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[jetproppilot]

Question to all of you as to your standard proving negative pregnancy in your young female patients.

Example:

ASA-1 22yo female (obviously)
scheduled for Diagnostic laparoscopy at 0730
Serum pregnancy 7 days prior negative.
States that there is no way possible she can be pregnant (right).
Cannot provide urine sample because she just voided. It is 725 am

Your thoughts.

Important topic as this happens everywhere, everyday.

Previous gig had UPTs in day surgery.....quick, reliable.

Current gig if situation like you described comes up, nurse has patient sign a form saying theres no way she could be pregnant. Dont know how legally useful this is but thats how they do it.

 

[excalibur]

Jet,
What is your current gig? Are you out of New Orleans? Please PM me if you don't feel like giving the details of your new job on the thread. Thanks.

 

[Syranope2]

Question to all of you as to your standard proving negative pregnancy in your young female patients.

Example:

ASA-1 22yo female (obviously)
scheduled for Diagnostic laparoscopy at 0730
Serum pregnancy 7 days prior negative.
States that there is no way possible she can be pregnant (right).
Cannot provide urine sample because she just voided. It is 725 am

Your thoughts.

Forgive me if I'm totally off, just a med student, but can't you just place a foley and do a urine pregnancy test from that? She should have some urine in there, even if she just voided.

 

[Noyac]

Forgive me if I'm totally off, just a med student, but can't you just place a foley and do a urine pregnancy test from that? She should have some urine in there, even if she just voided.

You can't just do a procedure in the preop area to test for pregnancy. If yo are saying that you place a foley once she is asleep then it is too late. The reason for the pregnancy test is to catch it b/4 you put her to sleep.

I had an attending in residency that felt that if the pt stated that she wasn't pregnant then that was all he needed. Others felt that these cases were a no go unless emergencies until the UPT was negative. I currently, use the quick urine test if necessary but we usually have it sent to lab early on in the pre admit.

 

[TIVA]

Guys, in all fairness, who cares if the patient is pregnant. It's not going to change your anesthetic plan. A positive pregnancy test might change the surgeon's plan (e.g. elective abdominal or pelvic surgery), but it ain't gonna change your plan. Right? Versed and nitrous oxide are no longer considered to cause birth defects. Right?

Right now our institution is debating getting rid of pregnancy tests in our pre-op clinic as well as same-day surgery center. If the surgeon orders it, fine, we'll do it. But if the surgeon doesn't order it, we're not inclined to order it either.

 

[zippy2u]

Put that 18 gauge in her real quick like and open it up. Slip lasix 5mgs.IV pronto. She'll fill up that little cup soon enough and keep everyone happy. Tell surgeon to empty bladder prior to case after she's asleep. Regards, --Zip

 

[rmh149]

Guys, in all fairness, who cares if the patient is pregnant. It's not going to change your anesthetic plan. A positive pregnancy test might change the surgeon's plan (e.g. elective abdominal or pelvic surgery), but it ain't gonna change your plan. Right? Versed and nitrous oxide are no longer considered to cause birth defects. Right?

Right now our institution is debating getting rid of pregnancy tests in our pre-op clinic as well as same-day surgery center. If the surgeon orders it, fine, we'll do it. But if the surgeon doesn't order it, we're not inclined to order it either.

Possibly, but I don’t know if I would agree to do an anesthetic for an elective diagnostic laparoscopy on a pregnant person where the surgeon is going muck around in her abdomen with sharp things real close to the uterus. Not to mention, if we don’t know she is pregnant...and they stick that uterine manipulator in their uterus....it can’t be good for the little one.

It is still my opinion...we dont go back for elective procedures unless I know without a doubt she is not pregnant. If she is....I am not touching her. Even if everything was perfect, and she has a spontaneous abortion a couple of weeks later (like so many do), I can still see a line of attorneys knocking on her door to get a piece of my liability insurance cash.

For this case stated above, we pulled as serum pegnancy. We moved on to the next scheduled patient. The day was 30 minutes behind....but we had piece of mind.

 

[TIVA]

Possibly, but I don’t know if I would agree to do an anesthetic for an elective diagnostic laparoscopy on a pregnant person where the surgeon is going muck around in her abdomen with sharp things real close to the uterus. Not to mention, if we don’t know she is pregnant...and they stick that uterine manipulator in their uterus....it can’t be good for the little one.

It is still my opinion...we dont go back for elective procedures unless I know without a doubt she is not pregnant. If she is....I am not touching her. Even if everything was perfect, and she has a spontaneous abortion a couple of weeks later (like so many do), I can still see a line of attorneys knocking on her door to get a piece of my liability insurance cash.

For this case stated above, we pulled as serum pegnancy. We moved on to the next scheduled patient. The day was 30 minutes behind....but we had piece of mind.

Try not to paint yourself in a corner. A surgeon "mucking around" in the abdomen can damage many other organs other than a pregnant uterus, including the liver, bowel, and major vessels. It's a risk that comes with the surgery. It's a surgical risk, not an anesthetic risk. With that line of thinking, you would cancel any case that involved trespassing the abdomen, pregnant or not.

And don't be so quick to cancel elective procedures on pregnant patients. Would you also cancel hand surgery cases like carpal tunnels?

 

[rmh149]

Try not to paint yourself in a corner. A surgeon "mucking around" in the abdomen can damage many other organs other than a pregnant uterus, including the liver, bowel, and major vessels. It's a risk that comes with the surgery. It's a surgical risk, not an anesthetic risk. With that line of thinking, you would cancel any case that involved trespassing the abdomen, pregnant or not.

And don't be so quick to cancel elective procedures on pregnant patients. Would you also cancel hand surgery cases like carpal tunnels?

Honestly, I probably would. Maybe I wont in the future when there is enough evidence to show otherwise.

And I very seriously doubt any of our surgeons would proceed with an elective procedure if the patient was pregnant.

Just recently we had a positive pregnancy test on a GYN patient. Her HCG levels were only 35....very low...but positive. We cancelled her case.

 

[TIVA]

And I very seriously doubt any of our surgeons would proceed with an elective procedure if the patient was pregnant.

.

Yes, that's my point. A pregnant patient is a surgeon's consideration. Not ours.

 

[BLADEMDA]

Honestly, I probably would. Maybe I wont in the future when there is enough evidence to show otherwise.

And I very seriously doubt any of our surgeons would proceed with an elective procedure if the patient was pregnant.

Just recently we had a positive pregnancy test on a GYN patient. Her HCG levels were only 35....very low...but positive. We cancelled her case.

I'm sure the surgeons are very happy when a CRNA decides to cancel one of their cases. After all, your Medical School Education makes your decision the final say in the matter, right?

 

[BLADEMDA]

Yes, that's my point. A pregnant patient is a surgeon's consideration. Not ours.

Wrong. You share the medical liability in every decision made to do a case.
This is why you are a Doctor and not a Nurse. The jury expects you to "stand up" to the other Doctor when needed. I have seen this fact first hand and you can't just expect to automatically get away with "the surgeon wanted to proceed" or "surgeon requests" when you are a Physician. When something goes wrong (and it will eventually) it will AMAZE you how much authority the surgeon will state in court you had over the case and the medical decisions.

Blade

 

[rmh149]

I'm sure the surgeons are very happy when a CRNA decides to cancel one of their cases. After all, your Medical School Education makes your decision the final say in the matter, right?

You are correct. My nursing anesthesia education makes my decision the final say when it comes to me providing that patient anesthesia. The surgeons dont argue. They know we are the last authority to cancel or proceed with the case.

Blade, would you proceed or cancel an elective procedure for a patient with a positive serum pregnancy?

 

[Planktonmd]

Wrong. You share the medical liability in every decision made to do a case.
This is why you are a Doctor and not a Nurse. The jury expects you to "stand up" to the other Doctor when needed. I have seen this fact first hand and you can't just expect to automatically get away with "the surgeon wanted to proceed" or "surgeon requests" when you are a Physician. When something goes wrong (and it will eventually) it will AMAZE you how much authority the surgeon will state in court you had over the case and the medical decisions.

Blade

I have to agree with this statement, I've been there too.

 

[TIVA]

Wrong. You share the medical liability in every decision made to do a case.
This is why you are a Doctor and not a Nurse. The jury expects you to "stand up" to the other Doctor when needed. I have seen this fact first hand and you can't just expect to automatically get away with "the surgeon wanted to proceed" or "surgeon requests" when you are a Physician. When something goes wrong (and it will eventually) it will AMAZE you how much authority the surgeon will state in court you had over the case and the medical decisions.

Blade

What your saying is completely legitimate. But not quite what I was getting to. I don't condone simply relegating yourself to a tech on a factory line.

But to get back on topic, how would your anesthetic management change for a 22 y.o. ASA I female undergoing a Dx laparoscopy, who may or may not be pregnant? I don't think I'm reckless in saying that my anesthetic management won't change. At least the ASA Anesthesia Newsletter on Obstetric Anesthesia (published a few months ago) agrees with my sentiments. I'll try to find the exact article and post it.

 

[rmh149]

What your saying is completely legitimate. But not quite what I was getting to. I don't condone simply relegating yourself to a tech on a factory line.

But to get back on topic, how would your anesthetic management change for a 22 y.o. ASA I female undergoing a Dx laparoscopy, who may or may not be pregnant? I don't think I'm reckless in saying that my anesthetic management won't change. At least the ASA Anesthesia Newsletter on Obstetric Anesthesia (published a few months ago) agrees with my sentiments. I'll try to find the exact article and post it.

My anesthetic plan would not change if I proceeded despite a positive pregnancy result. However, I would only proceed if the case was not elective.

 

[caroladybelle]

Important topic as this happens everywhere, everyday.

Previous gig had UPTs in day surgery.....quick, reliable.

Current gig if situation like you described comes up, nurse has patient sign a form saying theres no way she could be pregnant. Dont know how legally useful this is but thats how they do it.

No dice, love.

My every two year scope is done under diprovan - and every single time, they require me to pee in the cup.

It doesn't matter that I am 42 and frequently have the social life of a nun. I can swear to the Heavens that I can't be pregnant (can't have the disease if you aren't exposed within the appropriate incubation period), I still have to pee in a cup. And after being NPO for 8-12 hours, this is a bit difficult. They usual crank some IV fluids.

A few years ago, I sustained an animal bite, that was suspect for rabies. They made me have a pregnancy test before gamma globulin and vaccination. Interesting conundrum: so if I had been positive, would they have just let me die of rabies?

Interestingly the same facility did numerous chest xrays on me without testing for pregnancy....while I was younger and exposed to more risk. They also gave chemo to me without checking for pregnancy - it just got "missed".

 

[epidural man]

Forgive me if I'm totally off, just a med student, but can't you just place a foley and do a urine pregnancy test from that? She should have some urine in there, even if she just voided.

No, but you can use serum on a pregnancy dip stick - it will turn positive if the preggers hormone is around.

 

[Noyac]

Even if everything was perfect, and she has a spontaneous abortion a couple of weeks later (like so many do),

What do you mean "like so many"? Are you saying that "so many" have spont ab's after surgery or that they just have spont ab's often in general?

 

[rmh149]

What do you mean "like so many"? Are you saying that "so many" have spont ab's after surgery or that they just have spont ab's often in general?

Often in general.

 

[armygas]

This was a study on that very topic and conducted by an anesthesiologist for which I have the utmost respect (truly one of the most intelligent people I have ever met and worked with), you may find it interesting.

http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ija/vol7n1/pregnancy.xml

The Usefulness Of A Preoperative Pregnancy Questionnaire In Determining The Need For Pregnancy Testing Prior To Anesthesia



Results

The data collected from the patient histories indicated that only 21 patients should have undergone preoperative testing. These assessments were made based on inconclusive information regarding last menstrual period, sexual activity and the use of contraception. Even with our concerns from the histories, only one of the 21 tested positive. That particular patient indicated on the questionnaire that there was no chance that she could be pregnant, but said that she was sexually active and used a barrier method (condom) for contraception.