Procedure Page 1 of 3 L&D/OB-GYN - Unit Practice Manual John ...

Procedure Page 1 of 3L&D/OB-GYN - Unit Practice ManualJohn Dempsey Hospital – Department of NursingThe University of Connecticut Health CenterPROCEDURE FOR: AmniocentesisPOLICY: To provide safe nursing care during and after the amniocentesis.Amniocentesis is performed in Labor & Delivery to assess fetal lungmaturity, establish rupture of membranes, rule out infection, evaluatefetal well-bring or evaluate for chromosomal abnormalities.POLICY:1. All pregnant patients with potentially viable fetus’ who requireamniocentesis will be performed on the Labor and Delivery unit.2. A minimum tracing of 20 minutes before and 30-60 minutes after theamniocentesis will be obtained to establish fetal and uterine status.3. RH status will be determined before amniocentesis procedure.4. All patients will have IV access prior to procedure.EQUIPMENT:1. Amniocentesis kit2. #20 or #22 gauge 3.5 or 6 inch spinal needle3. Lidocaine 1% (optional)4. Ice if for L/S ratio5. Laboratory requisition form6. Electronic Fetal Monitor*If amniocentesis is to rule out spontaneous rupture of membranes (SROM)add:a) Indigo Carmineb) #20 or #22 gauge needlec) 12 cc syringed) Tampon*If amniocentesis is for twins add:a) Additional spinal needleb) Indigo Carminec) #20 or #22 gauge needled) 12 cc syringe*If amniocentesis is for genetics add:a) Two or more plastic centrifuge tubes with orange plug seal capsb) A copy of the patient’s insurance card or ‘face sheet’ withinsurance information on it. Send to lab with requisition.

Procedure Page 2 of 3L&D/OB-GYN - Unit Practice ManualJohn Dempsey Hospital – Department of NursingThe University of Connecticut Health CenterPROCEDURE FOR: AmniocentesisDOCUMENTATION:1. Document time of procedure on appropriate flow sheet.2. Fetal heart rate (FHR) baseline and uterine activity (UA) baselineshould be documented both before and after the procedure on theappropriate flow sheet.PROCEDURE:ACTIONPOINTS OF EMPHASIS1. Explain procedure to patient. Givesupport as needed.1. Written consent must be obtained by MD.2. Positions patient in low Fowlers ordorsal recumbent position with hip roll.3. Place the patient on the fetal monitor.4. Obtain maternal vital signs and IVaccess. If Rh status unknown obtain typeand screen.5. Before beginning the procedure a “timeout” will be called.3. A minimum tracing of 20 minutes beforethe procedure should be obtained toestablish fetal and uterine status.5. Document “time out” check was completed.6. When ready, remove the fetal monitor andassist the physician as needed with theprocedure.7. Label the specimens with patient’s T00#and the patient’s name.7. A tracing of 30-60 minutes should berecorded following amniocentesis toestablish fetal.8. Re-apply the fetal monitor after theprocedure to document FHR and UA postprocedure.9. To rule out SROM, place a tampon in thevagina after the procedure. Encourageambulation after completion of fetalmonitoring. Remove tampon after aminimum of two hours. Inspect for colorchange.9. Include the gestational age anddiagnosis, T00#, attending physician andreason for testing.a) Fluid must be send to lab by 11:00A.M. if an L/S ratio result is to becompleted by that evening.b) Bilirubin in amniotic fluid breaksdown if exposed to light.c) If the specimen is bloody a FISHcannot be done because of maternalcell contaminations.

Procedure Page 3 of 3L&D/OB-GYN - Unit Practice ManualJohn Dempsey Hospital – Department of NursingThe University of Connecticut Health CenterPROCEDURE FOR: Amniocentesis10. Enter order for amniocentesis; lablabels will generate.a) For L/S ratio place specimen in a redtop tube, place on ice and transfer tolab.b) For Delta O/D 450 place in red toptube and immediately wrap tube inaluminum foil from amnio kit.c) For genetics specimens, no ice isrequired. A minimum of 25 cc ofamniotic fluid is required. Transferthe fluid from the syringes into thecentri-fuge tubes (with orange plugseal caps). Label the tubes with thesticker going lengthwise taking carenot to cover the numbers on the tube.Send the fluid to central processing(same as for all lab specimens).*Fill out a cytogeneticsrequisition form.*In the “Indication for Test”area under “Additional ClinicalInformation”, please note ifthere is an intrauterine fetaldemise (IUFD) / if the patienthad an amnioinfusion / if laboris being induced / or any otherrelevant clinical information.11. Give Rhogam if indicated before patientis discharged11. Discharge instruction Sheet must besigned by patient and witnessed. Copygiven to patient. Original placed inpatient chart.12. Provide post amniocentesis dischargeinstructionREFERENCES:CREDENTIALS:Nursing Standards CommitteeRNEFFECTIVE DATE: 5/79REVISION DATES: 8/93, 6/02, 1/04, 6/04, 1/09, 5/12, 12/12