Download Magnesium Sulphate Infusion PROCEDURE

Magnesium Sulphate Infusion
for the
Obstetrical Patient in Labour
Grey Nuns and
Misericordia
Community Hospitals
– Initiation and Maintenance of -
PROCEDURE
Approved by:
Director, Women’s Health, Covenant Health, GNH/MCH
Site Leads, Obstetrics/Gynecology, GNH/MCH
Labour and Delivery
Manual
Original Date
January 2004
Revised Date
June 2011
Next Review:
July 2014
Page 1 of 5
1.0
PURPOSE
To reduce the risk of and/or control seizure activity associated with preeclampsia and eclampsia.
2.0
GENERAL INFORMATION
2.1
Physician Responsibilities
General Practitioner will have obtained a transfer of care to Obstetrician
prior to initiation of infusion.
2.2
3.0
Registered Nurse Responsibilities
2.2.1 Obtain premixed solution from Pyxis (or prepare solution as per
procedure if premix not available).
2.2.2 Administer and maintain infusion.
2.2.3 Monitor condition of mother and/or fetus.
2.2.4 One to one nursing is recommended. Constant attendance is
required during the loading dose.
EQUIPMENT
3.1
3.2
3.3
3.4
3.5
3.6
3.7
IV Solution 1000mL Ringers Lactate for control
Premixed Magnesium Sulphate (MgSO4) Solution 50g/500mls 2/3 – 1/3
Alaris IV tubing x 2
Alaris Pump with minimum of 2 channels
IV tray / IV equipment
Fetal monitor
BP cuff (mechanical preferred)
HAVE TOXEMIA TRAY AVAILABLE AT BEDSIDE CONTAINING:
MgSO4 ANTIDOTE – CALCIUM GLUCONATE 10% 1g (10mL) solution
Dosage: 1 gram slow IV over 3 minutes
REFLEX HAMMER
4.0
PROCEDURE
Grey Nuns and Misericordia Community Hospital
Procedure Name: Magnesium Sulphate Infusion for the Obstetrical Patient in Labor
Initiation and Maintenance of
4.1
4.2
4.3
4.4
4.5
4.6
4.7
4.8
4.9
4.10
4.11
4.12
Check the chart to ensure physician’s order is written.
Explain the procedure to the patient.
Ensure oxygen and suction available at bedside and functional.
Prepare Control solution of 1000mL of Ringer’s Lactate. Control
solution should be primed through Alaris tubing.
Prime a second Alaris IV tubing with the pre-mixed MgSO4 solution
supplied by Pharmacy. Attach tubing to Alaris pump. Label tubing
above and below pump.
Establish IV and attach control tubing directly to IV catheter.
Once IV is established attach control solution tubing to Alaris pump.
Run Control infusion at 50mL/hour until MgSO4 infusion is started.
Perform baseline assessment of mother and fetus. Document in
progress notes.
- BP, pulse, respirations
- Deep tendon reflexes
- Contractions
- Fetal heart rate
Position patient preferably in left lateral position.
Piggyback MgSO4 solution to lowest port of control solution IV line.
Program Alaris pump for MgSO4 infusion with a second Registered
Nurse present to verify pump setting is correct.
Initiate MgSO4 solution loading dose of 4 grams as ordered. Run
pump over 20 minutes.
How to Program the Alaris Pump for a Magnesium Sulphate Infusion.
To set maintenance dose:
▪ Press Guardrail Drugs on Alaris panel.
▪ Choose MgSO4 Continuous (magnesium sulphate continuous)
▪ Concentration – choose 50 gm/500mls
▪ Under Continuous Infusion, input maintenance dose to run at
ordered 1-2 grams.
To set bolus dose:
▪ At bottom of panel, choose bolus.
▪ Input dose of 4 grams, duration 20 minutes (120 mL/hr).
2
Grey Nuns and Misericordia Community Hospital
Procedure Name: Magnesium Sulphate Infusion for the Obstetrical Patient in Labor
Initiation and Maintenance of
3
4.13
NURSING ALERT:
Continuous fetal monitoring is necessary while administering Magnesium
Sulphate.
4.14
5.0
At completion of 4 gm bolus Loading Dose, Alaris pump will
automatically switch to the set maintenance dose as ordered.
MONITORING PARAMETERS DURING MAGNESIUM SULPHATE
INFUSION
5.1
To assess patient as per chart below and document parameters on
appropriate records.
Frequency
Parameter*
Signs of
Toxicity
Action
Respirations
less than 14 or
greater than 26
Stop MgSO4
Notify house staff/
physician/ resident
Q 1 Hour
Should be co-checked at
shift change
Absent patellar
reflexes
Loss of deep
tendon reflexes
Stop MgSO4
Notify house staff/
physician/resident
Intake and
Output
(Insert foley
catheter)
Q 1 hour
Use of urinary Urometer
is recommended
Less than 30ml
(CHA Regional
Pharmacy 2005)
Notify house staff or
physician
Urine Protein
Test urine hourly with
dipstick
Loading Dose
Maintenance dose
BP
Q 15 minutes
Pulse
Q15 minutes
Q15 minutes for first
hour then Q1h X 4 then
Q4h or as ordered
Q 30 minutes
Respirations
Q15 minutes
Q 30 minutes
Breath sounds
Prior to start of
loading dose
Q 2 hours
Deep Tendon
Reflexes
(DTRs)
Prior to start of
loading dose
Level of
Consciousness
Q 15 minutes
Grey Nuns and Misericordia Community Hospital
Procedure Name: Magnesium Sulphate Infusion for the Obstetrical Patient in Labor
Initiation and Maintenance of
5.2
4
Signs of MgSO4 toxicity
NURSING ALERT: Stop MgSO4 and notify Primary Care Provider if any signs of
MgSO4 toxicity are present.
SIGNS OF MgSO4 TOXICITY:
 altered level of consciousness
 decreased respirations (less than 14)
 absent deep tendon reflexes
 urinary output is less than 30 mL/hour
6.0
DOCUMENTATION
5.1
5.2
5.3
5.4
5.5
Partogram and/or Patient Care Record.
I.V. Therapy Sheet
Medication Sheet (MAR)
Hourly Intake and Output Sheets
Blood Pressure Printout Record (if NIBP used)
NURSING ALERT:

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
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
Nursing Management of Seizure Activity
Protect the woman from harm (bedrails, falling, glasses, sharp objects) –
current practice is not to introduce an airway or tongue depressor into the
mouth.
Call for help.
Ensure the suction and O2 are ready.
Prepare the medications that are likely to be needed.
Start IV lines when the seizure ends (if not already done – beware volume
overload).
Position in left lateral when the seizure ends.
Restart EFM when the seizure ends.
Communicate with the family.
Document
In the event that premixed bags are not available:
Draw up 25g MgSO4 (50mL) (use filter straw for glass ampoules) (see Fluid
Therapy Manual “Use of Filter Straw”).
Add 25g (MgSO4) to 200mL Normal Saline (N/S) (concentration – 1g/10mL).
Grey Nuns and Misericordia Community Hospital
Procedure Name: Magnesium Sulphate Infusion for the Obstetrical Patient in Labor
Initiation and Maintenance of
7.0
REFERENCES
Alberta Health Servcies Regional Parenteral Manual – Edmonton Zone.
Retrieved June 21, 2011 from
www.intranet2.capitalhealth.ca/pharmacy/pm/index.asp
American Hospital Formulary Service Drug Information ’92
Guide to Parenteral Admixtures, 1990
Handbook on Injectable Drugs 6th edition, L. Trissel (1990)
JOGC
Kennedy, B.B., Ruth, D.J., Martin, E.J., (2009) Intrapartum Management
Modules. A Perinatal Education Program . (p.240) Philadelphia: Wolters
Kluwer Health, Lippincott Williams and Wilkins. 4th edition.
MOREOB Program. Retrieved on Hypertensive Disorders in Pregnancy.
June 21, 2011 from www. moreob.com
U.S.P.D.I. 12th edition, 1992
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