Nitrazine Paper - Point of Care Testing - Duke University

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Policy Deployment
Policy Name: Nitrazine pH Paper Institution: Duke University
Health System
Supersedes: Division: Durham Regional
Hospital
Policy Level: Department Department: Patient Care
Owner(s)
Approved by:
Susan Montsinger,
MT(ASCP)
Victoria Orto, MS,
RN, NEA-BC
Contributing
Departments:
Manual Name:
Patient Care
Original Effective 11/1997 Manual Chapter:
Date:
Revision Date: 09/27/12
Scheduled Review
Date:
APPLICABLE STANDARDS: THE JOINT COMMISSION
POLICY:
Scheduled Review
Interval:
36 months
WT.01.01.01- WT.05.01.01
PURPOSE:
To offer guidelines on the use of Nitrazine pH paper to rule out ruptured membranes in the patient
with intrauterine pregnancy. To differentiate amniotic fluid that is slightly alkaline, from urine and
purulent material (pus), which are acidic. Nitazine pH is for screening as an aid to diagnosis of fetal
membrane rupture.
GENERAL POLICIES
The policies and procedures pertaining to Nitrazine pH testing, quality control, and record
keeping are reviewed by the Laboratory Point of Care Coordinator and Laboratory Director
annually.
Any changes to the text as they apply to methodology, instrumentation, or testing policy are signed by
the appropriate authority, dated, and inserted in the policies and procedures manual.
Any obsolete or superseded procedures are replaced in the policies and procedures manual, but
retained for filing and legal purposes.
Nitrazine pH testing may be performed by credentialed RN’s, LPN’s, PCA’s, and Health Care
Techs. Nursing students under the supervision of a credentialed RN may perform the procedure.
Universal precautions and guidelines must be followed when performing the Nitrazine pH test.

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Nitrazine pH analysis must be ordered by the patient’s physician.
PATIENT IDENTIFICATION:
Verify patient identification by checking the patient's name and date of birth on the arm band.
PATIENT PREPARATION:
Explain the purpose of the test and the steps of the procedure to the patient prior to performing
the test.
The operator’s hands must be washed before and after testing.
Because of the hazardous nature of handling specimens contaminated with blood and body
fluids, it is required that disposable latex gloves or an acceptable substitute be used when
collecting specimens and test procedures. Standard precautions shall be observed for all
specimens contaminated with blood and body fluid and they should be handled at Biosafety
Level 2 as recommended for any potentially infectious material in the Centers for Disease
Control/National Institutes of Health manual, Biosafety in Microbiological and Biomedical
Laboratories, 1988 or in the National Committee for Clinical Laboratory Standard Document
M29, Protection of Laboratory Workers from Infectious Disease Transmitted by Blood, Body
Fluids, and Tissue, 1991.
SUPPLIES: Gloves
Nitrazine paper
Nitrazine pH Quality Control buffers
STORAGE:
It is recommended that the Nitrazine pH paper be stored securely in its holder in a dry place at room
temperature. Nitrazine pH papers expire on the date printed on the foil wrapper.
QUALITY CONTROL:
1. Nitrazine pH paper test strips should be tested when opening a new container and at least
weekly using Nitrazine pH buffer controls, 5.0 and 7.0.
2. Check the expiration date of the Nitrazine pH paper.
3. Check the pH of each buffer; 5.0 and 7.0. Record the results on the Nitrazine pH QC Log.
4. Note any failures on the Nitrazine pH QC Log. Retest; if failure again, obtain a new box of
Nitrazine pH paper and /or buffer(s) and follow steps= 1-4. Document corrective action
taken on the QC Log.
PROCEDURE:
1. Explain procedure to woman/couple.
2. Ensure that the fluid is appropriate for Nitrazine pH testing. Do not use for urine or gastric
pH.
3. Check the expiration date of the Nitrazine pH paper.
4. Remove 3-4 inches of Nitrazine pH paper from container. With gloved hand, insert
Nitrazine pH paper into the introitus of the vagina. Remove hand and paper.

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INTERPRETATION OF COLOR CHANGE:
COLOR pH INTERPRETATION
yellow 5.0 membranes are probably not ruptured
olive 5.5 “
olive-green 6.0 “
blue-green 6.5 membranes are probably ruptured
blue-grey 7.0 “
deep blue 7.5 may be due to blood or cervical mucous\
**The Nitrazine pH values of blood, vaginal mucus, and certain secretions from vaginal infections are
also alkaline. If the amount of amniotic fluid is small or absent but the above substances are present
in large amounts, a false positive test could result. The Nitrazine pH test is not considered a definitive
test for diagnosing ruptured membranes. Refer to the Fern Test for this.
REPORTING RESULTS:
1. Record patient results as positive or negative in the narrative nursing notes.
2. Notify physician of results.
3. The RN in charge of the patient will review , correlate, and assess results over
each 24 hour period. The patient’s physician reviews results at a minimum each 24
hours.
COMPETENCY/CREDENTIALING
The Nitrazine pH test competency certification/evaluation will be conducted annually. The
Nurse Manager conducts the orientation training. The unit Nurse Manager or designee is
responsible for overseeing this process of orientation and annual training. The training records
are kept in the employee continuing education file. The nurse manager will submit a list of
certified operators and their dates of competency training each year to the Laboratory Point of
Care Coordinator.
QUALITY ASSURANCE
The Laboratory Point of Care Coordinator will submit a Quality Improvement Report to the
Laboratory Director for PPM and Waived testing (nursing), Nurse Mangers, and DRH
Laboratory Director quarterly.
REFERENCE:
Martin, Jean E, RN,(edited) Intrapartum, Management Modules- A Perinatal Education Program.
Nitrazine Paper Test for Rupture Membranes. 1990.
Procedure reviewed/approved by:
___________________________________
Victoria Orto, MS, RN, NEA-BC Date
Chief Nursing Officer