Responding to Amniotic Fluid Embolism - AORN

JUNE 2009, VOL 89, NO 6Dobbenga-Rhodesstart directing her recovery; however, nursesshould not wait to implement these actions.These should be carried out alongside advancedcardiac life support protocols. Performing andproviding fundal (ie, uterine) massage can indicatethe degree of uterine atony and the patient’sresponse to therapy. Administration of oxytocin,a medication familiar to obstetric nurses, will berequired. Programming of IV pumps for oxytocinand the knowledge of its side effects ofwater intoxication from large infused volumes 53may be unfamiliar to critical care or perioperativenurses. Keeping the obstetric nurse involvedin the care of this patient after delivery, duringresuscitation, and while providing supportivecare allows the obstetric nurse to share his or herunique knowledge and expertise. A team approachto this lengthy—sometimes days-long—resuscitation effort will benefit the patient.Epidural catheters placed for labor analgesiashould remain in place until the patient has aplatelet count of at least 100,000 per millimeter. 5,54While on bed rest, pneumatic compression deviceswill help reduce the patient’s risk of otherthromboembolic events. 25 The ongoing task ofinspecting the patient’s episiotomy may requirethat the obstetric nurse educate OR, PACU, andcritical care nurses about how best to performthis task. Continual monitoring of postpartumblood loss can be done by weighing sanitarypads (1 g = 1 mL). Frequent patient care visits tothe PACU and critical care unit (CCU) by obstetricnursing staff members will ensure appropriateevaluation of the patient for breastfeeding,routine breast pumping, or general breast care.Routinely scheduled application of a breastpump every four hours for 15 minutes also mayhelp with uterine involution and decrease theneed for long-term oxytocin use.FAMILY SUPPORT. Unlimited family visitation inthe PACU and CCU is instrumental in the maternalpatient’s recovery, especially if the neo -nate is unable to visit or has died. Despiteneonatal outcome, facilitation of maternal-infantbonding should occur. This may mean havingsupport persons in the PACU and working withthe perinatal nursing staff members to safelytransfer the neonate for visitation. Pictures of thedeceased neonate or family viewing and holdingof the neonate’s body has been shown to aidKeeping the obstetric nurse involved inthe care of the patient after delivery,during resuscitation, and whileproviding supportive care allows theobstetric nurse to share his or herunique knowledge and expertiseto benefit the patient.in grief resolution. 55 Viewing should be encouragedthroughout the patient’s hospitalization,and trips to the morgue to retrieve the neo nateshould be conducted with respect and modesty.Allowing unlimited viewing of the deceasedinfant as well as unsupervised family time withthe mother is helpful. Family members maywant to take pictures of the infant, mother, orboth, which may seem morbid to someone unfamiliarwith perinatal loss, yet families expressdeep gratitude for any memento they have ofthis time. 55 The opportunity for such activitymay need to occur in the OR or PACU settingwhen there is little time or little hope of survivalof the maternal patient, the neonate, or both.Nursing staff members should anticipate a widerange of family members’ emotions, particularlyif the mother dies and the neonate survives. 33Many obstetric units have dedicated memoryboxes to hold copies of footprints, locks of hair,identification bands, receiving blankets, and pictures.Maternal patients and surviving familymembers may need counseling after such a traumaticevent. In some instances, the counselingmay include reproductive counseling for survivorswishing to undertake another pregnancy.Although this may seem daunting or ill-advised,there are six case reports of successful pregnanciesafter AFE with no recurrence. 56STAFF MEMBER SUPPORT. Care and support offeredto patients and family members is a natural re-1086 • AORN JOURNAL