Tuesday, 27 September 2011

Cannulation success!

Cannulation success!

21.9.11 :

Today we were in maternity again. Quite an interesting day in that we got to see a vacuum assisted birth for the first time here (have seen one previously in England). The labour was not progressing quickly enough and the baby was starting to go into foetal distress - as shown by heavily meconium stained amniotic fluid that was released when the doctor ruptured the membranes, so the doctor decided to use the vacuum pump (ventouse delivery) to get the baby out. It was good to see something being done quickly about foetal distress for once! Aj had to pump the device (it is manual here rather than suction occurring by electricity like I think it does in the UK) and she was terrified she was going to pump too much and detach the babies scalp as this is a rare complication of using a ventouse. Fortunately this did not happen and the baby was born completely healthy, so good management by the doctor of this birth :D.

Second patient in maternity also had slow progress of labour in that she was not having regular enough contractions so it was decided to give her some oxytocin (promotes uterine contractions) and dextrose (literally sugar for energy). For this drip she needed a cannula put into one of her veins so I asked the midwife if I could have a go under her guidance. I’ve tried once before to get a cannula in while I’ve been here but last time although I initially got it into the vein, it came out before we had it properly secured as the woman was moving her arm about a lot with a contraction. I’ve never tried to cannulate in England except for on a prosthetic arm during a workshop, so I really wanted to get practice doing this while I was here. With help from the midwife (I did make a fair few initial mistakes and definitely needed her guidance) I got it in - Wooooo!! Glad to have one successful cannulation under my belt now – means if a patient asks me in England if I have done it before I can legitimately say yes!

- A cannula being inserted (Not by me! A) I wore gloves and B) my hands were probably shaking too much for a clear picture!)

The midwife also showed me how to do the quick HIV status check on the patient (involves just a finger prick and a test otherwise much like a pregnancy test) as this patients notes said that she was POSITIVE and the midwife wanted to double check. This test showed her to be NEGATIVE. Well I don’t know what the accuracy of the test is but it is pretty shocking if this lady has been told that she had HIV when actually she does not. I hope that was not the case and that the notes had just been written wrong!

She ended up needing a caesarean later in the evening as her labour still was not progressing enough. I watched the operation and the baby was born with a low Apgar score again and required CPR which I assisted in. This time I tried to make sure the CPR was done to the right guidelines and tell the midwives (I was doing the chest compressions so did this to the right number but the midwife was bagging to the wrong number again so I tried to tell her in a polite way what the current guidelines say the ratio should be) what these are…. It didn’t work, they ignored me. So I guess I have my answer to whether in the case of the baby who died (Blog: First do no harm and Who is to blame?) I could have made a difference; realistically they probably would not have listened to me then either. At least I tried to get the CPR done right this time though. This baby did start crying though and his Apgar score improved so I hope he will be ok.

Halfadoc x

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