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    C-Section Room Setup:: OB Rotation Notes

    Uploaded by

    Eric
    This document provides guidance on setting up for a C-section procedure, including ensuring necessary equipment and medications are prepared. It outlines the documentation required during the procedure and for emergency situations. Instructions are given for preparing an epidural or spinal block, including pulling the correct medications and labeling syringes. Key details on administering the initial bolus and maintenance doses are highlighted.

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    © All Rights Reserved
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    C-Section Room Setup:: OB Rotation Notes

    Uploaded by

    Eric
    73 views5 pages
    This document provides guidance on setting up for a C-section procedure, including ensuring necessary equipment and medications are prepared. It outlines the documentation required during the procedure and for emergency situations. Instructions are given for preparing an epidural or spinal block, including pulling the correct medications and labeling syringes. Key details on administering the initial bolus and maintenance doses are highlighted.

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    OB Notes

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    This document provides guidance on setting up for a C-section procedure, including ensuring necessary equipment and medications are prepared. It outlines the documentation required during the procedure and for emergency situations. Instructions are given for preparing an epidural or spinal block, including pulling the correct medications and labeling syringes. Key details on administering the initial bolus and maintenance doses are highlighted.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    73 views5 pages

    C-Section Room Setup:: OB Rotation Notes

    Uploaded by

    Eric
    This document provides guidance on setting up for a C-section procedure, including ensuring necessary equipment and medications are prepared. It outlines the documentation required during the procedure and for emergency situations. Instructions are given for preparing an epidural or spinal block, including pulling the correct medications and labeling syringes. Key details on administering the initial bolus and maintenance doses are highlighted.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 5

    OB Rotation Notes

    C-Section Room Setup:


    full machine check 
    ancillary O2, nasal cannula, EKG pads
    paperwork: anesthesia record, preop questionnaire, charge sheet, post-op sheet, order set.
    ETT (7, 6.5, 6) with stylets and syringes
    2 working laryngoscopes with 1 Mac, 1 miller blade + extras in drawer
    emesis basin / working suction
    LR bags x 2 (LUD IV)
    empty syringes for emergency induction: 10cc sux, 20cc propofol 

    Drugs: 
    5cc syringe for oxytocin need 2 vials for 2cc (20units) total = 10units/cc final concentration

    10cc syringe + TB for phenylephrine (neosynephrine) syringe draw up 0.1cc and add to 10cc of
    NS = 100mcg/cc final concentration

    5cc syringe for ephedrine, draw up 1cc (1 vial of 50mg/cc) ephedrine add to 4cc NS = 10mg/cc
    final concentration

    TB syringe, draw up 0.2cc of duramorph from 10cc vial, save for adding to spinal, draw up
    remainder in a 10cc syringe, (save for pain management after baby out)

    5cc syringe for zofran (1-2 vials) 2mg/cc final concentration

    two empty 3TB syringes and 23g IM needle for Tordol (after cleared with surgeon)

    one empty 10cc syringe for antibiotic

    1 cup 30ml sodium citrate (bicitra) give to patient in room as soon as done interviewing when
    ready to proceed

    AMPLE history for Emergencies:


    Allergies
    Meds
    Past illness/surgeries
    Last meal
    Events (leading up to emergency)

    Epidural/spinal risks/benefits

    RISKS
    OB Rotation Notes

    Back & Nerve pain, damage (back pain = most common)


    Hematoma (blood clot)
    Infection (we use sterile technique)
    Not work/one-sided
    Blood pressure drop/nausea
    PDPHeadache (HOLD STILL)
    Slow or speed labor time

    BENEFITS
    Makes labor tolerable (not pain & pressure free)
    Goal: 4/10 pain scale
    Allow relaxation/nap

    NOTIFY US IF
    Nausea
    Unable to lift legs
    SOB/tingly fingers
    Pain 7/10

    C-Section Room Documentation:


    ___: Interviewed and assessed.
    __:Time to OR #__
    patient safely to OR table with assist.
    lower lumbar sterile prep and drape
    __cc lidocaine skin wheel
    Introducer inserted at L4-L5 
    20g needle – blood, - paresthesia, + CSF.
    __cc bupovacaine 0.75% with 0.2mg duramorph injected. – paresthesia
    ___: T4 level noted
    Foley with clear yellow urine.
    MD notified.

    __: uterine incision


    __: baby out
    __:oxytocin 20units added to IV fluid bag.
    APGARS__\__

    __: to room #__. VSS. Awake and talking. no distress. Report to RN. 

    Emergency / Failed block C-Section Documentation:


    __: Interviewed and assessed. Anesthesia education. States no questions.
    __: To CS#, transferred to OR table safely with assist. 
    Spinal per MDA/CRNA name. +CSF, marginal aspiration. Failed block. Patient elects to GA.

    -or-
    OB Rotation Notes

    Multiple attempts at SAB by RRNA, CRNA, MDA without success. Patient elects to GA.
    Standard O2 and monitors placed. Pre-oxygenated, surgical prep and draped. SIVI. Intubated per
    CRNA. ETT secured # at lip. Detention as preop. Clear yellow urine in foley bag. MD notified. 

    __:Uterine Incision
    __:Baby Out
    __:APGARS

    __: 20units oxytocin added to IV fluid bag.


    __:Additional 20units oxytocin added to fluid bag per surgeon request (etc)

    __: Awake. Follows commands. Good resp. effort. VSS. Suctioned and Extubated.

    __:To room #. Report to RN. Awake and talking. VSS.

    Epidural /Spinal Prep

    get name and room number from nurse


    take 8 patient stickers from chart
    2 for epidural/spinal sheet + yellow copy
    1 for patient questionnaire
    3 for syringes
    1 for blue card 
    1 for epidural bag

    pull meds from pixis:

    RRNA Kit:
    100mcg/cc vial fentanyl

    30cc vial Marcaine (0.25% bupivicaine)

    epidural bag of marcaine + 3.6mcg/cc fentanyl from fridge

    1cc vial of ephedrine (if not included in epidural kit) mix with 4cc NS

    draw up 10 cc syringe labeled blue and gray with 100mcg fentanyl and 9cc Marcaine 

    draw up 10cc syringe x 2 gray labeled syringes with 10cc each Marcaine

    draw up 5cc syringe labeled purple with 4cc NS to add ephedrine to

    set on top of cart:


    paperwork
    OB Rotation Notes

    o2 pulsoximeter
    meds labeled with patient stickers
    primed epidural bag with yellow tubing from bottom drawer
    correct size sterile gloves
    2-3 extra tegaderms

    nurse will have epidural kit in room

    insure fluid bolus (500-1000mL) received within last 30 min

    check for platelet count (must be >150, >100 if approved by anesthesiologist)

    Initial bolus: 10cc 0f 0.25% bupivicaine with 100mcg fentanyl


    Maintenance: ____ cc/hr of 0.1% bupivicaine with 3.6mcg/cc fentanyl

    OB Intrathecal Prep: 

    get name and room number from nurse


    take 4 patient stickers from chart
    2 for epidural/spinal sheet + yellow copy
    1 for patient questionnaire
    1 for blue card 

    pull meds from pixis:

    0.3cc Demerol (15mg) in TB syringe


    0.3cc of 0.75% Sensorcaine (often found in Spinal kit)

    set on top of cart:

    paperwork
    o2 pulsoximeter
    meds labeled with patient stickers
    correct size sterile gloves

    nurse will have spinal kit in room

    insure fluid bolus (1-2L) received within last 30 min

    check for platelet count (must be >150, >100 if approved by anesthesiologist)


    OB Rotation Notes

    Extra notes:
    Spinal/Intrathecal based on concentration (patient position)
    Epidural/caudal based on volume (1-2mL per dermatome)

    0.75% bupivicaine w/ 8.25% dextrose = hyperbaric (sinks based on gravity)

    Isobaric (stays where you inject it) {Tetracaine diluted w/ equal part CSF}

    Tetracaine alone = hypobaric


    ex: for hip fx (lateral position w/ broken hip in air), but make sure their head isn’t up! Or you
    will end up doing a general anyway

    Duration 2-ish hours


    Tetracaine alone = 3hrs
    Tetracaine w/ epi = 6hrs
    Ester vs. amide matters
    Epi or not matters
    Epi doesn’t usually help prolong hyperbaric bupivicaine

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