8/8/2019 DR Guidelines CCMC

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HANDLE RESPONSIBILITIES1. Wear mask.2. Do proper gloving. Observe sterile technique.3. Arrange instruments in the DR pack (1 Kelly curve,1 Kelly

straight, 1 surgical scissors, 1 bandage scissors,1 needleholder, 1 forceps with teeth, 1 kidney basin, 1 abdominalsheet, 1 bulb syringe, OS and sanitary napkin for perinealsupport).

4. Place the abdominal sheet on the mothers abdomen. Instructher not to touch it.

5. Prepare the sanitary napkin.

6. Give bandage scissors if the patient is for episiotomy.7. Once the babys head is visible, support the perineum.8. Continue supporting until the whole body of the baby is out.9. *Take note of the time. Verbalize loudly but do not shout. (e.g.

Baby Out, 7:30 am)10. Once baby is out, drop the napkin in the dry pail.11. Clamp the umbilical cord.

a. Clamp using K. Curve first. Then, milk the cord towards thebaby.b. Clamp towards the babys side using the K. straight.

12. Cut the cord using the surgical scissors. Once cut, do not letgo of the two clamps.

13. Give the straight clamp to the cord dress.14. Give the curve clamp to the doctor.15. Prepare the kidney basin.16. Catch the placenta using the basin.17. *Take note of the time. Verbalize loudly but do not shout. (e.g.

Placenta Out, 7:35 am)18. *Take the postpartum BP. Record.19. Do perineal flushing. Ask assistant to help.20. Assist in suturing.

SUTURING/EPISIORRHAPHY

a) Prepare Lidocaine.b ) Use 3 cc syringe.c) Aspirate until syringe is full. Repeat as

ordered.d) *Open suture pack. Drop on mayo table.e) Attach needle to needle holder. NOTE: The

tip of the needle holder should hold theblunt end of the needle with the sharp endfacing your left and facing up.

f) Arrange instruments and assist the doctor.g) KEEP STERILE!

AFTER CARE (done with the assistant)a) Do perineal flushing.b) Wipe the inguinal area using wet OS.c) Include the thigh and other parts especially

those with blood.d) Wash the mothers feet.e) Drop the Kelly pad in the big pail.f) Use the abdominal sheet to clean the

buttocks of the mother. Drop the sheet inthe dry pail.

g) Put on the mothers diaper. Change her

clothes.h) Bring the mayo tray and the pails in thewash room.

i) Place the placenta in a plastic. Weigh it.j) Get the cord from the cord dress.k) Put Zonrox in the plastic with placenta.

Throw it in the red placenta container insidethe big cabinet in the wash room.

l) Clean the instruments. Place them in thedryer.

m) Clean the pails and the Kelly pad.n) Strain the contents of the big pail.o) Place whatever is collected in the strainer

in the plastic (that which is used in the drypail) and place them in the infectiousgarbage can.

p ) Once done, clean your used glovesthoroughly. Let it dry.

TRASNSPORTa) Get the stretcher outside the DR.b) Transfer the mother.c) Side rails up.

d) Transport to the Receiving Area.e) Call the institutional worker so that themother may be transported to the ward.

ASSIST RESPONSIBILITIES1. You are in charge of the babys chart.2 . Supply the data asked.3. Take note of important times (Baby Out and Placenta Out).4. Once the chart is done, give it to the nurse on duty.

BASED ON CCMC PROTOCOL. THIS MAY NOT BE APPLICABLE TOOTHER INSTITUTIONS.

CORD DRESS RESPONSIBILITIES1. Wear mask.2. Do proper gloving. Observe sterile technique.3. Ask for the babys sheet.4. Place the sheet on the anterior chest with both arms covered.5. Ask handle for the bulb syringe.6. Once baby is out, suction mouth and nose properly. Do it fast

but gently.7. Empty it on the pail below.8. Continue suctioning until the cord is cut.9. Receive the baby. Use the babys sheet and NEVER WITH

YOUR GLOVED HANDS ONLY.10. Do not let the clamp dangle. Hold it. If you find it difficult, then

place it on the babys abdomen. Just be careful that it doesntcut the babys skin.

11. Take the baby to the crib.12. Clean and dry the baby using the babys sheet.13. Wipe with OS soaked in water with Lactacyd. (face, head,

anterior torso, upper extremities, genitalia, lower extremitiesand posterior torso).

14. Do not force to remove all the vernix caseosa.15. Change dirty linen with a clean one.16. Change gloves. Observe sterile technique.

CORD DRESSING AND CAREa) Wipe the cord wi th cotton soaked in

Betadine from base to top. Do this twice.b) Place the cord clamp approximately 1 inch

above the base and lock (you will hear aclicking sound).

c) Cut the cord above the clamp (leave about 1mm cord before cutting).

d) Ask assistant to give the cut cord to thehandle to be discarded with the placenta.

e) Wipe the cord and the clamp with cottonsoaked in Betadine from top to base. Dothis twice.

f) Wipe the cord and the clamp with cottonsoaked in alcohol from top to base. Do thistwice.

17. Take the babys measurements.a) Weight - in kgs or gramsb) Length (from t ip of head, down the back,

buttocks, back of thigh, popliteal area, down tothe heel) - in cm

c) Head circumference (above eyebrows) - in cmd) Chest circumference (nipple line) - in cme) Abdominal girth - in cm

18. Administer Erythromycin 1 squirt OU from inner to outercanthus. Try to open the babys eyes but do not force.

19. Administer Vit. K at left thigh.a) If wt. is above 2 kgs: 0.1 ml IMb) If wt is below 2 kgs: 0.05 ml IM

20. Take vital signs.a) Temperature (rectal: 2-3 mins)b) Heart Rate (apical: 1 full minute)

c) Respiratory Rate (observe rise and fall of chest: 1full minute)21. Put on diaper and clothes.22. Take the babys right and left footprint.23. Place the babys identification tag (blue for males then pink for

females). Write the babys weight at the back of the tag.24. Wrap the baby snugly.25. Bring the baby to the nursery for Hepatitis B injection.26. Do after care. Discard materials in the proper containers.

*ASSISTANT of the CORD DRESS:i. While waiting for the baby to be born, prepare 2 kidney basins

with water on the cord dress table.ii. Mix a litt le Lactacyd on ONE basin only.iii. Put sterile OS in the basin with Lactacyd.iv. Prepare the cord dress t ray. Make sure i t is complete

(alcoholized cotton, cotton with Betadine, bandage scissorsand OS).

v. Prepare the babys lampin, diaper, cord clamp and babysclothes.

BASED ON CCMC PROTOCOL. THIS MAY NOT BE APLLICABLE TO OTHERINSTITUTIONS.