Cardiotocography

 CARDIOTOCOGRAPHY

CTG machine has two sensors:

 

• Cardio probe: placed on the mother’s abdomen at the foetal anterior shoulder to measure the foetal heart rate. 

• Toco probe: placed on the mother’s fundus to record uterine muscle contraction.  

(Jelly is to be applied between the probe and the site of application of the probe)

 

CTG paper moves at rate of 3cm/min 

Therefore 1cm = 20 sec on x-axis

        

Also 1 cm = 10 bpm on Y axis

To be taken every 2 hours towards the end of pregnancy.

 When analysing a CTG look for 4 things: 

     1.      Baseline heart rate

     2.      Beat to Beat variability 

     3.      Accelerations

     4.      Decelerations 

1. Foetal Heart rate: Normal: 110-160 bpm 

2. Beat to beat variability:  Normal: 5-25bpm showing saw tooth pattern      

3. Foetal accelerations: 

• Abrupt increase in FHR above baseline. 

• If a rise of 15 bpm persists for 15 sec or more but less than 2 mins is seen twice during a 20 min period then this is adequate contractions or REACTIVE (after 32 weeks). 

 

4. Foetal decelerations: 

• Decrease of 15 bpm in FHR for ≥15 seconds  

• Time from onset of the deceleration to the lowest point of the deceleration >30 seconds in variable decelerations.

  
  

  
  
  

• Early decelerations: Cause: pressure on the foetal head during labour (normal)

 

• If late or variable decelerations are present, call a senior. 

 

    If all 4 parameters normal: REASSURING NST 

    If any 1 abnormal: SUSPICIOUS NST  

    If any 2 or more abnormal: PATHOLOGICAL NST 

 

If CTG is non-reassuring: 

• Set up IV line

• Start RL/Oxygen 

• Give left lateral position

• Call the resident

• Stop oxytocin

• Ask sister to give OT changes/scrubs  

Written by our guest author - Yash Bandewar and Anveshi Nayan

Illustration by Devi Bavishi

#Ae(ONE)INTERN

 

 

 

  

Ascitic Tap

Requirements

Written informed consent, Betadine, Spirit, Sterile gloves, Sterile drapes, a 1.5-3.5 cm 20-22 G needle, a 5-20mL syringe is used, 18-20 G needle attached to a non-collapsible tube (can be made by breaking drip chamber of an IV set and putting one end of it in an empty water bottle for therapeutic tap tubing to a sterile collection bag)

Procedure:

1. Follow universal precautions. 

2. Skin around the site of puncture to be disinfected with betadine or Chlorhexidine and spirit and draped with sterile drapes.

3. Position: The patient should be in supine position( can be asked to roll slightly to left)

4. Site: a) At the junction of medial two-third and lateral one-third of the line join umbilicus and left Anterior superior iliac spine (left side is preferred over right to avoid damage to caecum)

OR 

b) 4 inches above iliac crest, whichever is more dependent

Site has to be lateral to rectus muscle. Avoid areas of scar.

5. Local Anaesthesia:

a) Skin, subcutaneous tissue, abdominal wall layers up to parietal peritoneum to be anesthetized with 2% lidocaine filled syringe using a 22-25 G needle.The needle is advanced into the subcutaneous tissue aspirating every 2-3 mm prior to injecting. 

b) Once a loss of resistance is felt and peritoneal fluid is drawn into the syringe, it indicates that we have entered the peritoneal cavity. Additional lidocaine is then injected to anesthetize the pain-sensitive parietal 

peritoneum. 

(A total of approx. 4-5 ml lidocaine is adequate.) 

c) The needle is then withdrawn. 

6. Puncture: 

For diagnostic tap – a 1.5-3.5 cm 20-22 G needle attached to a 5-20mL syringe 

is used. 

Technique – The aim is to prevent leak by ensuring the skin puncture site is 

not directly over the puncture site into the peritoneal cavity. 

 Z track technique – Pull skin about 2 cm downward before puncturing 

skin→ then leave the skin after entering few mm so as to form a Z

OR 

prick the skin, go for some distance in the subcutaneous plane and then change the angle to vertically downwards to enter the peritoneal cavity.  

For therapeutic tap - A large bore 1.5-2 cm 16-18 G needle is used instead.The syringe is detached and the needle is attached to a non-collapsible rubber tubing.The ascites fluid is drained slowly through the rubber tubing connected to the needle into a sterile collection bag. 

7. Seal : After the puncture, the punctured skin is sealed with a tincture benzoin 

seal. 

8. Post procedures: T.P.R, B.P to be recorded half hourly and the 

patient should not be given feeds for the next 4 hours. If there is pain, analgesics may be given.

- Mitali shroff

Internship diaries: Perception of nipple discharge

A 60-year-old female complained of clear discharge from her right breast for one week. 

On examination, the right breast nipple was painful and there was clear fluid around the nipple. Expressing the breast produced no discharge. Incidentally, she mentioned a rash that was hurting on her right shoulder. The rash was a distinctive cluster of fluid-filled blisters with inflamed underlying skin, suggestive of shingles. 

Approach to seeing patients on July 1st for Internal Medicine residents

INTERNSHIP DIARIES EPISODE 05 – Who Resides In Your Blood? (Blood Cultures)

It was a bright day. You reached the ICU ward and introduced yourself to the resident there.You got ready with cap and mask and asked to take vitals of patient.

"He developed a spiking fever, and the central venous catheter was removed on day 14 of treatment. Fever is not responding to antibiotics, Sir." said one resident to the  consultant.

"Send the blood for culture and inform me." said the consultant.

"Dr. Kesh , Can you arrange the items for sampling and fill up the laboratory forms?" the senior resident looks at you.

"Yes, Sir." Says you excited to know and expand your knowledge about blood culture.

**********************************

5.1 BLOOD CULTURES:

INDICATION FOR BLOOD CULTURE:

1.Where the possibility of septicemia or bacteremia is suggested by the presence of fever,shock or other signs and symptoms occurring in association with a known or suspected local infection such as sepsis in a surgical wound ,Osteomyelitis,peritonitis,Arthritis,Enteric fever.

2.Pyrexia of unknown origin (temperatures of >38.3°C (>101°F) on several occasions with fever of >3 weeks and failure to reach a diagnosis despite 1 week of inpatient investigation)

3.Unexplained leucocytosis or leucopenia

4.Suspected fungemia specially in Immunocompromised patients, HIV patients.

STEPS:

I)Obtain consent

II)Hand washing

III)Arranging items for sampling (MATERIALS REQUIRED)

·        70% isopropyl alcohol swabs

·         10% Povidone iodine swabs

·        dry cotton

·        Sterile gloves of suitable size

·        2 syringes (adult: 20 cc, paediatric: 5 cc)

·        2 needles (adult: 22 gauge or preferably larger butterfly or standard needle; paediatric: 25- or 23-gauge butterfly or standard needle)

·        Blood culture bottle (Aerobic and anerobic)

IV) vein selection

• Arterial vs venous blood

 • Indwelling arterial or venous lines

• Central or peripheral

V)Hand washing and Gloving

VI)Preparation of a skin

VII)Venepuncture and drawing a blood sample

VIII)Inoculating in blood culture bottle and shake the bottle

IX)Labelling, storing and documenting

• Ask the patient about allergies to iodine.

• Apply the tourniquet, select the site.

(Be careful that the ends of the tourniquet do not fall onto the puncture site, thereby contaminating it, if the tourniquet does accidentally touch the prepared puncture site, the site must be recleaned)

• Apply alcohol/acetone pad at the puncture site for 30 seconds till it dry.

• Apply the iodine swab, apply to puncture site, move the iodine in concentric circles outward. Keep it for 60 seconds (till it dry).

• Again, clean the site with alcohol/acetone and allow it to dry.

• Perform the venepuncture, following routine venepuncture procedures. Do not repalpate the site.

• If the blood culture is one of a series of samples to be drawn from a patient, the blood culture must be collected first.

• Withdraw needle from vein and insert into the top of the blood culture container.

(Other than syringe and needle, by closed system, consisting of vacuum bottle and double needle collection tube can be done.)

• Do not change the needle.

• Do not hold the container in your hand, this may result in a needle exposure.

• Do not push the blood. Mix the content. (An adequate space above broth ensures that blood is not injected under undue pressure and some air is still available for strict aerobes)

• Keep at room temperature.

• Label the blood specimen collected, following standard labelling procedures. Be sure to include the site used and the number of the specimen in the series ordered.

Blood Cultures should NOT be taken from the following sites

•       Veins which are immediately proximal to an existing peripheral IV cannula.

•       A femoral vein due to difficulty in skin disinfection of the site. This area poses a high risk of contamination.

•       Catheter drawn blood cultures are equally likely to be truly positive (associated with sepsis), but more likely to be colonized.

(One drawn through catheter and other drawn through vein PPV of 96%)

VOLUME OF BLOOD drawn is the single most important factor influencing sensitivity

• For adult: minimum 10 ml

 • For infant and children: 1-5 ml

1-2 ml= neonate

 2-3ml= 1 month - 2year age

 3-5ml= Older children

 • 20 ml of blood obtain in sequence is more effective and sensitive (98%) specially in intermittent bacteremia.

 • Patients who have received antibiotics should give 3 separate collections of blood. Also, one or two of which on 2nd day also.

TIMING OF BLOOD CULTURE

• Before starting antimicrobial therapy

• At the time of fever peak

 • Minimum 30-60 minute interval between 2 samples except in critically ill septic patient.

 • In continous bacteremia-timing of blood culture is not important, but in intermittent bacteremia 2 or 3 culture should be spaced an hour apart.

TEST PERFORMED AFTER SAMPLE REACH TO LABORATORY

Blood to broth ratio: 1:5 only, should not be <1:5 or > 1:10

• Agitation during incubation

-  Length of incubation: • Not more than 7 days • 5 days is sufficient • >5 day-contaminants • 7 days is useful for: • Fungemia • Bacteremia due to fastidious organisms like HACEK group, brucella, legionella • For patients suspected of endocarditis who has been treated with antimicrobial before obtaining blood culture • Mycobacterial culture > 4 weeks

• Atmosphere of incubation: aerobic and anaerobic

ASK YOUR MICROBIOLOGICAL DEPARTMENT TO HELP YOU IN SELECTION OF BROTH :

• Glucose broth: useful in endocarditis

• Bile broth: In enteric fever

• Trypticase soy broth (inhibits Neisseria and S.pneumoniae)

• Brain heart infusion broth: multipurpose broth

• Thioglycolate broth: for anaerobes

• Columbia or brucella broth

• Mycobacteria: Middlebrook 7H9 with 0.05% SPS, BHI with 0.5 % polysorbate 80

• Fungus broth

Additives in broth: • Anticoagulant- bacteria are trapped in blood clot • Antimicrobial- if patient is already in antibiotics • Anticomplementry agents- to inactivates complement action • Antiphagocytic

 Type of blood culture bottle (AEROBIC AND ANAEROBIC CULTURE BOTTLE)

• Standard aerobic bottles- most common bacterial pathogens, including aerobes, facultative anaerobes and for candidemia

• Smaller bottles are used for neonates and young children

• After inoculation, bottles are incubated aerobically.

SIGNS OF BACTERIAL GROWTH:

• Macroscopically:

-Generalized turbidity

-Hemolysis

- Gas production

- Discreate colonies on the surface of the sedimented red cells

-recoverable bacterial growth may occur before turbidity is evident.

Subculture from bottles as a routine

  • For subculture:

- Subcuture should be done at least once during the first day after 5-6 hours and at interval thereafter which should be at least twice during first 2-3 days.

• Gram stain:  Should be made and examined at the subculture stage. Any positive finding should be reported at once to clinician as the morphological type of organism may guide the physician to start antibiotic.

• Quantitative counts of bacteria in blood: Inoculate 1 ml amounts of blood into several tubes of melted agar and make pore plates either directly from patients. Another method is treat the patient sample with lytic agent. Then lysed sample is centrifuged and harvested organism cultured directly on a suitable solid medium to allow identification and to give a semi-quantitative indication of its presence in blood. (When monitoring colonization associated with a prosthesis or catheter) 

INTERPRETATION OF POSITIVE BLOOD CULTURE REPORT:

1. Whether true or contaminant (ASEPSIS, ASSES RISK FACTOR PRESENT IN PATIENT)

2.FIND THE SOURCE

3.DETERMINE THE NEED FOR TREATMENT (whether patient is toxic and in shock)

4.ADDRESS UNDERLYING INFECTIOUS FOCUS

5.LOOK FOR PATHOGEN SPECIFIC FACTORS DURING ANTIBIOTIC TREATMENT (Toxins that are produced)
6.HELPS IN IDENTIFYING OTHER RISK FACTOR WITH INFECTION (The identification of S.bovis organism also prompted the ultimate identification of colonic carcinoma, which is an underlying risk factor for S. bovis bacteremia)
7.LOOK FOR REASON OF IMMUNOCOMPROMISED STATE (Rule out malignancy or HIV as bactremia may be a result of oppurtunistic infection)

Therefore,clinical examination is of utmost important. As positive blood culture is not a disease in itself. It may be a result of underlying disease or part of complication.

After starting treatment, document the blood culture clearance duration.

SOME DEFINITIONS:

Bacteremia – presence of bacteria in blood stream.Some conditions have a period of bacteremia as part of the disease process (ex. Meningitis, endocarditis)

Septicemia – bacteremia plus clinical signs and symptoms of bacterial invasion and toxin production

Transient bacteremia lasts for minutes or a few hours and most frequently occurs after manipulation of nonsterile body sites—for example, during dental procedures; after gastrointestinal biopsy; after percutaneous catheterization of the vascular system, bladder, or common bile duct; and after surgical debridement or drainage—that is, after procedures involving contaminated or colonized skin and/or mucosal surfaces are performed and also at the onset of acute bacterial infections.

Intermittent bacteremia is defined as bacteremia due to the same microorganism that is detected intermittently in the same patient because of a cycle of clearance and recurrence. Intermittent bacteremia is often associated with undrained closed-space infections, such as intra-abdominal or soft-tissue abscesses, and may also occur in patients with liver abscesses, cholangitis, and focal infections, including pneumonia, osteomyelitis, and spondylodiscitis. 

Persistent bacteremia is a characteristic of infective endocarditis (IE) and other intravascular infections, such as vascular-graft infection, a mycotic aneurysm, or an infected thrombus. Persistent bacteremia also occurs during the early stages of systemic bacterial infections, such as brucellosis and typhoid fever.

********************************
After labelling the sample, storing and documentation, you went to ICU again. Taking vitals and documenting it in files. Feeling happy to learn about blood culture. 

*******************************

HAPPY STUDYING !

UPASANA Y. AND JAY

EPISODE 04 - INTERNSHIP DIARIES (What will I do with your blood? -Vials and sampling)

- By Upasana and Jay

It has been a tired day at the hospital. You are almost at the end of your day of duty when your senior resident asks you,

“Dr Kesh, can you please prepare the Laboratory forms, sign them for me and then, submit these blood samples to the Main laboratory?

“Yes sir!” You pressure a smile and look at the blood samples and the empty Laboratory request forms needing your signature and your gleaming new stamp with your licence number.

You sit down to prepare the blood samples.

EPISODE 03 - INTERNSHIP DIARIES (Let me gain access into your veins)

(Lesson 1.2)

Inserting an IV line or an Intravenous line is a very much of an expected skill from a Medical professional. Although often performed by Nurses, the skill can come handy at any time because in a case of a hard insertion the nurse or the ancillary staff may refer the patient to you to perform.

Before inserting an IV line you need to know what is an IV Cannula or an IV Catheter.

A cannula or a catheter is a small tube made out of medical grade materials that would allow a medical professional introduce or extract a substrate to or from the body. In a case of an INTRA-VENOUS cannula the access is taken in to the VEINS.

Usually an IV cannula can be used to introduce IV fluids, IV medications as well as sometimes to draw blood(often at the insertion moment).

1. The catheter itself is composed of (a) a tip for insertion into the vein, (b) wings for manual handling and securing the catheter with adhesives, (c) a valve to allow injection of drugs with a syringe also called a LUER lock-valve, (d) an end which allows connection to an intravenous infusion line, and capping in between uses.
2. The needle (partially retracted) which serves only as a guidewire for inserting the cannula.
3. The protection cap which is removed before use.

(By courtesy of Wikipedia (https://en.wikipedia.org/wiki/Peripheral_venous_catheter) retrieved 7/5/2019)

These cannulas come in different shapes and sizes, and the sizes are measured in BIRMINGHAM GAUGE SYSTEM often abbreviated as G. In this system the lower number is having a higher diameter and a higher number is having a lower diameter of the catheter tube. (This is different from French Gauge System where it is opposite from this numbering system and is often used in NGT tube sizes)

So, an 18G IV cannula is larger than a 20G IV cannula.

The recognizing of these cannulas are done by the colour of its Luer lock-valve or the tip of the needle in some varieties.

The colours are pretty constant throughout the world but sometimes it differs. So always refer to your senior before checking out a cannula for the first time or better yet, READ WELL of its packaging.

(Note that in some countries 26G could be of Purple colour)
- Table by courtesy of Wikipedia (Retrieved 7/5/2019) -

Check for your needed equipment and material.

• Alcohol or Hand Sanitizer/Soap and water
• An alcohol wipe. - To sanitize the skin
• A tourniquet. - To block the venous flow and engorge the vein as well as fix it.
• An IV cannula - As mentioned above.
• A suitable plaster or a Tegaderm® - To fixate the IV cannula/catheter on to the skin
• A syringe with normal saline - To flush the Catheter
• A clinical waste bin with a sharp disposal section - To dispose the waste including the needle.

STEPS

1. Identify a visible and/or tangible vein. Try to feel it. A rule of thumb is, the better you feel the vein the more successful your insertion will be.
2. Once you identify the vein, apply the tourniquet and recheck on the vein if its engorged and tangible.
3. Apply alcohol on your hands and clean it. Wear your gloves properly as explained before; in case you were already wearing gloves, check if you can request for a change of your gloves. Touching a patient without gloves is discouraged.
4. Clean the patient's skin with Alcohol wipe, a cotton ball soaked in Isopropyl Alcohol 70% or Ethyl Alcohol 70% is alright.
5. Before inserting the catheter and check if the catheter tip is clear without any manufacturer's defects such as a defect end. Check the needle for its bevel up. 
6. Stretch the skin distally, and look for your insertion point. If your vein-in-concern is not much engorged you can try slightly tap on it.
7. Tell your patient to expect a sharp pinch on their point of insertion.
8. Insert your needle beveled up, usually around 30-45 degrees to the skin and advance your needle to see if there is a flashback of blood at the hub of the syringe.
9. If you see the flashback, then advance the whole needle about 2-3mm and then retrieve the needle slowly and check if a streak of blood is following the returning needle. If it does...Congratulations! IF NOT, try withdrawing the needle a bit and change the position until you see the flashback.
10. If you cannot do it while the needle is inside, then retrieve the whole catheter and re insert at a different point of a different vein.
11. If you still cannot, then ask for help from a senior.
12. In the fortunate incident of you are already inside the vein, remove the tourniquet and while removing the needle, give pressure to the top of the cannula tip already inside the body so the blood will not reek out making your field a mess!
13. Insert your prepared flush into the catheter and try to inject. If it proceeds with no resistance, then you are good to go!
14. Get your Primed IV line or HEPLOCK (which is used to administer IV medications in a later  time via the catheter and it will stop the blood from reeking out) or close the end with the white cap of the needle(Often used with those catheter types with Luer lock-valve where a heplock is not needed)
15. Take your previously prepared Plasters or already opened Tegaderm® and secure the IV catheter on to the skin. There are several methods of securing the IV catheter on to skin using plasters. We will discuss 
16. Dispose your needle to the sharps disposal.
17. Clean and wash your hands.

Congratulations, you are done with your IV catheter/cannula insertion.

*******

You look at the face of the patient after finishing your work, and you are proud that you got access in one hit and did not spill the blood.

"Thank you doctor!" Your patient thanks you.

"You are welcome!" You smile and leave the patient with your tray.


*************

Thanks guys for the support! Thanks for the messages you have been sending to my Whatsapp requesting for more articles. We will try to provide more topics soon. 

With love,

Jay

EPISODE 02 - INTERNSHIP DIARIES (Protecting you and myself)

NOTICE!

Awesomites, I'm super sorry for being super late, I was so busy with my MD graduation hence I couldn't update the promised topics on Internship Diaries. I will update as soon as possible all the topics we need to discuss.

With love,

Jay

(LESSON 1.1)

WEARING SURGICAL GLOVES

       There are three forms of wearing gloves. 

1. OPEN, 
2. CLOSED 
3. ASSISTED. 

Closed is the most sterile method and used mainly in operating rooms where you wear gowns and glove yourself and asepsis is highly expected. 

You utilize the Open method in situations in wards, and other Non-OR situations. 

Assisted method is when someone else such as, a nurse or a fellow colleague will serve you the gloves and you simply slip your hands in.

OPEN method,

1. Remove whatever you are wearing in your hands, including rings, bracelets and watches. Try to keep it free elbow-down.
2. Wash your hands with soap, and use Sterilium(R) or Isopropyl or Ethyl alcohol 70%. (Using them will eliminate the remaining bubbles of the soap.) 
3. Then wipe your hands with a sterile towel.
4. You will take your surgical gloves, open the outer cover and bring the inner cover outside without touching inside the gloves. 

   

   Surgical Gloves Inner cover

5. Leave it on a flat clean surface and open the flaps, and you will see two gloves one for the right hand and the other for left hand.
6. You will also notice the sleeves of the gloves are rolled upwards. The inside out part is considered unsterile and the inside the roll part is considered sterile. 

   

   S = Sterile part   |    US = Unsterile part

7. So you use your non sterile dominant hand, hold the glove from the non sterile outside part and slip over your non dominant hand. Do NOT flap back the sleeve because will get contaminated because you are not yet wearing gloves on that hand.
8. Now use your non dominant hand with the glove on, and slip the four long fingers of your hand into the rolled sleeve of the other glove. Because it is sterile. Bring it up and slip the glove over your non gloved hand. And flip back your sleeve.
9. Then use your newly gloved hand to roll down the sleeve of your other glove from the inside the roll.

You are successfully gloved!!!

In closed method someone will open the outer cover for you and you take the inner cover out, and wear it in such a way where you do not touch the glove at all skin-to-skin directly, but it will be discussed later. Too much info in one post will cause brain freeze. 

In Assisted method after gowning yourself, someone else will open gloves and serve you. Check if the thumb side is correct accordingly and slip in. If not you will be stuck and will need a new pair of gloves. Waste of time, waste of gloves and waste of effort!!

*******
You put on your gloves and see the nurse has prepared alcoholized cotton balls, 5 plaster strips of around 4 inches long and partially opened the IV catheter pack.

You take one alcoholized cotton ball and start looking for a vein.

[ To be continued... ]

*******

The answers to our previous questions regarding gloving are,

1. There are 3 methods
       1. Open
       2. Closed
       3. Assisted

2. There are 2 types of gloves
       1. Examination gloves - Often clean but not essentially sterile although some sterile varieties exist.
       2. Surgical gloves - Often sterile and comes in a tightly sealed pack. Do not use if the pack is already open.

EPISODE 01 INTERNSHIP DIARIES - (The best way to FINISH is to START first!)

PROLOGUE

                   It’s a busy day, and to top with that you are running late. It’s your first day as a Medical Intern and you are super excited for your future 1 year.

You are entering into this huge sophisticated hospital with the shining silver name plate attached to it “SAN JOSE GENERAL HOSPITAL” and you reach the smiling and pleasant looking receptionist with round glasses on.

“Hello Good morning, I am Kesh, a new medical intern here. Where should I go?”

“One minute please!” She tells you and starts checking something on her computer.

“Hello Dr. Kesh” She looks back at you.

“Omg!” You think. “This is it! People are calling me doctor now! Yoohoo!” you smile widely.

“Please proceed to the Department of Internal Medicine, please look for Dr Wen, your mentor!”

You thank her and follow her guide.

****

Dr. Wen is a helpful young doctor in his late thirties who happens to be the Chief Resident of Internal Medicine. His orientation on the hospital rules were quite lengthy but was important. His ending was quite remarkable.

“Being a doctor is a dream of many but achieved by few. You are among the lucky few. You are supposed to lead a health care team. which means you should know all the necessary medications and side effects and how it would affect the human being! Your whole team relies on you. There for you need to be responsible and accountable to yourself, your team and your patient.” Dr Wen said. “ You have spent years in Medical school already, and now it's time for the training here and I wish that all of you would take the best chance of that objective by learning to how to be a good healer.” he continued.

“Please proceed to your respective wards now. If you have any problem during your internship, please ask for my help. I will definitely help you!” said he at last.

You check the slip in your hand.

“Ward 3” it says. You slowly walk toward your post.

***

“Dr. Kesh” You hear your nurse is shouting your name

“Yes?”

“Could you please insert an IV line to this new admission?” She asks.

“Here are your gloves, your aseptic instruments and IV catheter. Thanks you so much!”

The nurse leaves you with a full tray and a newly admitted patient who looks worried.

“Can I please insert you an IV line for your vein so that we can hook you up to IVF?” You seek consent!

“Yes sure” Patient gives permission.

You take the pack of Surgical gloves into your hands.

"Now what to do?" you think!

[To be continued...]

********

Pre lesson questions

1. What are the gloving techniques you know?

2. What are the types of gloves you know?

3. What unit is used to measure the IV cannula size?

4. What are the most common areas of IV cannula insertion?

5. What is a heplock?

Expect the next episode with the answers and the lesson.

You can answer the questions here in the comments, or if you are in our Medicowesome Whatsapp group, you can message me (Jay) or Upasana privately with your name and answer. I will post the names of the first 5, who gave the correct answers with our next post.

Enjoy!


DEFINITION OF TERMS

1. Consent - The consent or receiving the willingness of the patient to undergo a medical procedure is a must before you would perform any medical procedure. It could be ranging from a simple needle prick test or to an imaging or an operation.
2. IVF - Intra Venous Fluid. These are the liquid substances directly delivered into a vein. 

.