word: intrauterine pressure catheter: uterine activity...

INTRAUTERINE PRESSURE CATHETER (IUPC): UTERINE ACTIVITY MONITORING AND AMNIOINFUSION

DOCUMENT TYPE: PROTOCOLSite Applicability

This practice applies to the Birthing area of the Maternal-Newborn Program at BC Women’s Hospital. Practice Level/Competencies

Insertion of an intrauterine pressure catheter (IUPC) is a specialized skill performed by an Obstetrician or Obstetrics Resident.

Care for an IUPC is an Advanced Skill that may be performed by a Registered Nurse or an Obstetrician/ Obstetrics Resident.

Indications for Intrauterine Pressure Catheter (IUPC) Insertion

An intrauterine pressure catheter (IUPC) is used for two indications:

1. To accurately measure uterine activity and the strength of contractions (in mmHg) within the context of:

- Titrating oxytocin and ruling out labour dystocia - Inability to accurately monitor uterine activity by external toco

2. For amnioinfusion to increase amniotic fluid volume in an attempt to reduce cord compression and thus repetitive variable decelerations during labour.

Contraindications for Intrauterine Pressure Catheter (IUPC) Insertion - Known or suspected placenta previa or vasa previa

IUPC Insertion

Equipment & Supplies- Electronic Fetal Monitor- Intrauterine pressure catheter (IUPC)- Intrauterine Pressure Catheter Reusable Cable – (purple cable located in fetal monitor drawer)- Adhesive Velcro pad from IUPC package- Sterile gloves, lubricant

Registered Nurse: Steps & Rationale

Directions Note1. Ensure all equipment is available and ready for

connection 2. Ensure that the pregnant patient’s bladder is

empty 3. Assist pregnant patient into a comfortable position

for vaginal exam and IUPC insertion4. Continue electronic fetal monitoring during the

IUPC insertion procedure.5. Open sterile IUPC package for the physician

C-06-13-62564 Published Date: 18-Aug-2021 of 5 Review Date: 18-Aug-2024

This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current.


DOCUMENT TYPE: PROTOCOL6. Once IUPC in place, receive catheter from

physician and use the reusable purple IUPC cable to connect to the toco cable, inserted into the electronic fetal monitor

7. Anchor the catheter in place with the Velcro adhesive to pregnant patient’s upper thigh

8. Zero the system during uterine relaxation by pressing the re-zero button on the cable; adjust the fetal monitor to zero.

9. Ask the pregnant patient to cough and check for spike on the tracing in response.

A spike on the fetal heart tracing in response to the cough indicates proper positioning of the catheter.

10. lf no peak, gently pull catheter back 1 - 2 centimeters.

11. Document procedure in Partogram and Interprofessional Notes, noting time of insertion, baseline resting tone, patient position

Obstetrician or Obstetrics Resident: Steps & Rationale Directions Note

1. Perform vaginal exam to determine:- The membranes are ruptured- The cervix is sufficiently dilated (≥2-3cm)- The presenting part - Optimal position for IUPC placement2. Insert the tip of the hard plastic introducer (with the

flexible catheter inside) just inside the cervical os, avoiding placement between the decidua and membranes.

3. Advance catheter to the cervical os. Note: Do not advance introducer through the cervix.

4. Feed catheter until the 45-centimeter mark (cm) is at the introitus.

5. Slide the introducer out of the vagina along the catheter. Separate the introducer from the catheter. Anchor the catheter in place and pull the introducer off the catheter.

The catheter should go in easily and never be forced. If any resistance is met, the obstetrician should change the angle or position of insertion of the catheter.

Flow of amniotic fluid through the catheter at this point indicates appropriate placement

6. Pass the end of the catheter to Registered Nurse7. Document procedure in Provider’s Notes

Assessment of Uterine ActivityC-06-13-62564 Published Date: 18-Aug-2021 of 5 Review Date: 18-Aug-2024



DOCUMENT TYPE: PROTOCOL

Evaluate strength of contractions by the quantitative measurement in Montevideo Units (MVU):

180 - 250 MVU in 10 minutes are considered effective for progress in labour. Record the MVU on the Partogram. The formula used to calculate MVU is:

The sum of the intensities (in a 10 minute period) minus the sum of baseline tone (in a 10 minute period) equals (=) MVU

Example: Baseline tone = 20Number of contractions in 10 minutes = 4Intensity of each contraction = 70 (70 x 4) = 280 - (20 x 4) = 80 = 200 MVUOr 50 X 4 = 200 MVU

Troubleshooting:

Re-Zeroing

The IUPC may require re-zeroing due to a change in patient position, or if their resting tone baseline is reading less than zero. 1. Press and hold the re-zero button on the purple cable (green light flashes for five seconds) 2. Adjust the fetal monitor to zero while re-zero button is flashing NOTE: When a change in resting tone is observed, record the maternal position and palpate the uterine resting tone

Cable Check

If cable performance is in question, follow this procedure:

Disconnect catheter from the cable. Insert the cable check plug (found on purple cable) into the catheter end of the cable.

NOTE: The cable remains plugged into the monitor.

1. Verify that the light is continuously lit (no flashing) 2. If the light does not illuminate, replace the cable

NOTE: If the light is flashing, verify that the light is inserted completely into the cable.

WARNING: The cable test function is not meant to test the accuracy of the system, only to confirm cable function.

NOTE: If you need to change the monitor, disconnect the cable from the monitor, plug the cable into a new monitor and re-zero the system.

Amnioinfusion




DOCUMENT TYPE: PROTOCOLAmnioinfusions are used to relieve decelerations caused by umbilical cord compression, by adding fluid to the intrauterine space to cushion the umbilical cord. This procedure has been shown to reduce the occurrence of the decelerations, improve short-term measures of neonatal outcomes, and lower the use of Cesarean section.

There is no evidence that intrapartum amnioinfusion is effective at managing chorioamnionitis or reducing the risk of meconium aspiration syndrome. It is therefore not recommended for use only in the presence of chorioamnionitis or thick meconium-stained amniotic fluid in the absence of variable decelerations.

Equipment & Supplies

- Alaris IV Pump- Intravenous infusion tubing

- Normal saline 1 Litre at room temperature, labelledNote: There is no evidence that warming the fluid above the ambient room temperature before administration confers any advantage.

- See equipment listed for IUPC insertion, above

Preparation- Insert IUPC, as indicated above- Prime the IV tubing with NS, clamp, and load into the IV

pump- Don gloves- Remove the cap from the amnio port on the IUPC- Attach the primed IV tube to the amnio port

Infusion- Infuse a bolus of 300 milliliters (mL) of Normal Saline in

20 minutes (900mL/hour) or as per physician’s order- After the bolus has infused, adjust infusion rate according to physician’s order (usually 100-200

mL/h)- Document the total volume of Normal Saline infused

Monitoring- Continuous EFM (per protocol)- Every 15 minutes for the first hour after start of amnioinfusion, then hourly:

o Colour and amount of fluid returno Fetal heart rate assessment and classificationo Intrauterine pressure catheter placement at introituso Uterine pressure in Montevideo units (see above)

Note: The resting tone recording will be higher (by approximately 15 mm Hg) than normal, caused by the positive pressure flow from the fluid at the end of the catheter.

Discontinuation of IUPC- Discontinue the IUPC after a physician’s assessment and receiving orders. - Consider the ongoing need for the IUPC to monitor uterine contractions versus external uterine

monitoring - Review need for IUPC in second stage of labour. Consider removal if not needed.




DOCUMENT TYPE: PROTOCOL

Documentation- PSBC Partogram- Interprofessional Notes- History and Progress Notes

ReferencesDore, S. & Ehman, W. (2020). Fetal Health Surveillance: Intrapartum Consensus Guideline No. 396. Journal of

Gynecologists and Obstetricians of Canada, 42(3). 316-348. https://doi.org/10.1016/j.jogc.2019.05.007

Goldfarb, I.T. (2020). Amnioinfusion. UpToDate. Retrieved June 16, 2021, fromhttps://www.uptodate.com/contents/amnioinfusion

Hofmeyr G.J. & Lawrie, T.A. (2012). Amnioinfusion for potential or suspected umbilical cord compression inlabour. Cochrane Database of Systematic Reviews, 1(CD000013).doi:10.1002/14651858.CD000013.pub2.

Hofmeyr, G.J. & Kiiza, J.A. (2016). Amnioinfusion for chorioamnionitis. Cochrane Database of SystematicReviews, 8(CD011622). doi: 10.1002/14651858.CD011622.pub2

Hofmeyr, G.J., Xu, H., & Eke, A.C. (2014). Amnioinfusion for meconium-stained liquor in labour. CochraneDatabase of Systematic Reviews, 1(CD000014). doi: 10.1002/14651858.CD000014.pub4.

Kendall Intrauterine Pressure Catheter System. https://www.cardinalhealth.com/en/productsolutions/medical/woman-and-baby/labor-and-delivery-essentials/intrauterine-pressure-catheter- system.html

Pauli, J.M. (2020). Use of intrauterine pressure catheters. UpToDate. Retrieved June 16, 2021, fromhttps://www.uptodate.com/contents/use-of-intrauterine-pressure-catheters

Perinatal Services BC. (2021). Decision Support Tool #2 - Intrapartum Fetal Health Surveillance.http://www.perinatalservicesbc.ca/Documents/Guidelines-Standards/Standards/ Competencies/DST%20January

%202021%20-%20Intrapartum%20Fetal%20Health%20 Surveillance.pdf

UBC Continuing Professional Development eLearning. (2020). Fundamentals of Fetal Health SurveillanceOnline Manual (5th ed). https://elearning.ubccpd.ca/

Developed ByBCW Maternal Newborn Program – Perinatal Clinical Educator

Version HistoryDATE DOCUMENT NUMBER and TITLE ACTION TAKEN27-Jul-2021 C-06-13-62564 Intrauterine Pressure Catheter:

Uterine Activity Monitoring And AmnioinfusionApproved at: Maternal Newborn Best Practice Committee

DisclaimerThis document is intended for use within BC Children’s and BC Women’s Hospitals only. Any other use or reliance is at your sole risk. The content does not constitute and is not in substitution of professional medical advice. Provincial Health Services Authority (PHSA) assumes no liability arising from use or reliance on this document. This document is protected by copyright and may only be reprinted in whole or in part with the prior written approval of PHSA



https://elearning.ubccpd.ca/

https://www.uptodate.com/contents/amnioinfusion