CSECTION SKILL

mayo setup

primary incision: 2 #10s

pickups: Bonnie, adson tissue, Russian

retractors: 1x Rich, 1x Bladder blade

clamps: 2x Kochers, 2x Criles, x4 Kellys, Bovie

scissors: Metz, Cvd Mayo, ST Mayo, bandage

other: LH covers, Yankauer, 2x Laps, scratch pad, ruler, marker

back table set up

Drape out ring stand before procedure start!

for baby:

- placenta bucket

- cord blood collection cup

- 20 mL syringe

- baby bulb (one for each neonate)

Circulator:

- saline in basin

- irrigation fluid in pitcher

- no local!

- remember clamp and scissors when counting, grab blood syringe from ring stand

First step of procedure, AFTER time out

check skin for numbness, with Bonnie

After skin check

Marker and #10 blade
Put used #10 on back table

Retraction and dissection

Big rich (smaller side)
Cvd mayo and bonnie

take rich out

tag fascia with 2x kochers

Further dissection

Dissect fascia from muscle, then -

Muscle, separated manually

Deeper retraction

Retract superiorly with Rich (big side), inferiorly with De Lee

More dissection (of what?) after muscle

Peritoneum (bladder flap), with Metz and Russian forceps

TAKE ALL LAPS AND INST OFF FIELD in anticipation of water break and delivery

Final incision

Fresh #10 blade for uterus
Put blade on back table

WATER BREAK

SUCTION

breaks on its own or manually; inst and laps already off field from prior step

towel on field to catch baby

Delivery

FUNDAL PRESSURE

Pass ear bulb to suction fluid out of baby’s mouth

Suction amniotic fluid

Clamp cord with 2x Kellys

Collect blood

Draw up, throw in ring stand

Baby handed off in towel, with ear bulb, one Kelly, and bandage scissors

Placenta

More pressure

2x wet laps, clean out uterus and hold uterus with other

Collect placenta with container

(HA) sponge ring to get leftover placenta

REMOVE CLAMP

Specimen 3 Qs

Exteriorization and first layer closure

note: load two sutures at this point to be ready for next layer, after count

Uterine:

2x Allis

Mayo Hegar

Russian forceps

big 0 Vicryl CT, 2 layers, Laps

FULL COUNT

Between 1st and 2nd close

Irrigation

Second closure

Peritoneum:

Mayo Hegar

Russian forcep

2-0 Vicryl CT

Third closure

Fascia:

Mayo Hegar

Bonnie

big 0 PDS or Vicryl CT

FULL COUNT

Fourth closure

SUBQ 3-0 chromic gut CT

mayo hegar and bonnie forceps

At this step, verbalize all inst going into sterile water basin

Skin closure

Staples or 4-0 Monocryl PS

If staples: two adsons to approximate

NH

FINAL SOFT COUNT

note: Remember to provide suture scissors at each layer

Finishing steps

Wet/dry lap

Towel for incision

Grab clamps and bovie tip

Pull back

Dressings:

Mastisol and Steri-Strips OR just Dermabond

4×4 gauze

Tegaderm

irrigation used: 750 mL (pitcher) + 250 mL (asepto) + 1000 mL (big basin)

BREAK WHEN…