Placement Procedure
Preparation
Explain procedure, the need/indication for it, the risks and benefits, and obtain verbal consent.
If available, check the ultrasound report for placenta placement, and ideally avoid this location for placement.
Wash both hands thoroughly.
Open sterile package or have an assistant (nurse) do it.
Put on appropriately sized sterile gloves.
Examine the IUPC and set up according to manufacturer's instructions. Equipment, including adaptor cable, syringe with sterile saline, and monitor, should all ready. Typically, the nurse would have done this ahead of time (see Figure 1 below).
In this image: FIgure 1. The IUPC should be examined before placement.
Placement
Perform a vaginal examination, confirm vertex presentation, and assess fetal position if possible. You may place the FSE at the same time, if so desired.
Determine cervical site for catheter placement and place your fingers between the cervix and the presenting part (fetal head).
Hold the IUPC with the non-examining hand, slide the introducer sheath along the second and third examining fingers; insert the distal end of the sheath 1-2cm between the cervix and the fetal head (see Figure 2 below).
Ensure the catheter introducer sheath does not extend beyond the tip of your examining fingers.
In this image: Figure 2. The practitioner holds the IUPC with the non-examining hand.
While holding the introducer sheath in place with your examining hand, use the non-examining hand to advance the catheter through the sheath until you are in-between the 30cm and 45cm markers on the catheter.
Do not insert IUPC into uterus beyond the 45cm mark (see Figure 3 below).
In this image: Figure 3. The stopping point is indicated on the IUPC.
If the catheter does not advance easily, stop and reposition your fingers as well as the introducer in another place. Never forcibly advance the catheter. Remove the catheter if signs of fetal distress occur.
Once the catheter is in place, hold it with your examining hand. Using your non-examining hand, pull out and remove the introducer sheath by splitting the proximal end in half.
Check and Document
Connect the IUPC to the monitoring apparatus and secure tubing onto patient's thigh with tape provided in kit.
Have patient cough to ensure proper placement and functioning. The pressure reading on the tocodynamometry should jump with a cough.
Assess maternal contraction frequency and strength.
Document placement of the IUPC (see FSE Documentation).
Remove the IUPC (see FSE Removal information).