minimum access for c section?

[caligas]

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For example: non stat primary c/s for obese PIH pt, hct 31, has 20g butterly in distal hand that runs decently. Poor IJ landmarks but ultrasound avail. Decent surgeons. Unable to place another peripheral.

 

[RussianJoo]

I'd say that's pretty risky. if you have an US you can always try to get a deep peripheral, an EJ, or an IV in her foot. But at the same time our OB's are slow and unreliable. Maybe if the C-section takes 20min or so then maybe you can risk it, but definitely preload the pt with a few litters of fluids.

Just my opinion.

 

[sevoflurane]

I've done countless C/S with a nicely running 20G. Just raise the LR another foot and a half and see what your drip rate looks like. Most of the time I'm kew with that.

I you need to stick the neck.. you need to stick the neck. Having an 18g PIV is usually a mute point at that point in time.

Of course I'd prefer a good running 18G to start out with.

Now if RJ is @ a training center that routinely takes 1.5 hours to do a C/S... then that's another story... cuz it usually means that they are also taking their time suturing the uterus (can be a significant portion of blood loss). 45 minutes skin to skin is soooooo nice. I was floored how quick we do c/s once I got out to PP.

I was like....

 

[sevoflurane]

that's with our typical population... In the skinny moms and the senior OB dudes... 30 minutes is routine.

 

[jwk]

that's with our typical population... In the skinny moms and the senior OB dudes... 30 minutes is routine.

The range in our PP is amazing. There are a couple that take 90min+ routinely (those I would never do with a 20), and there are a handful that are routinely 15 min skin to skin. I've seen twins with a tubal in 10 minutes flat skin to skin - and this was a guy that simply didn't have complications. Pleasant but all business in the OR, no wasted motion, hands never stopped moving. It was quite impressive to watch.

 

[sevoflurane]

I've seen twins with a tubal in 10 minutes flat skin to skin - and this was a guy that simply didn't have complications.

Whoooaaa!

 

[pgg]

I'd do a routine section with just a 20, provided it ran fine.

You said u/s was available. It's a rare patient that I can't get an easy 20 or 18 peripheral IV with u/s.

 

[Planktonmd]

In private practice a 20 gauge is enough.
In residency: Place a central line.

 

[BLADEMDA]

In private practice a 20 gauge is enough.
In residency: Place a central line.

20G which runs well is fine but not a butterfly. I would want one decent IV for postop.

 

[Planktonmd]

👍

20G which runs well is fine but not a butterfly. I would want one decent IV for postop.

 

[imfrankie]

There is also the issue of precedent. If the staff starts to think a weak butterfly is all you need you'll get more and more.

You've got the U/S, why not just put a nice 18 in the arm somewhere under vision? Of course you'll do plenty of these tenuous IV cases in a pinch and all will work out fine except you'll kinda tax your antiperspirant a bit. But why have that on your mind if you needn't.