www.bloodsafelearning.org.auFebruary 2015
eLearning Australia
Example of a Postpartum Haemorrhage (PPH) box
BloodSafe eLearning Australia would like to thank the Delivery Suite staff at the Women’s and Children’s Health Network, Adelaide, South Australia, for allowing their postpartum haemorrhage box to be photographed as an example.
eLearning Australia
www.bloodsafelearning.org.auFebruary 2015
eLearning Australia
This is a guide only. Organisations will need to take in their individual requirements when developing a postpartum haemorrhage box.
BloodSafe eLearning Australia recommended:
• incorporatingyourorganisationsmassivetransfusionprotocolflowcharttoassistrapidaccess of emergency blood components as required
• follow the Australian Commission on Safety and Quality in Health Care recommendations for User-appliedlabellingofinjectablemedicines,fluidsandlines
PPH box content IV Cannulation (contents stored in a plastic bag)• 16 gauge cannula x 2• 10 mL syringes x 2• Clear adhesive IV site dressing x 2 (eg Tegaderm) • J Connector loops x 2• Lever lock cannula x 2• Interlink bungs x 2• Blunt plastic cannula access x 2 • Alcohol wipes x 2• 0.9% Sodium Chloride for injection 10 mL• Tourniquet x 1
Pathology specimens (contents stored in a plastic bag)• Blood Bottles: • Blue (Coags) x 1• Small Purple (for Complete Blood Picture) x 1 • Large Purple (for Group and Crossmatch) x 1• Green (Electrolytes) x 1
• 20 mL syringe x 2• 10 mL syringe x 2• 21 gauge needles x 4• Tourniquet x 1• Alcohol wipes x 1
IV Fluids• Hartmann’s solution 1 litre x 2• Gelofusine 500 mL x 2• AirwayfilterforGelofusinex1(egventedspike)
IV Giving set• IVBaxtergivingsetwith200micronfilterx2(bloodadministrationline)
IV Fluid/Blood warmer• Disposablewarmercartridgex1–specificforenFlowIVfluid/bloodwarmer• Extension tubing• Interlink extension set
IV Pressure infusors • MedexC-Fusor1000mLx1• MedexC-Fusor500mLx1
page 2 of 8
www.bloodsafelearning.org.auFebruary 2015
eLearning Australia
PPH box content continued
Syntocinon infusion (contents stored in a plastic bag)• “Medication Added” labels x 2• 10 mL syringe x 1• 2 mL syringe x 1• Needles: 18 gauge x 1, 21 gauge x 1, 23 gauge x 1• Alcohol wipes x 2
Purple information folder (purple folder)• Patient assessment of haemorrhagic shock
Note: A similar chart can be found in the Patient Blood Management Guidelines: Critical Bleeding/Massive Transfusion Module 1 Page 22
• MassiveTransfusionProtocol(MTP)FlowChart Note: It your organisation does not have a protocol for managing massive transfusions an example of an MTP can be found in the Patient Blood Management Guidelines: Critical Bleeding/Massive Transfusion Module 1 Page 5.
• Emergency blood record• Blood test required list• Specimen bags• Documentation records: • pathology forms• transfusion request form• pre-operative check list• spare medical record progress notes• high dependency unit (HDU) observation chart• HDUfluidbalancechart
Indwelling catheter equipment • 14gaugeFoley’scatheterx1• Disposable dressing tray x 1• 0.9% Sodium Chloride (normal saline) sachet x 1• 5 mL syringe x 1• 10 mL water for injection ampoule x 1• Urine drainage bag x 1
Vaginal pack (contents stored in a plastic bag)• Vaginal packs with radio opaque strip (10 cm x 2 m) x 3 • Vaginal plugs with radio opaque strip x 4
Equipment• Sponge holders x 4• Sims speculum x 1• Disposable vaginal retractor x 1
Pulse oximeter• Fingerprobeanddisposableadhesiveprobe• Self adhesive material tape (eg Coban) to secure small disposable adhesive probe
Emergency thermal blanket• Silver space blanket x 1
Medication kept in PPH box• Misoprostol 200 mcg tablets x 1 sachet – kept in PPH box
page 3 of 8
www.bloodsafelearning.org.auFebruary 2015
eLearning Australia
Additional medication and equipment
Medication kept in Yellow PPH box in refrigerator in drug room• Syntocinon10IU/1mLx5ampoules• Syntometrine(ergometrinemaleata0.5mg+oxytocin5IU/1mL)x5ampoules-intramuscularonly• Ergometrine0.5mg/1mLx5ampoules
Additional Medication PPH box kept in drug cupboard – Prostaglandin F2 alpha • ProstaglandinF2alpha5mg/1mL• 1 mL syringe x 1• 10 mL syringe x 1• Drawing up needle x 1• 0.9% Sodium Chloride for injection 10 mL x 1• Spinal needles: 27 gauge x 1, 22 gauge x 1, 20 gauge x 1 • Alcohol swabs x 2• Sterile KY Jelly sachet x 1
Note: See Appendix 1 for Women’s and Children’s Health Network, information sheet on Prostaglandin F2 alpha kept in the box with above equipment.
This box is often collected when the woman is being transferred to theatre. Midwifery staff will also collect a Bakri SOS Balloon at the same time.
page 4 of 8
www.bloodsafelearning.org.auFebruary 2015
eLearning Australia
PPH box content images
IV Cannulation – plastic bag
Pathology specimens – plastic bag
Syntocinon infusion – plastic bag
Vaginal packs – plastic bag
page 5 of 8
www.bloodsafelearning.org.auFebruary 2015
eLearning Australia
PPH box content images continued
Sims speculum
Sponge holder
Disposable vaginal retractor
Misoprostol 200 mcg tablets
Disposable adhesive pulse oximeter probe
page 6 of 8
www.bloodsafelearning.org.auFebruary 2015
eLearning Australia
PPH box content images continued
Pulseoximeter–withfingerprobe
IVPressureinfusor(MedexC-Fuser500mL)
IVenFlowfluid/bloodwarmercartridge
page 7 of 8
www.bloodsafelearning.org.auFebruary 2015
eLearning Australia
APPENDIX 1
Women’s and Children’s Health Network
Information sheet on Prostaglandin F2 ALPHA – kept in box with equipment
Note: This is a guide only. Please follow your local organisations polices and procedures.
Preparation of Prostaglandin F2 alpha (PGF2α)• PGF2α5mgin1mLampoule
Prepare• Dilute(5mg)1mLofPGF2αto10mLwith0.9%SodiumChloridetogive0.5mgPGF2αpermL• Discard 4 mL from 10 mL 0.9% Sodium Chloride to leave the maximum dose of 3 mg (6 mL). This
procedure decrease the chance of overdose
AdministrationAt laparotomy/LSCS• Infiltrate2mLofpreparedsolution(1mg)directlyintothemyometriumusinga21gaugespinal
needle, aspirating intermittently to avoid direct systemic injection. Repeat 10-15 minutes later if necessary. Avoid cervical injection because of increased risk of direct systemic uptake
After vaginal delivery• Usinga22gaugespinalneedle,themedicalofficerinjects1mL(0.5mg)ofdilutedPGF2αthroughthe
anterior abdominal wall into the myometrium on each side of the uterine fundus, or 2 mL (1 mg) into the uterine fundus, aspirating to avoid direct systemic injection. Repeat if required to maximum dose of 3 mg. Ultrasound guidance maybe useful
Unsuccessful response• Proceed to alternative management regimens which include balloon tamponade, uterine packing,
B-Lynch suture, uterine artery and internal iliac artery ligation, pelvic arterial embolisation and hysterectomy
Contraindications • ProstaglandinF2(PGF2α)isapotentsmoothmusclecontractorwhichis90%metabolisedonfirst
passage through the lungs• AlargebolusofPGF2αcanoverloadthelungmetabolicpathwaysandallowun-metabolisedPGF2α
into the systemic arterial system, with resultant cardiovascular effects
Relative contraindications • Sever asthma, lung disease and cardiovascular disease
Side effectsThe following adverse side effects have been reported:• Bronchopulmonary: bronchosparm, pulmonary oedema due to raised pulmonary artery pressure,
hypoxia due to pulmonary shunting• Cardiovascular: acute hypertension – usually transient and requiring no treatment. Occasionally acute
hypotension, rarely cardiac arrhythmia including ventricular tachycardia • Gastrointestinal: abdominal cramps, diarrhoea and vomiting• Other:convulsions(rarely),flushing,shivering,uterinerupture,headache–usuallymildandtransient
Prerequisites • Experienced anaesthetist on standby • Intravenous access x 2 using 16 gauge cannulas• Pulse oximetry and oxygen administration• Resuscitation equipment on hand
page 8 of 8
