From: Validation of an instrument for the evaluation of exchange transfusion (INEXTUS) via an OSCE
INEXTUS INSTRUMENT FOR TRAINING AND EVALUATION OF EXCHANGE TRANSFUSION | ||
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Station 1. Clinical history and risk approach of the patient with neonatal jaundice | Yes | No |
1. The student identifies background of pregnancy and childbirth | ||
a. Inquires about obstetric care and birth spacing | ||
b. Asks about history of the evolution of previous pregnancies (emphasis on abortions, deaths or stillbirths) | ||
c. Asks about pathological history during pregnancy (UTI, infections, preeclampsia, tropical exanthematous diseases) | ||
d. Inquires about the number of prenatal check-ups and when they started | ||
e. Determines the gestational and chronological age of the patient | ||
2. Review prenatal exams (Complete blood count, serology, blood typing and indirect Coombs, thyroid stimulating hormone, ultrasound. Others according to particular case) | ||
3. The student identifies history and risk factors for severe neonatal jaundice | ||
a. Jaundice in the first 24 h | ||
b. Group incompatibility—verifies maternal and neonatal blood typing | ||
c. Coombs positive | ||
d. Gestational age from 35 to 37 weeks | ||
e. Family history of haemolytic disease | ||
f. Clinical factors: cephalohaematoma and exclusive breastfeeding | ||
g. History of maternal blood ingestion | ||
Percentage of skills met at Station 1: _____% | ||
Station 2. Comprehensive evaluation of the patient with jaundice | Yes | No |
1. Evaluates skin and mucosal colouration describing percentage of extent of involvement | ||
2. Evaluates signs and symptoms of acute hyperbilirubinemic encephalopathy | ||
a. Hypotonia | ||
b. Lethargy | ||
c. Poor suction | ||
3. Evaluates signs and symptoms compatible with haemolysis | ||
a. Evaluates vital signs of the new-born | ||
b. Evaluates state of consciousness | ||
c. Performs abdominal palpation to rule out hepatomegaly | ||
Percentage of skills met at Station 2: _____% | ||
Station 3: Definition of clinical behaviour | Yes | No |
1. The student determines the use of paraclinical tests and requests: | ||
a. Complete Blood Count. (CBC) | ||
b. Total and direct bilirubin levels | ||
c. Direct Coombs test of the new-born | ||
d. Reticulocytes | ||
e. Peripheral blood smear | ||
2. The student performs the comprehensive interpretation of the data and classifies the patient | ||
a. Classifies the type of hyperbilirubinemia according to the results as severe | ||
b. Orders immediate intensive phototherapy | ||
3. Indicates that exchange transfusion is required according to the use of the nomogram | ||
4. The student explains the behaviour to the parents and resolves their concerns | ||
5. Sign informed consent | ||
Percentage of skills met at Station 3: _____% | ||
Station 4. Preparation of the equipment for the procedure | Yes | No |
1. The student verifies that he or she has the appropriate personnel to perform the procedure (head nurse and nursing assistant) | ||
2. Properly selects the catheter | ||
i. Preterm: 2.5f; Near-term: 5f; At term: 5-7f | ||
3. Requests, prepares and verifies equipment for catheter passage (Gloves, gauze, sterile gown and drapes, mask, cap, cloths, sterile gauze, scalpel blades, 3 and 4 zero floss, syringes loaded with heparinized serum, chlorhexidine solution, surgical team) | 1 | 2 |
4. Request, prepare and verify equipment for exchange transfusion | ||
i. 5,10 and 20 ml Syringes | ||
ii. Three-way stopcocks | ||
iii. Bag to dispose of blood and metal support to hang it | ||
iv. Pipes to connect the systems | ||
5. The student requests the blood from the laboratory and verifies it when it is delivered | ||
i. Properly requests blood according to group and Rh compatibility | ||
ii. Request fresh blood less than 5 days old | ||
6.The student determines the type of fluid to be used and the volume of replacement | ||
i. The student performs the adequate calculation of the replacement volume considering the diagnosis of the patient (5 cc in premature infants, 10 cc at term) | ||
Percentage of skills met at Station 4: _____% | ||
Station 5. Performance of exchange transfusion | Yes | No |
1. The student verifies the conditions of the patient and monitors vital signs | ||
i. Check blood pressure | ||
ii. Heart rate | ||
iii. Respiratory rate | ||
iv. Oxygen saturation | ||
2. The student performs the umbilical catheter passage appropriately | ||
i. Verify the distance at which the catheter will be inserted | ||
ii. Follow the rules of asepsis and antisepsis for performing the procedure | ||
iii. Adequately and successfully introduces the catheter to the previously determined site | ||
iv. Check its permeability | ||
v. Fix the catheter | ||
vi. The student requests images to verify the position of the catheter (Request an abdominal x -ray) | ||
3. The student performs the exchange transfusion sequentially and in an orderly manner | ||
i. Properly connect the exchange transfusion system | ||
ii. Complies with the order of introducing the aliquot—blood extraction in the stipulated time and volume | ||
iii. Instructs the help staff to record in detail the meticulous aliquot process | ||
4. The student orders post-exchange transfusion monitoring to detect the appearance of early complications | ||
5. The student requests diagnostic testing at the end of the procedure and 6 h after it (blood count, bilirubins and serum electrolytes) | ||
Percentage of skills met at Station 5: _____% | ||
Station 6. Information to parents | Yes | No |
1. The student reports the results of the procedure to the parents | ||
Percentage of skills met at Station 6: _____% |