MCN RLE | SHAVING
I. SHAVING . WHY IS IT IMPORTANT TO SHAVE THE SKIN AROUND
A. The rules on pre-operative hair removal
• Leave hair in place whenever possible, but if you need to
remove hair because it might interfere at or around an
incision or port site, electric or battery operated clippers
or depilatory creams are less abrasive and harming to
the patient's skin than a razor is
B. Razors are banned.
• If there's a razor hiding in a drawer at your facility, you
should find it and throw it away, says the Institute for
Healthcare Improvement, which has urged the
prohibition of all razors at surgical facilities.
• Even in the gentlest hand, a sharp razor blade scraping
across a patient's skin can do damage.
• Clinical studies have shown the practice can cause
micro-abrasions in the surface, creating a portal of entry
for bacteria residing on the skin and thus increasing the
risk of surgical site infection.
• Clippers, the safer and faster option.
C. Recommended method of hair removal from an
operative site
1. Clipping is widely considered the preferred method of
pre-operative hair removal as shaving has been linked
to skin damage and increase the risk of infection
2. Shaving with razors creates micro abrasions that can
act as a portal for infection and allow microorganisms
dwelling on the skin to enter the incision site
D. Depilatory cream
• Depilatory creams are another acceptable method of
hair removal, though they're not the preferred method
in many surgical facilities
II. HAIR REMOVAL TIMING
• Hair removal, when requested, should be undertaken
immediately before surgery.
• The question of where to remove hair is also often a
physician's preference.
III. HAIR REMOVAL TIPS
• Here are some tips to make the job easier:
a. Use water. Wetting the hair before clipping it can
make it easier to clean up.
b. Use surgical tape to collect loose hair.
c. Alternatively, 1 surgical staffer can operate the
clippers while another taps at the patient and drape
with a piece of surgical tape, lint roller-style, to pick
up the hair, as we do to collect the loose hair.
THE OPERATIVE SITE?
• Shaving too soon before the procedure allows for
bacteria to remain in the surgical area.
• CDC guidelines also suggest that patients shower or
bathe using soap or antiseptic agent at least on the night
before surgery.
• Your surgeon will prep the area before surgery as well.
A. Shaving the patient:
• Hold skin taut with non-dominant hand.
• Hold razor with dominant hand at a 45-degree angle to
the skin and shave in short strokes in the direction of hair
growth.
B. Do you wear gloves when shaving a resident?
• Apply shaving cream to resident's face.
• Apply gloves before shaving. (Remove gloves, sanitize
hands, and re-glove as needed)
• Hold skin taut to prevent nicks.
D. Why remove hair from the site of incision?
• The removal of hair from the site of incision may be
necessary to access the surgical site.
• The perception that the presence of hair at the site
increases microbial contamination, and therefore risk of
SSI is not supported by evidence.
• Systematic reviews have found no difference in SSI rates
between procedures involving hair removal and no hair
removal.
E. How should hair be removed from the operative site?
• If hair must be removed, then the method used should
avoid damage to the skin.
• Micro-abrasions, such as those caused by razors, may
encourage the proliferation of microorganisms on the
skin surrounding the operative site and increase the risk
of the incision becoming contaminated.
• The longer the period between hair removal and the
incision being made the greater the risk of
contamination.
1. Pain
PROBLEMS OF
SHAVING
2. Allergy
3. Infection risk
MATERIALS FOR SHAVING
• Clean gloves • Shaving cream or soap
• Container / bowl for water / betadine soap
• Tissue / paper towel • Betadine surgical soap
• Bath towel or absorbent / scrub
pad • Depilator/razor
 MCN RLE | OXYTOCIN TREATMENT
II. OXYTOCIN TREATMENT
A. OXYTOCIN
• Oxytocin is often known as the "hormone of love"
because it is involved with:
a. Lovemaking
b. Fertility
c. Contractions during labor and birth
d. Release of milk in breastfeeding.
• It helps us feel good, and it triggers nurturing feelings
and behaviors.
• Receptor cells that allow your body to respond to
oxytocin increase gradually in pregnancy and then
increase a lot during labor.
• During labor and birth, the pressure of the baby against
your cervix, and then against tissues in the pelvic floor,
stimulates oxytocin and contractions. So does a
breastfeeding newborn.
• Oxytocin injection is used to begin or improve
contractions during labor.
• Oxytocin also is used to reduce bleeding after childbirth.
It also may be used along with other medications or
procedures to end a pregnancy.
• Oxytocin is in a class of medications called oxytocic
hormones.
Low levels of oxytocin during labor and birth can cause
problems by:
1. Causing contractions to stop or slow, and making
labor take longer.
2. Resulting in excessive bleeding at the placenta site
after birth.
3. Leading health care providers to respond to these
problems with interventions.
You can promote your body's production of oxytocin
during labor and birth by:
1. Staying calm, comfortable and confident.
2. Avoiding disturbances, such as unwelcome people or
noise and uncomfortable procedures.
3. Staying upright and using gravity so your baby is
pressed against your cervix and then, as the baby is
born, against the tissues of your pelvic floor.
4. Stimulating your nipples or clitoris before birth, and
giving your baby a chance to suckle (breastfeed)
shortly after birth.
5. Avoiding epidural analgesia.
B. WHY DO THEY GIVE OXYTOCIN DURING LABOR?
1. Oxytocin stimulates powerful contractions that help to
thin and open (dilate) the cervix, move the baby down
and out of the birth canal, push out the placenta, and
limit bleeding at the site of the placenta.
2. Stimulation with oxytocin is defined as the
administration of oxytocin to improve and/or increase
the frequency and intensity of contractions in women
whose delivery begins spontaneously.
III. ADMINISTRATION OF OXYTOCIN
1. Oxytocin perfusion consisted of a dilution of five units
of oxytocin in 500 ml of saline. The perfusion started
with the use of 6 ml/h, which was doubled every 30
minutes up to a maximum of 96 ml/h, until achieving
adequate contractions.
2. It is used in women with spontaneous labor onset, in
situations in which there is low frequency and/or
intensity of uterine contractions or when the expansion
process has failed and not progressed; although it is
also used in other cases to increase uterine activity and
thus accelerate the delivery process.
A. INDUCTION AND AUGMENTATION
INDUCTION AUGMENTATION
Induction is artificial Augmentation is assisting
initiation of labor labor that started
spontaneously
• For induction, the fetus must be mature, in longitudinal
lie, engaged, and in cephalopelvic proportion (the fetal
head can pass through the pelvis).
• The patient must have a ripe cervix (soft and supple to
the touch rather than firm), which allows for:
a. cervical effacement
b. dilation
c. effective coordination of contractions.
• Several methods may be used to induce labor:
amniotomy, prostaglandin administration, or oxytocin
administration.
a. Amniotomy involves the artificial rupturing of
membranes with a sterile instrument ; under
favorable conditions, about 80% of patients enter
labor within 24 hours
• Induction with oxytocin involves the administration of
I.V. oxytocin
• (Pitocin) as an infusion to augment or stimulate uterine
contractions.
• Labor induction and augmentation should be done
cautiously in women aged 35 and older and in those with
grand parity or uterine scars.
B. ACCORDING TO LIPPINCOT:
• Piggyback the oxytocin solution to the primary I.V. line.
• Continuously monitor uterine contractions and fetal
heart rate (FHR) patterns.
• If a problem occurs, such as decelerations of the FHR or
fetal distress, stop the piggyback infusion immediately
and resume the primary line.
The maximum dosage of oxytocin is 20 to 40
milli units/minute. Typically, the
recommended labor-starting dosage is 10
ALERT:
units of oxytocin in 100 ml of isotonic solution
To run at 0.5 to 1.0 milli units/minute, with the
maximum dosage being 20 to 40 mU.

C. COMPLICATIONS OF OXYTOCIN ADMINISTRATION

• Oxytocin can cause uterine hyper stimulation.

▪ This, in turn, may progress to tetanic contractions,
which last longer than 2 minutes.
• Signs of hyper stimulation includes:
a. contractions less than 2 minutes apart and lasting 90
seconds or longer,
b. uterine pressure that doesn't return to baseline
between contractions
c. intrauterine pressure that rises to more than 75 mm
Hg
D. ADDITIONAL POTENTIAL COMPLICATIONS
▪ Other potential complications include fetal distress,
abruptio placentae, and uterine rupture.
▪ In addition, watch for signs of oxytocin hypersensitivity
such as elevated blood pressure.
▪ Rarely oxytocin leads to maternal seizures or coma from
water intoxication