Kiwi® 5 Step Vacuum Assisted Delivery Technique (Animation) – Feb 2017 Updated Version

Kiwi® 5 Step Vacuum Assisted Delivery Technique (Animation) – Feb 2017 Updated Version


Thank you for taking the time to watch this animation that will demonstrate step-by-step instructions needed for best outcomes when using the Kiwi® Omni Cup. Each step in the technique is important for the best outcomes, so please review carefully. Step One is to calculate the flexion point and calculate the cup insertion distance. It is important to know the length of one’s middle examining finger. The distance from the tip of the finger to the proximal interphalangeal joint is usually five to six centimeters, and that from the tip of the finger to the metacarpal phalangeal joint is usually 10 to 11 centimeters. The flexion point is located during vaginal examination by identifying the posterior fontanelle and then moving the middle examining finger a distance of three centimeters along the sagittal suture, toward the anterior fontanelle. The tip of the middle finger will then mark the location of the flexion point. With the knowledge of the length of one’s finger the clinician then calculates the distance from the flexion point to the perineum by noting where the posterior fourchette makes contact with the back of the examining fingers when the tip of the middle examining finger is at the flexion point. In this particular example the distance measured to the flexion point is approximately 8 centimeters. This is called the insertion distance. Step Two is to hold and insert the cup. The clinician holds the cup on its side ensuring as low a profile as possible with the thumb on the tube in the groove on the backside of the cup and the index finger on the edge of the cup. One or two fingers of the other hand is used to retract the perineum if necessary while the cup is placed gently against the fetal head. At this point the fingers are removed from the vagina and the clinician lets go of the handle to allow the stem to rest on the perineum, naturally. Step Three is to maneuver the cup toward and over the flexion point. Note that the Kiwi Omni Cup contains marks at 6 and 11 centimeters to assist the user in accurate insertion distance to place the cup over the flexion point. Once the cup is placed against the fetal head the clinician should note where the stem of the Kiwi Omni Cup intersects the posterior fourchette. If the distance is not what was measured in step one then use both index fingers to push the cup posteriorly in the midline of the maternal pelvis until the mark on the stem is equal to the distance calculated in step one, which was eight centimeters in this particular example. The key during this step is to ensure that the cup is moved along the midline of the maternal pelvis and avoid the natural tendency to push the cup laterally. Step Four is to create the vacuum and exclude maternal tissue. Initiate cup seal by increasing the vacuum using the palm pump. Check that no maternal tissue is trapped underneath the cup by gently sliding one’s finger around the anterior and lateral portions of the cup. There is no need to check posteriorly as maternal tissue will rarely be trapped there. Increase the vacuum to 600 millimeters of mercury, 0.8 bar/80 kilopascals. That is, the top of the Green Zone Step Five is to direct traction along the axis of the pelvis using the finger and thumb technique to avoid cup detachment. Press the thumb of the non pulling hand against the backside of the cup and place the index finger on the fetal scalp to prevent cup detachment and monitor the descent of the fetal head. Apply traction in line with the axis of the maternal pelvis. The axis will change as the fetal head descends. In general, one should maintain a 90 degree angle between the cup and the stem of the vacuum when possible Note this may not be possible with the first traction effort in malpositioned babies. Ensure to time your traction with maternal pushing efforts. Finally when delivering the fetal head across the perineum, ensure the non pulling hand remains on the backside of the cup and the fetal scalp to help prevent cup detachment. Ask an assistant to provide perineal support if desired. Once the fetal head is delivered, remove the cup from the scalp by depressing the vacuum release button found on the Kiwi palm pump opposite the side of the vacuum gauge. Then finish delivering the fetus in the usual fashion. Thank you for watching the video on the Kiwi Five-Step Vacuum Technique. Following these five steps will improve your vacuum delivery outcomes significantly. Not only will they increase your success rate, but will also decrease any potential complications. For additional information, please visit clinicalinnovations.com

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