Toco placement and palpating contractions

[tsm007]

I am doing my senior practicum in L&D and I'm doing fine with placing the US strap and finding FHT (sorry not sure if that's the right term for it), but struggling with placing the toco. I am also having trouble palpating contractions. I can feel them if I'm poking around at the belly like just pressing and letting go and I'm not even consistent with that. I can't feel them at all if I'm doing like the other nurses and just putting my hand on the belly and waiting to feel it contract. I don't know what I'm doing wrong. Everything I read just tells you how to tell the strength of the contraction. I can tell the strength IF I can feel them, but I can't always feel them. I am also having trouble reading the strips for determining contractions. I can read the obvious contractions, but the small ones I have a hard time telling if they are contractions or not. I bought Mosby's Pocket Guide to Fetal Monitoring and am working through that now. I think that will help with the reading the strips, but looking for some practical advice for placing the toco and palpating cx.

[Katie71275]

The Toco goes at the top of the fundus. It can be hard to pick up on larger patients. I stay at the bedside and when the patient feels a contraction I have them tell me and feel the belly as well as place the toco so it will pick up. The only thing that will monitor the strength of the ctx is an IUPC.

[tsm007]

Katie71275 said:

The Toco goes at the top of the fundus. It can be hard to pick up on larger patients. I stay at the bedside and when the patient feels a contraction I have them tell me and feel the belly as well as place the toco so it will pick up. The only thing that will monitor the strength of the ctx is an IUPC.

Thanks for your help. Should it be centered or too the side? I see nurses moving it around quite a bit. I am going to try finding the contraction first and then placing it. Another question, if they are not having contractions (and just being triaged or NST) would you just put it centered at the top of the fundus?

The tips I found here really helped me with finding FHT so I was hoping for the same with toco placement.

[toomuchbaloney]

The tocodynamometer measures the movement of the fundus against the device which is equiped with a pressure transducer.

In order for it to be optimally effective you need to place it against the portion of the abdomen where the greatest amount of uterine "movement" with the contraction will be experienced by the transducer; that is typically the fundus. Clinicians may move the toco around in an effort to improve the recording or tracing of the contraction patterns or to provide an improved reflection of the intensity or duration. That would be important if one is noticing accelerations or decelerations in FHT that should be compared to the contractions. It is more difficult to externally monitor women who have significant fat coverage of the midsection.

Good luck, be glad you are not trying to accomplish this in the back of an ambulance or in a helicopter. LOL