P.99 Empowering midwives with arterial-line management

Dickerson, J.; Rowan, C.; Hartley, P.; Licari, O.

Introduction: Arterial pulse waveform analysis provides beat- to-beat monitoring of maternal cardiac output and is increasingly utilised in the management of obstetric patients. Common indications include preeclampsia, haemorrhage, obesity or cardiac disease. Such patients would ordinarily be managed in a high dependence or critical care area and 18% of women cared for in our obstetric high dependency unit required invasive arterial monitoring. We observed varying degrees of comfort amongst midwifery staff on managing arterial lines and sought to formally assess this. Methods: An anonymous survey was sent to 67 midwives in our maternity unit across a two-week period in November 2020. We asked five questions regarding confidence in handling of arterial lines (Likert-type scale) and two in response to a series of proposed interventions. After identifying a service need, we designed a poster and distributed this both in visible locations on labour ward and online. We followed this with an educational package and drop-in sessions and repeated the survey in January 2021. Results: 46% (31) of midwives completed our initial survey. Following a poster campaign and drop-in sessions, 36% (24) of midwives completed a follow-up survey. 92% (22) had reviewed our poster and all found it useful. 18 midwives attended a drop-in session, all of whom found it useful. All assessed areas of arterial line care improved. [Formula presented] Figure: Midwife self-reported comfort with arterial-lines Discussion: Arterial lines are integral in management of critically-ill obstetric patients and demand high acuity nursing care. The Enhanced Maternal Care Guidelines include comprehensive statements regarding arterial line care. 1With the low frequency of individual midwives encountering an arterial line, attrition of skills is likely. Our goal is to empower midwives with educational resources to build on and maintain their skills and confidence. Our poster has been well-received and circulated to all midwives, placed in high visibility areas in labour ward and in the midwifery reference handbook in the high dependency unit. Educational sessions were challenging to coordinate during the COVID-19 pandemic so we are now moving to a virtual platform. We hope to capitalise on this significant improvement in midwifery confidence levels in arterial line management, but also to continue to foster our multi-disciplinary communication and working relationship between anaesthetic and obstetric teams.