Welcome to Ellavi

Introduction

Why Ellavi UBT

Chapter 1

Introduction to PPH

Chapter 2

Components

Chapter 3

Inserting Ellavi

Chapter 4

Monitoring & Management

Chapter 5

Transport

Chapter 6

Managing without a drip stand

Chapter 7

Removal

Chapter 8

C-Section Protocol

Post-Training Form

ToT Certification

Reference Materials

1. monitoring for active bleeding

1.1 Insert 2 fingers into the vaginal canal to evaluate whether there is active bleeding or bleeding has stopped

1.2 if bleeding continues, and the supply bag is completely empty: close the tap and add a further 500 ml to the supply bag. hang the bag back at the previous height and reopen the tap. continue monitoring for bleeding. (balloon max capacity = 1.5 liters).

1.3 If bleeding has not considerably decreased within 15 minutes of balloon insertion, the bleeding is potentially due to the presence of tears, uterine rupture, etc. – complications other than uterine atony only. Surgical measures must be considered; These could include:

  • Compression sutures: Remove the balloon prior to the insertion of compression sutures. If haemostasis is not achieved with compression sutures, the uterine balloon may be re-inserted
  • Systematic devascularisation
  • A subtotal or total hysterectomy

Important: always start with the supply bag at 1.2 meters above the bed. as the patient’s clinical condition improves, the supply bag may be lowered,  while continuously checking for recurring bleeding 

2. managing the height of the supply bag:

Note: This will only be done once the patient has been stabilised 

2.1 After 8 hours of insertion, check if the bleeding has stopped: Keep 2 fingers at the cervix while the supply bag (with the tap open) is lowered to the level of the bed. If bleeding recurs, hang the supply bag back at the appropriate height. If bleeding has stopped, continue to the step of Ellavi removal (chapter 7)

2.2 Alternatively, the supply bag may be incrementally lowered over a period of time while continuously checking for the recurrence of bleeding, e.g.

  • Lower the supply bag every 30 to 60 minutes with 20 to 30cm
  • Regularly monitor for the recurrence of bleeding, especially directly after each height change of the supply bag
  • If bleeding recurs at any time during this process of lowering the supply bag, hang the bag back up at the previous height. If the bleeding continues, lift the bag higher until there is no more bleeding. When the patient is stable, restart the process of lowering the supply bag over time.

This can be compared to putting direct pressure on an external bleeding wound. A high pressure bleed from a large artery (e.g. femoral) requires more pressure for the bleeding to stop. A low pressure bleed from a capillary (e.g. a finger wound) requires little pressure for bleeding to stop.

Remember: The higher the supply bag hangs above the bed, the higher the pressure inside the balloon will be.
The lower the supply bag hangs, the lower the pressure inside the balloon.

3. Patient Discomfort

If a patient complains of discomfort, implement the following steps:

1. Lower the supply bag half way. Gently rub up the uterus. Some fluid from the balloon flows back to the supply bag, relieving the discomfort. Hang the supply bag at the original height

2. Monitor the patient for bleeding throughout this process

3. If bleeding occurs when lowering the supply bag, immediately hang the bag back at its original height

chapter 3
chapter 5