Procedural Skills Instruction Arterial Blood Gas (ABG) Checklist

Please rate the examinee on the following items: 1. Clean hands.

2. 3. 4.

___Done __Not Done ___Done __Not Done ___Done __Not Done __Correct Technique __Incorrect Technique __Not Done

Check that all necessary equipment is available and ready to use. Put on examination gloves. Identified location of radial artery (palpated pulse lateral to flexor carpi radialis tendon. Thumb may not be used in palpation)

Describe and demonstrate the steps in the Allen Test 5. Hold patients hand up and have patient clench and unclench hand several times to drain blood from the hand. 6. Compress the radial and ulnar arteries while patient is clenching the hand. 7. Lower hand and have patient relax the arm and hand to alleviate tension which can cause inaccurate results. (Must verbalize) 8. Release pressure on the ulnar artery and observe for brisk return of color to hand. (Must verbalize) 9. Describe potential results - Participant answer need not be verbatim but must be complete: Positive Test: Color returns to hand in 14 seconds or less and procedure can be done; Negative Test: Color returns to hand in 15 seconds or greater and procedure must be aborted. Assess the other hand.
10.

__Correct Technique __Correct Technique __Correct Technique __Correct Technique

__Incorrect Technique __Incorrect Technique __Incorrect Technique __Incorrect Technique

__Not Done __Not Done

__Not Done

__Not Done

__Correctl __Incorrectly y Described Described

__Not Done

Prepared area with alcohol wipe to simulate CHG (chlorhexidine gluconate) or idophor. Must state that solution stays on site for 2 minutes until dry before puncturing the skin. Palpated artery with index finger of non-dominant hand proximal to (above) planned puncture site

__Correct Technique __Correct Technique

__Incorrect Technique __Incorrect Technique __Incorrect Technique __Incorrect Technique

__Not Done

11.

__Not Done __Not Done __Not Done

Using a Heparinized syringe, removed residual air from syringe. __Correct For credit, cap must be removed. Technique o. 13. Slightly adduct arm and dorsiflex the wrist approximately 30 __Correct Inserted needle at a 60 angle to the skin and advanced to the artery Technique with bevel side up. (This must be done proximal to model) *You may Prompt participant to verbalize proper positioning.
12.

ABG 3/20/2012

14.

Assessed for flashback of blood into the syringe, then allowed syringe to fill. (about 1 cc - assessor should tell examinee that a smaller amount is sufficient for the purpose of the exam. Assessor may prompt for aspiration.)

__Correct Technique

__Incorrect Technique

__Not Done

15. Placed 2x2 gauze pad over puncture site and withdrew needle and syringe. Needle safety device is engaged. 16. Slowly inverts the syringe 10 times, and then roll between palms to mix.
17.

__Correct Technique __Correct Technique

__Incorrect Technique __Incorrect Technique __Incorrect Technique __Done

__Not Done __Not Done __Not Done __Not Done

In the patients presence, labels the specimen and places in a __Correct biohazard bag. MUST VERBALIZE if no bag is available. Technique 18. Upon SIs question, How long should pressure be applied to puncture site? Answered, At least five minutes or Five Minutes. 19. Ask: What must you do once the procedure is completed? Answer: Document in the patient chart. 20. Patient comfort was a priority.
21.

___Yes ___Yes ___Done ___Complete

___No ___No ___Not Done ___Not Complete

Maintained sterility appropriately throughout the procedure.

22. Procedure documented on patient chart. (Location of puncture site ,results of Allen Test, and any complications MUST be documented on patient chart.) Assessment based on ability to perform skills on a medical task trainer only.

Total Missed______________

ABG 3/20/2012

Procedural Skills Instruction Basic Airway #1: Bag-Valve-Mask Ventilation ASSESSORS: PLEASE DO NOT LEAVE ANY ITEM UNRATED
Oral and Nasal Airways (#7) can be done in conjunction with BVM or as a separate task. 1. Assessor Prompt: What equipment should be set out and __Correct __Incorrect Response Response checked for the procedure? Correct Response: Oxygen, ambu bag, Oral & Nasal Airways, Suction, stethoscope. 2. Washed Hands 3. Put on Gloves 4. Chooses Appropriate Sized Mask. 5. Attaches Oxygen with tubing and adjusts regulator to at least 15 liters. 6. Checks patients mouth for foreign material and/or small or illfitting dental devices. (Good-fitting full dentures may be left in place to get a better seal.) 7. Oral or Nasal airways properly measured (Tip of lip to angle of jaw/Tip
of nare to angle of jaw) and inserted. (If oral, curve up towards hard palate first, then rotated at soft palate - or used tongue blade; if nasal, lubricated generously and initially inserted with bevel tip toward the septum.)

__Dont Know

__Done __Done __Correct __Incorrect Technique Technique __Correct __Incorrect Technique Technique __Correct __Incorrect Technique Technique __Correct __Incorrect Technique Technique

__Not Done __Not Done __Not Done __Not Done __Not Done

__Not Done

Ask: When is a(n) oral/nasal airway used. Answer: Indicates gag reflex uses nasal vs. no gag reflex uses oral. 8. Head-tilt, Chin-lift performed. 9. Hand positioned one-handed technique to fit and seal the bag against
the face. (Proper hand placement: Thumb & Index finger on body of mask, rd th th 3 & 4 digits on jawbone, 5 digit at the angle of the jaw. Little or NO pressure to the sub-mandibular soft tissue.)

__Correct __Incorrect Technique Technique __Correct __Incorrect Technique Technique

__Not Done __Not Done

10. Hand positioned two-handed technique to fit and seal the bag against
the face. Assessor should squeeze the bag for the participant. (Proper rd th hand placements: Thumbs & Index fingers on body of mask, 3 & 4 digits th on jawbone, 5 digit at the angle of the jaw. Little or NO pressure to the sub-mandibular soft tissue.)

__Correct __Incorrect Technique Technique

__Not Done

11. Assessor prompt What needs to be checked now?

Correct Response: Auscultation of chest.(By a second person) 12. Ask: What must you do once the procedure is completed? Answer: Document in the patient chart.

__Done __Done
___Done

__Not Done __Not Done

___Not Done

13. Procedure documented on patient chart. Documentation should in clude: indications for BVM ventilation, one or two person, time, response to ventilation, complications, initials.

Total Missed________ Assessment based on ability to perform skills on a medical task trainer only. ABG 3/20/2012

Procedural Skills Instruction

Basic Airway #2: Oxygen Delivery (NC, Simple Mask, NRB) Checklist
ASSESSORS: PLEASE DO NOT LEAVE ANY ITEM UNRATED All Items MUST be done in the correct order per the checklist. Participant MUST verbalize full range of oxygen liter flow for each device.

NASAL CANNULA
1. Connect end of tubing to Oxygen regulator (flowmeter). ___Done ___Not Done

2. Turn on Oxygen from 2 to 6 liters. (states range) 3. Place nasal cannula on patient w/prongs correctly placed in nares and tubing gently looped over ears. 4. Patient comfort was a priority. ___Correct Technique

___Done ___Not Done ___Incorrect ___Not Done Technique _________Done ___Not Done

SIMPLE MASK
1. Connect end of tubing to Oxygen Regulator (flowmeter) 2. Turn on Oxygen from 6 to 12 liters. (states range) 3. Place mask over patients face and gently place elastic strap around the back of the head. 4. Patient comfort was a priority. ___Done ___Not Done

___Done ___Correct ___Incorrect Technique Technique ___Done

___Not Done ___Not Done

Not Done

NON-REBREATHER MASK
1. Connect end of tubing to Oxygen Regulator (flowmeter) 2. Turn on Oxygen to 12 -15 liters. (states range) 3. Place thumb over vent until reservoir bag is full. 4. Place mask over patients face and gently place elastic strap around the back of the head. 5. Patient comfort was a priority. ___Done ___Not Done

___Done ___Correct ___Incorrect Technique Technique ___Correct ___Incorrect Technique Technique ___Done

___Not Done ___Not Done ___Not Done

___Not Done

*Ask: What must you do once the procedure is completed? Answer: Document in the patient chart. Documentation should include: date, time, adjunct used, liter flow, response, initials. Assessment based on ability to perform skills on a medical task trainer only. Total Missed_________ ABG 3/20/2012

Procedural Skills Instruction IV Insertion Checklist ASSESSORS: PLEASE DO NOT LEAVE ANY ITEM UNRATED
Please rate the examinee on the following items 1. Checked that all necessary equipment is available and prepared to use. 2. Washed hands 3. Put on gloves 4. Cleaned insertion point. Must use at least 3 wipes, as shown on the training video, for credit. 5. Applied tourniquet (may be done prior to cleaning if necessary to locate appropriate site.) 6. Inserted needle superficially with bevel side up; if blow-out occurred, removed needle and starts procedure over in a different vein with a clean needle 7. Removed tourniquet to release pressure in vein. 8. Using one finger to put pressure at the end of the catheter to stop blood flow, removed the needle. (If using needleless device, retracted needle first.) 9. Disposed of needle in Sharps container without recapping. 10. Attached IV tubing to hub of catheter and opened IV line to ensure proper flow of fluids. 11. Thoroughly secured cannula and tubing with tagaderm & tape. At least two pieces of tape must be used with the tagaderm for credit. 12. Labeled work with the minimum of initials, date, and size of needle. For credit, information must be recorded on piece of tape or on the tagaderm before it is placed on patients hand. 13. Used proper removal technique: removed tape, applied 2x2 gauze pad with pressure at removal point, disposed of cannula and attached one band-aid. Note: All steps required for credit; if any are missing or incorrect, item is to be marked incorrect technique 14. Placed biohazard materials in proper containers. 15. Patient comfort was a priority 16. Maintained sterility appropriately throughout the procedure.
17. Ask: What must you do once the procedure is completed? Answer: Document in the patient chart.

__Correct Technique

__Incorrect Technique ___Done ___Done __Incorrect Technique __Incorrect Technique __Incorrect Technique __Incorrect Technique __Incorrect Technique __Incorrect Technique __Incorrect Technique __Incorrect Technique __Incorrect Technique __Incorrect Technique

__Not Done __Not Done __Not Done __Not Done __Not Done __Not Done

__Correct Technique __Correct Technique __Correct Technique __Correct Technique __Correct Technique __Correct Technique __Correct Technique __Correct Technique __Correct Technique __Correct Technique

__Not Done __Not Done

__Not Done __Not Done __Not Done

__Not Done

__Not Done

__Yes ___Yes __Yes __Done

__No ___No __No __Not Done

Total Missed______
Assessment based on ability to perform skills on a medical task trainer only.

ABG 3/20/2012

Procedural Skills Instruction Lumbar Puncture Checklist

Instruct the Examinee: You are permitted to re-adjust by retracting the needle to the subcutaneous tissue. If no fluid is present on the second attempt or if the needle is completely removed while trying to readjust the angle, you must begin process over at a new insertion site starting with sterilization.

ASSESSORS: PLEASE DO NOT LEAVE ANY ITEM UNRATED

1. Clean Hands. 2. Checked that all necessary equipment is available and ready to use. 3. Put on Mask. 4. Identified correct puncture site (midline at L4-L5-S1. L4 is at the level of the iliac crest). 5. Open LP kit carefully to maintain sterility. 6. Open sterile glove package. 7. Put on sterile gloves maintaining sterile environment. 8. Prepped skin over proposed puncture site. ___Done ___Done ___Not Done ___Not Done

___Done ___Done ___Correct Technique ___Correct Technique ___Correct Technique ___Correct Technique ___Correct Technique ___Correct Technique ___Incorrect Technique ___Incorrect Technique ___Incorrect Technique ___Incorrect Technique ___Incorrect Technique ___Incorrect Technique ___Done ___Done

___Not Done ___Not Done ___Not Done ___Not Done ___Not Done ___Not Done

9. Place sterile drapes around site maintaining sterile environment. 10. Properly administered a local anesthetic. Must anesthetize four different tissue levels using smaller needle for initial levels and larger needle for deeper levels. 11. Verified proper fit of the stylette in the spinal needle. 12. Inserted the spinal needle with stylette into the puncture site w/bevel toward the iliac crest and at the proper angle. (10 degrees toward the umbilicus). 13. Advanced the needle into the subarachnoid space; if bony resistance was felt, backed needle out to the subcutaneous tissue, changed angle and re-advanced the needle. Ask: If boney tissue is felt, what would you do? Response should be as stated above. 14. Tested for presence of spinal fluid. Note: Credit given even if no fluid present. Ask: How much fluid is collected? Answer: 3 4 ml 15. If no fluid seen, examinee states they would back needle out to the subcutaneous tissue, changed angle and re-advanced the needle. 16. Stylette placed into needle. Placed gauze over puncture site and removed needle. (Must use gauze every time needle is removed for credit and stylette MUST be reinserted into needle before removal.) 17. Disposed of needle assembly in Sharps container

___Not Done ___Not Done

___Not Done ___Not Done

___Correct Technique

___Incorrect Technique

___Not Done

___Correct Technique ___Correct Technique ___Correct Technique

___Incorrect Technique ___Incorrect Technique ___Incorrect Technique

___Not Done

___Not Done

___Not Done

___Correct Technique

___Incorrect Technique

___Not Done

ABG 3/20/2012

18. Disposed of soiled or bloodied gauze into biohazard container. 19. When asked What would you now advise the patient to do? Correctly answered, To stay supine/laying down flat for at least several hours. 20. Ask: What must you do once the procedure is completed? Answer: Document in the patient chart. 21. Patient comfort was a priority. 22. Maintained sterility appropriately throughout the procedure.

___Correct Technique ___Correct Technique

___Incorrect Technique ___Incorrect Technique

___Not Done

___Not Done

____Yes

____No

___Done ____Done

___Not Done ___Not Done

Assessment based on ability to perform procedure on medical task trainer only.

Total Missed ____________________

ABG 3/20/2012