clinical skills

Question 1

what do you need for cannulation?

Answer 1

*Collect a plastic tray, and clean both the inside and outside of the box thoroughly with an alcohol surface disinfectant wipe. You will then need to collect:

· 1 pair of non-sterile gloves.

· Tourniquet.

· Cannula (size as required).

· Cannula extension set.

· 10mL 0.9% normal saline for injection. (not needed if syringe already loaded with saline)

· Blunt needle

· 10mL syringe

· Sponge that clicks (or alcohol swab)

· Sterile gauze.

· Sterile cannula dressing.

· Sterile field dressing.

· Sharps bin nearby

Question 2

how do you document cannula?

Answer 2

Please may I have the patient’s notes to document the cannulation?”

Patient’s name, hospital number, DOB, consultant name, number of attempts, indication, site, cannula size (e.g. blue is 22G), lot number from the cannula packaging, student name, title (medical student) and date.

Question 3

what are pink /blue cannulas used for?

what size are they?

Answer 3

Pink (20G) and blue (22G) cannulas are commonly used on the wards for fluid and medication infusions

Question 4

venepuncture

Common order of draw:

Answer 4

Common order of draw: (1) Light blue, (2) Yellow:, (3) Purple, (4) Pink, (5) Grey

Question 5

light blue - how many times to invert?

what is it for?

Answer 5

Haematological tests to assess clotting, including coagulation studies:

1. aPTT
2. PT
3. INR
4. D-dimer
5. Fibrinogen.

3-4 times

Question 6

yellow what is it for?

how many times invert?

Answer 6

Yellow:
Biochemistry 
1.	U+Es
2.	CRP 
3.	LFTs
4.	Cardiac enzymes
5.	Lipid profile 
6.	Amylase
7.	Bone profile
Endocrinology 
1.	TFTs
2.	B-hCG (pregnancy)
Toxicology 
1.	ethanol 
2.	drug levels
Tumour markers. 

5 times

Question 7

purple?

hiow many times invert?

Answer 7

fbc
esr 
blood film
hba1c
haem tests 
8-10 times

Question 8

pink ?

invert?

Answer 8

group and save
cross matching
8-10

Question 9

what questions to ask before suturing

Answer 9

1. Are you in any pain at the moment?
2. Has anyone given you anything for the pain? (If it’s been less than 15 mins, it will take some time for the pain relief to work so we can wait until the pain dies down before we start)
3. When you hurt your arm, did any rusty objects touch or get into the wound?
4. When did you last have the tetanus vaccine? If it’s been more than 10 years, say that you would give a tetanus booster which would give an immediate effect. I will also write a letter to the GP to book you in for a tetanus vaccine.
5. Do you have any allergies to latex? Do you have any other known allergies (for example, to nitrile gloves or nylon thread)
6. Are you taking any blood-thinning medication? (Aspirin or warfarin or heparin)
7. “How are you with needles?” If they have a needle phobia, “I understand that it can be a bit daunting but I will try my best to make it as quick and painless as possible. But if at any point, you would like me to stop, please let me know”

Question 10

intro for injections?

Answer 10

I have been asked to administer an injection for you which will be inserted into your muscle/ fatty tissue/just under the skin. I’ll just be giving you some medication using a small needle. You will feel a sharp scratch and there might be a little pain, but I will do my best to keep you as comfortable as possible. Would that be okay?

Question 11

what question is important to ask before any injection?

Answer 11

I’m not prescribing but I am administering the drug. Do you know what injection you’re having?

Question 12

questions before you inject

Answer 12

1. Are you allergic to latex gloves?
2. Have you received x drug in the past?
3. If yes: Did you have any adverse reactions to it?
4. Ask specific allergens for different drugs (see table below) e.g. If morphine sulphate: Are you allergic to sulphur?
5. How are you with needles? If they have a needle phobia, “I understand that it can be a bit daunting but I will try my best to make it as quick and painless as possible. But if at any point, you would like me to stop, please let me know”

Question 13

what is the blue needle for?

orange?

Answer 13

Blue intramuscular 22G, 
Orange intradermal or 
subcutaneous 25G (Green 21G buttocks IM not needed)

Question 14

what angle is a subcut done at?

Answer 14

pinch fatty layer- 2/3 needle at 45 degree

insert needle at rate of 1ml per 10

Question 15

advise patient after injecting?

Answer 15

: Thank you X, the injection has successfully been completed. I will just tell you a bit about how to look after it.
• (If not said previously) The site of the injection might become a bit sore over the next few days but you can relieve the pain by taking 2 paracetamol tablets, 8 hours apart.
• There may some bleeding but this is not a problem, just put some pressure on the area with a cotton pad.
• Also, if you experience any of the symptoms of a severe allergic reaction that I mentioned earlier like the tongue swelling, then please seek medical attention.
• Finally, please avoid massaging that area, because the medication might leak out of its desired space.

Question 16

advise patient for peak expiratory flow

Answer 16

So your reading is ___. You would reset the red marker and repeat the test 2 more times. Then record the highest reading in a peak flow diary. Do this once in the morning and once in the evening every day.

· If your readings in your diary seem to be going down then your symptoms may start coming back soon after. So try to see your GP as soon as you see any changes in your diary.

· Do you have any questions for me?

· Do you understand how to use the peak flow?

· Do you feel comfortable using i at home?

· If you have any questions in the future, then feel free to ask

· Ideally I’d like to offer the patient some visual information like a leaflet summarising the key steps.