Clinical Skills Flashcards
What are the steps of venepuncture?
- Prepare, introduce self, wash hands, gloves etc
- Apply tourniquet, and clean site
- Insert needle in line with vein, bevel up,
- Insert blood tube and wait for it to fill
- Remove tourniquet
- Apply cotton and remove needle in single movement
- Label blood sample
What are purple top blood tubes used for?
- FBC
What are yellow top blood tubes used for?
U&Es
LFTs
What are blue top blood tubes used for?
Coagulation tests
What are pink top blood tubes used for?
Transfusion
Cross match
What is the order of draw of blood tubes?
Blue (Aerobic) blood culture Purple (Anaerobic) blood culture Blue Yellow Red Green Purple Pink Grey
What is the equipment needed for venepuncture?
Gloves Antiseptic wipe Needle Needle holder Sharps bin Tourniquet Correct blood tube
What are blue blood culture bottles used for?
Aerobic cultures
What are purple blood culture bottles used for?
Anaerobic cultures
Why should purple blood culture bottles be used second?
The butterfly tubing may contain air
What needle should be used for venepuncture?
16-gauge needle
Green
What is the smallest IV cannula needle size?
Blue (22G)= Approx 20ml/m
What is the largest IV cannula needle size?
Orange (14G)= Approx 300 ml/m
What cannula size should generally be used?
Green (18G)= Approx 110 ml/m
What are the steps of cannulation?
- Prepare, equipment, introduce self, wash hands, gloves
- Support patients arm on pillow
- Apply tourniquet 5-10 cm above intended site
- Clean site for 30s
- Stretch the skin below site and insert needle in line with skin at 15-20 degrees, advance until flashback into hub of cannula
- Slightly withdraw needle until second flashback along length of cannula, and advance
- Once inserted, release tourniquet
- Apply pressure to vein proximal to tip, ancour the hub of cannula and then remove needle, attaching a bung to end
- Secure with dressing
- Flush cannula
What equipment is needed for cannulation?
Gloves Antiseptic wipe Tourniquet Cannula Sharps bin Dressing Saline Syringe Gauze
Where does the 1st ECG sticker go?
4th IC space, RHS of sternum
Where does the 2nd ECG sticker go?
4th IC space, LHS of sternum
Where does the 3rd ECG sticker go?
Between C2 and C4
Where doe the 4th ECG sticker go?
5th IC space, midclavicular line
Where does the 5th ECG sticker go?
Anterior axillary line between C4 and C6
Where does the 6th ECG sticker go?
5th IC space, mid axillary line
Where do the limb leads of an ECG go?
One on each wrist’s bony prominence (aVR and aVL)
One on each ankle’s bony prominence (N, aVF)
Where does the red ECG limb lead go?
Right wrist
Where does the yellow ECG limb lead go?
Left wrist
Where does the green ECG limb lead go?
Left ankle
Where does the black ECG limb lead go?
Right ankle
What are the steps of ECG taking?
- Introduce self, consent, draw curtains etc
- Remove clothing from upper half (Except bra) and remove tights/socks
- Ensure patient is lying supine
- Ensure skin is dry and shaved if needed
- Apply electrodes
- Ask patient to relax and refrain from talking/ moving
- Check machine is set at auto and press start
Where do the cardiac monitoring stickers go?
One on each shoulder, and one on lower left chest wall
Contraindications for venepuncture may include?
Broken skin
Lymph tissue removal
AV fistulae
When informing patients of potential complications of venepuncture you should include?
Pain
Infection
Bruising / haematoma
When performing venepuncture what are important to maintain asepsis?
Disinfecting rubber septum on culture bottles
Washing hands prior to procedure
Using an ‘aseptic non-touch technique’ when preparing equipment
Appropriate aftercare of venepuncture should always include?
Documenting the procedure
Disposing of PPE appropriately and washing hands
Applying pressure to puncture site
When confirming the ID of a patient prior to IVC, which information is checked?
Date of birth
Name
Hospital number
20g (pink) cannula is capable of delivering a maximum flow of?
55ml/min
Using ANTT during IVC means ensuring you don’t touch which key parts of your equipment?
The exposed end of the flushing syringe
The length of the cannula (up to the main body)
The needle
The purpose of a tourniquet during IVC is?
To allow the vein to fill, ensuring it is as visible & ‘bouncy’ as possible
To occlude venous return
During IVC which of the following are correct..
A) The cannula is always inserted in the direction of venous flow
B) The tourniquet is removed prior to removal of the needle from cannula
C) The cannula is always inserted with bevel facing downwards
D) Traction is applied to skin below site immediately prior to insertion
Correct answer= A, B,D
What do leads C1 and C2 of an ECG look at?
Leads C1 and C2 look at the right ventricle.
What do leads C3 and C4 of an ECG look at?
Leads C3 and C4 look at the interventricular septum and the anterior wall of the left ventricle.
What do leads C5 and C6 of an ECG look at?
Leads C5 and C6 look at the anterior and lateral walls of the left ventricle.
In most instances an ECG machine should be calibrated to which values?
25 mm/s (Speed)
10 mm/mv (Amplitude)
