Procedures for the Surgical Ward and Clinic

Question 1

How do you place a peripheral IV catheter?

Answer 1

1. Place a rubber tourniquet above the site
2. Use alcohol antiseptic
3. Place IV into vein with flash of blood
4. Remove inner needle while advancing IV catheter
5. Secure with tape

Question 2

How do you draw blood from the femoral vein?

Answer 2

Remember NAVEL:
Nerve, Artery, Vein, Empty space, Lymphatics.
Place needle medial to the femoral pulse.

Question 3

How do you remove staples?

Answer 3

Use a staple remover then place Steri-Strips

Question 4

How do you remove stitches?

Answer 4

1. Cut the suture next to the knot
2. Pull end of suture out by holding onto the knot
3. Place Steri-Strips

Question 5

How do you place Steri-Strips?

Answer 5

1. Dry the skin edges of the wound
2. Place adhesive (e.g. benzoin)
3. With the Adson pickup or with your fingers, place strips to gently appose epidermis (avoid tension)

Question 6

How do you place a Foley?

Answer 6

1. Stay sterile
2. Apply Betadine to the urethral meatus
3. Lubricate the catheter
4. Place catheter into urethra
5. As soon as urine returns, inflate balloon with saline

Question 7

How do you find the urethra in females?

Answer 7

First find the clitoris and clitoral hood.
The urethra is just below these structures.
Wiping Betadine-soaked sponge over this area will often result in having the urethra wink open.

Question 8

How do you determine how much of the NGT should be advanced into the body for the correct position?

Answer 8

Rough guide: from nose around ear, to 5 cm below the xiphoid

Question 9

How do you place the NGT in a nare?

Answer 9

First place lubrication, then place NGT straight back (not up or down)

Question 10

What is the best neck position for advancing the NGT?

Answer 10

Neck flexed (also have patient drink some water using a straw)

Question 11

What if there is 3 L per 24 hours drainage from an NGT?

Answer 11

Think duodenum (the NGT may be in the duodenum and not the stomach).
Check an XR.

Question 12

How can you clinically confirm that an NGT is in the stomach?

Answer 12

Use a Toomey syringe to inject air while listening over the stomach with a stethoscope.
You will hear the “swish” if the NGT is in place.

Question 13

What must you obtain and examine before using an NGT for feeding?

Answer 13

CXR/AXR to absolutely verify placement into the stomach and not the lung

Question 14

How do you draw a radial artery blood gas?

Answer 14

Feel for the pulse and advance directly into the artery.

ABG syringes do not have to have the plunger withdrawn manually.

Question 15

How do you drain an abscess?

Answer 15

I&D:
After using local anesthetic, use a #11 blade to incise and then open the abscess pocket.
Large abscesses are best drained with a cruciate incision or removal of a piece of skin.
Pack the open wound.

Question 16

How do you remove an epidermal cyst or sebaceous cyst?

Answer 16

1. Administer local anesthetic
2. Remove the ellipse of skin overlying the cyst, including the pore
3. Remove the cyst with the encompassing sac lining