Procedures for the Surgical Ward and Clinic

Question 1

How do you place a
peripheral intravenous (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”: In the lateral to
medial direction—Nerve, Artery, Vein,
Empty space, Lymphatics—and thus
place needle medial to the femoral
pulse

Question 3

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

Answer 3

Rough guide: from nose, around ear, to

5 cm below the xiphoid

Question 4

What is the best neck
position for advancing the
NGT?

Answer 4

Neck FLEXED! Also have the patient

drink some water (using a straw)

Question 5

What if there is 3 liters/
24 hours drainage from an
NGT?

Answer 5

Think DUODENUM—the NGT may be
in the duodenum and not the stomach!
Check an x-ray

Question 6

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

Answer 6

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 7

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

Answer 7

LOWER chest/upper abdominal x-ray to
absolutely verify placement into the
stomach and NOT the LUNG—patients
have died from pulmonary tube feeding!

Question 8

How do you draw a radial

arterial blood gas (ABG)?

Answer 8

Feel for the pulse and advance directly
into the artery; ABG syringes do not have
to have the plunger withdrawn manually

Question 9

How do you drain an

abscess?

Answer 9

By incision and drainage (or “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 10

How do you remove an
epidermal cyst or sebaceous
cyst?

Answer 10

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