punch bx

suture

knee aspiration

art stick

hand tying

catheterization

1. <1cm - place sterile towel around bx site

2. using an alcohol pad - clean the area

3. if 1 cm or larger scrub w/ chlorhexidine or povidone-iodine

4. drape with sterile towels

5. mark lesion margins with sterile marker

6. inject the lesion w/ anesthetic - allow time to work

7. select appropriate punch size

8. hold skin taut and perpendicular to lines of tinsion, wrinkle, or skin fold

9. hold punch perpendicular to the skin and place it so the lesion is centered wi/in punch area

10. apply downward pressure while rotating the punch - punch should extend into subcu

11. upon completion - remove punch - the specimen will remain attached to the subcu fat by a pedicle

12. once the specimen is removed completely, place it in the specimen container

13. suture wound, placing half as many sutures as size of punch - 4mm punch = 2 sutures

14. apply abx ointment and adhesive bandage

1. prep: explain drug, site, sensation

2. obtain verbal consent: risks and benefits

3. questions about allergies and types of reactions

4. aspirate ampule: ID pt, wash hands, select and assemble. flick neck of ampule, tap around neck, protect fingers w/ gauze, break off top, aspirate, remove air from syringe

5. vial aspiration: draw air equal to solute to aspirate, insert needle into vial and turn upside down, push air out of syringe and into vial, aspirate solution, remove air from syringe as needed

6. expose ventral forearm

7. cleanse 2-3 fingerbreadths from antecubital fossa

8. stretch skin taught

9. hold needle at 15 deg angle w/ free hand - bevel up

10. insert needle 1/8 in beneath skin and inject slowly

11. withdraw needle at same 15 deg angle

12. do not rub site

13. document: drug, dose, route, lot number, exp date, where, when, whom

14. assess response in 24-48 hours

1. 2-3 ml syringe w/ 24-33g needle & 5/16-1 in long

2. withdraw appropriate amount of drug

3. add 0.2 ml air to syring or not - if not, then aspirate before injecting med and if blood noted then withdraw and reattempt injection

4. bevel facing up - insert at 45-90 deg angle

5. after injection, remove at same angle

6. check site for bleeding

1. 2-5 ml syringe w/ 18022 g needle, 1-2 in long

2. withdraw appropriate amount of med then draw about 0.2 ml of air into the syringe

3. press down and stretch skin at site

4. position needle at 90 deg angle 2 in from skin

5. quick and firm thrust needle into muscle

6. aspirate for blood if clear remove at same angle

7. apply pressure

8. massage muscle

9. dispose of used materials

1. gluteal

2. infants: thighs, older kids: deltoid

3. IM: vastus lateralis #1, deltoid #2

4. Multiple injections: vastus lateralis or deltoid if mucsular enough

Supplies:

tourniquet

gloves, eye protection

chlorhexidine

IV catheter or butterfly

IV fluid

administration set

2x2 gauze

tape

arm board

IV pole

biohazard container

1. apply tourniquet above elbow

2. palpate veins for firmness/stability

3. choose the most distal vein large enough to accomodate size of required catheter

4. choose vein by how it feels --> one that is straight and w/o valves close to the site

5. release tourniquet and check to make sure all supplies ready (tape, IV tubing) within reach

6. make sure tubing is flushed w/ IV solution

7. reapply tourniquet

8. apply gloves and eye protection

9. cleanse puncture site w/ chlorhexidine or other cleanser

10. w/ nondominant hand, hold pts hand or arm and retract the skin distal to the insertion site toward the fingers to anchor the vein

11. makes skin taut and anchors vein to prevent rolling

12. w/ dominant hand, insert catheter needle bevel up through the skin at 15-30 deg angle then drop the hub down close to the skin and continue to enter into the vein watching for a flashback of blood

13. if unsuccessful, pull back but not out of skin

14. continue to advance 2-3 mm then advance catheter into vein

15. apply pressure to vein proximal the indwelling catheter tip w/ finger then release the tourniquet

16. if unsuccessful, release tourniquet and remove catheter

17. remove stylet and discard in sharps container

18. attach IV tubing and secure w/ gauze and tape

19. inspect to see if fluids are flowing

Materials:

- sterile gloves

- syringe 20-35cc

- 18 or 20 gauge needle

- iodine

- alcohol

- hemostat

- adhesive bandage

- 1% lidocaine w/o epinephrine

- 0.25% sensorcain w/o epi

1. Locate patella and site of injection

2. put sterile gloves on

3. prep site w/ betadine and alcohol

4. enter joint w/ needle

5. slowly pull back on plunger to fill syringe w/ fluid

6. remove needle and syringe once there is no longer fluid flwoing into syring and cap w/ sterile cap

7. place adhesive bandage over injection site

Materials:

- gloves

- 18 to 23 gauge needle

- vacutainer barrels

- collection tubes and spares

- labels

- syringes

- IV butterfly

- tourniquet

- gauze pads

- isopropylalcohol pads

- providine-iodine

- blood culture

- adhesive strips

- sharps disposal

- biohazard waste container

1. confirm compliane w/ prep instructions

2. discuss prior pt experience - ask them what vein is good for them

3. discuss the need for the procedure

4. encourage pt to be still

5. do not say this will only hurt a little

6. answer pt questions

Prep:

1. collect supplies

2. wash hands

3. put on gloves

4. confirm pt ID and the test

5. verbal informed consent

6. inspect for contraindications

7. ideal world: best vein is easily palpated, large, well anchored,

procedure:

1. apply tourniquet

2. put on gloves

3. alcohol prep

4. anchor vein

5. bevel up at 15-30 deg angle

6. once in, lower needle to level of skin

7. stabilize needle and vacutainer

8. remove need, cover site w/ gauze

9. discard needle

10. clean up

11. assess pt status

12. remove gloves, wash hands

materials:

- 3-5 ml glass syring or special heparinized syringe

- 21-25 gauge 1/2-5/8 in needle

- bad or cup of ice for transport

- iodine containing skin prep pads

- cork or rubber for needle safety

- rubber stopper or plug for syringe

- sterile gloves 2 pair

- sterile gauze

- arm board

- tape

- goggles

- 1:1000 lidocaide w/o epi

- syringe and needle for local anesthesia

1. DO ALLEN'S TEST

2. pt educaiton/informed consent/laying supine

3. secure and stabilize site

4. gloves

5. cleanse area

6. prep syringe w/ heparin 10,000 u/ml 0.5cc

7. anesthetize

8. palpate artery w/ nondominant hand for point of maximal pulsation

9. face pt

10. hold syringe like a dart w/ bevel up

11. insert at 40-60 deg angle

12. not blood return

13. collect 3-5 ml of blood

14. remove needle swiftly

15. apply pressure for 10-15 min

16. hold syringe and needle upright an dallow air bubbles to rise, expel air

17. insert needle into cork

18. remove needle and dispose

19. label, roll, and cap syringe

20. place in ice and transport to lab

21. recheck pt at 5 and 15 min

materials: 

-scalpel (10 or 15 blade)
- tissue forceps (adson)
- skin hooks - to retract skin edges

- needle driver

- scissors

1. #10 - long, straight incisions, #15 - short, tortuous incisions

2. closure of wounds under tension and for everting skin edges

3. vertical: concave surfaces and deeper wounds

horizontal: pulling wound edges over a distance

4. close a surgical incision or clean wound