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Flashcards in IACSS Deck (27):

What are the steps of handwashing?

Bare below elbows, wet hands and forearms, apply soap.
1. Palm to palm
2. Palm to palm with fingers interlaced
3. Back of hand to opposite hand with fingers interlaced
4. Back of fingers to opposing palms with fingers interlaced
5. Wash thumbs
6. Rub tips of fingers on palm
7. Wash wrists
Turn off tap with elbow and dry thoroughly.


Describe how you would consent a patient for vital signs?

Introduce self, check pt ID, ask how they would like to be addressed.
Vital signs are the measurement of temperature, blood pressure, pulse, breathing, and oxygen in blood. These are all painless procedures.
1. Temperature: This will involve me putting a probe in your ear which will beep and give me the temperature reading.
2,3. Pulse (and breathing) - no explanation needed
4. Blood pressure: This will involve me putting a cuff on your arm which i'll make tight and then gradually loosen it, and listen with a stethoscope on your arm to measure your blood pressure.
5. Oxygen: To take your oxygen saturation, I'll put a probe on your finger which will be linked up to a machine that'll give me the reading.


What questions would you ask a patient before proceeding with vital signs?

I'm going to ask some questions which I'll take into account when I interpret the results.
In the last 30 minutes, have you:
Eaten a large meal or had a drink?
Had a hot bath?
Smoked a cigarette?
Done exercise or exerted yourself?
Are you taking any medications? For your blood pressure?
Have you ever had any operations on your upper body or arms?
Have you ever had a fistula in your arm?
Do you have any pain, swelling, or weakness in your arms, or any reason why I should use one arm instead of the other?
(For temperature) Are you wearing a hearing aid? Do you have any ear infections?


How do you take temperature?

1. Put the cap on the prove
2. Insert into ear canal with the opening perpendicular to the surface being measured
3. Wait for beep before removing thermometer
4. Mark result on sheet with an X in the left column, reading off the right scale.


How do you take pulse and resp rate?

1. Make sure patient arm is supported.
2. Locate and palpate radial artery for a minimum of 15 seconds (use watch). Remember the number.
3. Whilst appearing to palpate the radial pulse, count the resp rate for a minimum of 15 seconds. Remember the number.
4. Multiply both by 4 and record.


How do you take blood pressure?

1. Make sure pt is comfortable. Ask not to move or talk.
2. Place cuff 2cm above antecubital fossa
3. Inflate cuff until can no longer feel radial pulse; this is the estimated systolic pressure.
4. Deflate cuff.
5. Place stethoscope over brachial artery
6. Reinflate cuff to 20-30 mmHg above estimated.
7. Deflate cuff at a rate of 2mmHg/s.
8. 1st Korotkoff sound = systolic BP. Remember the number
9. 5th Korotkoff sound (sound disappears) = diastolic BP. Remember the number, deflate and remove the cuff asap
10. Record the BP.


How do you take oxygen saturation?

1. Check for nail varnish/fake nails
2. Put peg on finger
3. Take reading off machine.


What equipment do you need for venepuncture?

3 Wipes - one for skin, one for each microbiology blood bottle.
Butterfly needle
Barrel (clear plastic thing)
2 Vacutainers - yellow for U&E, purple for FBC.
2 Microbiology bottles - aerobic and anaerobic
Cotton wool
Sharps bin


What would you say to consent a patient for venepuncture?

Identify the patient against the notes. I would like to take some blood from you today, so that we can check for an infection. This will involve me inserting a small needle into your vein and taking blood. You'll feel a sharp scratch as it goes in but you shouldn't be in pain after that. There is a risk of bruising and infection, but we reduce that risk by using clean single-use equipment and applying pressure to the site. Does that sound okay? Do you have any questions? Do you have any allergies?


How would you prepare for venepuncture on the patient?

1. Wash hands
2. Gloves and apron
3. Position patient comfortable with elbow extended and supported
4. Apply tourniquet approx 5cm above antecubital fossa.
5. Identify suitable site by inspection and palpation. REMOVE TOURNIQUET.


How would you perform venepuncture on the mannequin?

1. Clean blood bottles
2. Apply tourniquet, palpate vein
3. Clean site
4.Insert needle <45 degrees with barrel with bevel up. Check for flashback.
5. Microbiological: aerobic then anaerobic
6. Yellow U&E then purple FBC. Invert once filled.
8. Remove needle
9. Apply pressure with cotton wool and ask pt to apply pressure to reduce bruising.
10. Dispose of sharps
11. Label bloods - check with pt as you go
12. Tape cotton wool, check pt welfare, check for allergies
13. Fill out lab request form.
Ask pt to tell a nurse/doctor if they have any problems.


What is the black lab request form for?

Black = Microbiology (Aerobic and anaerobic).


What is the green lab request form for?

Green = Clinical chemistry (U&E)


How long should you clean for?

30 seconds then dry for 30 seconds.


What is the red lab request form for?

Red = Haematology (FBC)


What do you need for cannulation?

2 Wipes - one for pt and one in case you touch the bung.
Saline in date
Sharps bin


Consent a patient for cannulation.

Introduce self
Confirm pt identity against notes
I would like to put a cannula in your hand today, have you had one of those before? (no) This will involve me putting a small needle with a plastic tube in the back of your hand (indicate site) and then I will remove the needle and leave in the tube so that we can administer medications and fluids to make you feel better. You'll feel a sharp scratch when the needle goes in but apart from that it shouldn't be too painful. There are risks of bleeding and infection which we'll reduce by using clean equipment and elevating your arm.
Questions should already have been asked in vital signs, but check about allergies and contraindications.


How would you prepare for cannulation on the patient?

Expose and position patient arm, using a pillow if possible, check for contraindications
Identify vein
Apply tourniquet and recheck vein


How would you perform cannulation on the manikin?

Put tourniquet on and palpate vein
Clean site and do not touch after that
Remove equipment using non-touch procedure, put syringe in the saline.
Stretch skin
Insert needle
Advance needle until flashback appears
Withdraw needle and advance cannula, don't touch bung
Elevate arm, apply proximal pressure
remove needle
Discard sharps
Attach bung
Flush 'this could be cold, but apart from that should not be painful, tell me if you have any pain.'
Say you would add it to the patient notes.


What do you need to prepare a drug for administration?

Drug chart
'Drug' in date
2 Wipes - one for bung, one for bottle
2 saline - one for drug, one to flush, in date
2 syringes - one for drug, one for flush
1 needle
Sharps bin


How would you prepare a drug?

Ask about allergies
Check drug chart - drug, dosage, time, date, route
Make sure you SAY it's in date
Open equipment using no-touch technique (inside of packets should stay sterile so you can keep them in there)
Remove protective cap from vial and clean
Attach needle to syringe and draw up saline
Inject saline into vial
Release plunger and allow syringe to fill with air from vial
Shake until mixed
Inject air in syringe back into vial
Invert so vial is uppermost
Release plunger so syringe fills with drug, keeping needle in the liquid
Remove syringe and needle from vial and uncap syringe
Discard sharps
Ensure no bubbles


What are you checking for on the drug chart when mixing a drug?

Drug, dosage, time, date, route. Checking it has not already been administered.


How would you administer drugs via a cannula?

Double-check pt ID and drug
Clean bung
Say you would flush the cannula to ensure patency if you hadn't just done that
Inject drug - tell me if you have any pain, it may feel cold
Say you would fill in the drug chart
'Let one of my colleagues know if you feel anything that's not normal, for example, being short of breath, itching, or noticing any swelling or pain'.
Thank pt


What do you need to set up an IV infusion?

Fluid prescription chart
Sodium chloride 0.9% iv bag
Giving set
Wipe for bung
Drip stand
Infusion rate calculation sheet


How would you consent a patient for IV infusion?

Check pt ID and drug chart
I'd like to set up a drip today to put some saline into your blood to make you feel better. Have you ever had one of these before? (no)
I'll set up the drip which is this bag (indicate) which will stay connected to your hand through a long plastic tube. It won't hurt but might just feel a bit cold. Does that sound okay? (yes) Do you have any questions? (no)
Stop me at any time if you are in any pain or discomfort'.


How would you set up an IV infusion?

Check for allergies, any problems with the cannula.
Check drug chart - fluid to be infused, volume, rate, time and date
Collect fluid and check against prescription, check it is date and not damaged
Remove seal from infusion bag entry port aseptically
Open giving set aseptically
Close roller camp
Spike infusion bag entry port aseptically (don't touch spike)
Half-fill drip chamber by squeezing (the bit just under the bag)
Prime the line aseptically (expel air bubbles) by opening the roller clamp.
While maintaining asepsis, clean bung and connect to cannula
Commence infusion at correct rate. 500ml/hour = 3 drips/s.
Check pt welfare, ask them to let a colleague know if they have any problems
Say you would fill in the fluid chart


How would you calculate a drip rate for 500ml/hour, if the set gives 20 drops per ml?

Flow (drops per min) = Volume/time(h) x drops per ml/60.
500ml/1h x 20/60
= 500 x 0.33 = 167 drops per min. 167/60 seconds = 2-3 drops/s.