Procedural Skills Instruction Arterial Blood Gas (ABG) Checklist

Procedural Skills Instruction 

Arterial Blood Gas (ABG) Checklist 

Please rate the examinee on the following items: 

1. Clean hands. ___Done __Not Done 

2. Check that all necessary equipment is available and ready to use. ___Done __Not Done 

3. Put on examination gloves. ___Done __Not Done 

4. Identified location of radial artery (palpated pulse lateral to flexor 

carpi radialis tendon. Thumb may not be used in palpation) 

Describe and demonstrate the steps in the Allen Test 

5. Hold patient’s hand up and have patient clench and unclench hand 

several times to drain blood from the hand. 

6. Compress the radial and ulnar arteries while patient is clenching 

the hand. 

7. Lower hand and have patient relax the arm and hand to alleviate 

tension which can cause inaccurate results. (Must verbalize) 

8. Release pressure on the ulnar artery and observe for brisk return of 

color to hand. (Must verbalize) 

9. “Describe potential results” - Participant answer need not be 

verbatim but must be complete: “Positive Test: Color returns to 

hand in 14 seconds or less and procedure can be done; 

Negative Test: Color returns to hand in 15 seconds or greater 

and procedure must be aborted. Assess the other hand.” 

10. Prepared area with alcohol wipe to simulate CHG (chlorhexidine 

gluconate) or idophor. Must state that solution stays on site for 2 

minutes until dry before puncturing the skin. 

11. Palpated artery with index finger of non-dominant hand proximal 

to (“above”) planned puncture site 

12. Using a Heparinized syringe, removed residual air from syringe. 

For credit, cap must be removed. 

13. Slightly adduct arm and dorsiflex the wrist approximately 30 o. 

Inserted needle at a 60° angle to the skin and advanced to the artery 

with bevel side up. (This must be done proximal to model) *You 

may Prompt participant to verbalize proper positioning. 

__Correct 

Technique 

__Correct 

Technique 

__Correct 

Technique 

__Correct 

Technique 

__Correct 

Technique 

__Correctl 

y 

Described 

__Correct 

Technique 

__Correct 

Technique 

__Correct 

Technique 

__Correct 

Technique 

__Incorrect 

Technique 

__Incorrect 

Technique 

__Incorrect 

Technique 

__Incorrect 

Technique 

__Incorrect 

Technique 

__Incorrectly 

Described 

__Incorrect 

Technique 

__Incorrect 

Technique 

__Incorrect 

Technique 

__Incorrect 

Technique 

ABG 3/20/2012 

__Not Done 

__Not Done 

__Not Done 

__Not Done 

__Not Done 

__Not Done 

__Not Done 

__Not Done 

__Not Done 

__Not Done

14. Assessed for flashback of blood into the syringe, then allowed 

syringe to fill. (about 1 cc - assessor should tell examinee that a 

smaller amount is sufficient for the purpose of the exam. Assessor 

may prompt for aspiration.) 

15. Placed 2x2 gauze pad over puncture site and withdrew needle and 

syringe. Needle safety device is engaged. 

16. Slowly inverts the syringe 10 times, and then roll between palms to 

mix. 

__Correct 

Technique 

__Correct 

Technique 

__Correct 

Technique 

__Incorrect 

Technique 

__Incorrect 

Technique 

__Incorrect 

Technique 


__Not Done 

__Not Done 

__Not Done 

17. In the patient’s presence, labels the specimen and places in a __Correct __Incorrect __Not Done 

biohazard bag. MUST VERBALIZE if no bag is available. Technique Technique 

18. Upon SI’s question, “How long should pressure be applied to 

puncture site?” Answered, “At least five minutes” or “Five 

Minutes.” 

__Done __Not Done 

19. Ask: “What must you do once the procedure is completed?” Answer: 

“Document in the patient chart.” 

___Yes ___No 

20. Patient comfort was a priority. ___Yes ___No 

21. Maintained sterility appropriately throughout the procedure. ___Done ___Not 

Done 

22. Procedure documented on patient chart. (Location of puncture site ,results of Allen ___Complete ___Not 

Test, and any complications MUST be documented on patient chart.) 

Complete 

Assessment based on ability to perform skills on a medical task trainer only. Total Missed______________


Basic Airway #1: Bag-Valve-Mask Ventilation 

ASSESSORS: PLEASE DO NOT LEAVE ANY ITEM UNRATED 

Oral and Nasal Airways (#7) can be done in conjunction with BVM or as a separate task. 

1. Assessor Prompt: “What equipment should be set out and 

checked for the procedure?” 

Correct Response: “Oxygen, ambu bag, Oral & Nasal Airways, 

Suction, stethoscope.” 

2. Washed Hands 

3. Put on Gloves 

4. Chooses Appropriate Sized Mask. 

5. Attaches Oxygen with tubing and adjusts regulator to at least 15 

liters. 

6. Checks patients’ mouth for foreign material and/or small or illfitting 

dental devices. (Good-fitting full dentures may be left in place 

to get a better seal.) 

7. Oral or Nasal airways properly measured (Tip of lip to angle of jaw/Tip 

of nare to angle of jaw) and inserted. (If oral, curve up towards hard palate 

first, then rotated at soft palate - or used tongue blade; if nasal, lubricated 

generously and initially inserted with bevel tip toward the septum.) 

Ask: “When is a(n) oral/nasal airway used.” Answer: Indicates 

gag reflex uses nasal vs. no gag reflex uses oral. 

8. Head-tilt, Chin-lift performed. 

9. Hand positioned– one-handed technique to fit and seal the bag against 

the face. (Proper hand placement: Thumb & Index finger on body of mask, 

3 rd & 4 th digits on jawbone, 5 th digit at the angle of the jaw. Little or NO 

pressure to the sub-mandibular soft tissue.) 

10. Hand positioned– two-handed technique to fit and seal the bag against 

the face. Assessor should squeeze the bag for the participant. (Proper 

hand placements: Thumbs & Index fingers on body of mask, 3 rd & 4 th digits 

on jawbone, 5 th digit at the angle of the jaw. Little or NO pressure to the 

sub-mandibular soft tissue.) 

11. Assessor prompt “What needs to be checked now?” 

Correct Response: “Auscultation of chest.(By a second person)” 



13. Procedure documented on patient chart. Documentation should in 

clude: indications for BVM ventilation, one or two person, time, 

response to ventilation, complications, initials. 

__Correct 

Response 

__Correct 

Technique 

__Correct 

Technique 

__Correct 

Technique 

__Correct 

Technique 

__Correct 

Technique 

__Correct 

Technique 

__Correct 

Technique 

__Incorrect 

Response 


__Don’t 

Know 



__Incorrect 

Technique 

__Incorrect 

Technique 

__Incorrect 

Technique 

__Incorrect 

Technique 

__Incorrect 

Technique 

__Incorrect 

Technique 

__Incorrect 

Technique 

__Not Done 

__Not Done 

__Not Done 

__Not Done 

__Not Done 

__Not Done 

__Not Done 



___Done ___Not Done 

Total Missed________ 

Assessment based on ability to perform skills on a medical task trainer only.


Basic Airway #2: Oxygen Delivery (NC, Simple Mask, NRB) Checklist 


All Items MUST be done in the correct order per the checklist. 

Participant MUST verbalize full range of oxygen liter flow for each device. 

NASAL CANNULA 

1. Connect end of tubing to Oxygen regulator 

(flowmeter). 

2. Turn on Oxygen from 2 to 6 liters. (states range) ___Done 

3. Place nasal cannula on patient w/prongs 

correctly placed in nares and tubing gently 

looped over ears. 

___Correct 

Technique 


___Incorrect 

Technique 


___Not Done 

___Not Done 

4. Patient comfort was a priority. _________Done ___Not Done 

SIMPLE MASK 

1. Connect end of tubing to Oxygen Regulator 

(flowmeter) 


2. Turn on Oxygen from 6 to 12 liters. (states range) ___Done ___Not Done 

3. Place mask over patients’ face and gently place ___Correct ___Incorrect ___Not Done 

elastic strap around the back of the head. 

Technique Technique 

4. Patient comfort was a priority. ___Done Not Done 

NON-REBREATHER MASK 

1. Connect end of tubing to Oxygen Regulator 

(flowmeter) 

2. Turn on Oxygen to 12 -15 liters. (states range) 

3. Place thumb over vent until reservoir bag is full. 

4. Place mask over patients’ face and gently place 

elastic strap around the back of the head. 

___Correct 

Technique 

___Correct 

Technique 



___Incorrect 

Technique 

___Incorrect 

Technique 

___Not Done 

___Not Done 

5. Patient comfort was a priority. ___Done ___Not Done 

*Ask: “What must you do once the procedure is completed?” Answer: “Document in the patient 

chart.” Documentation should include: date, time, adjunct used, liter flow, response, initials. 

Assessment based on ability to perform skills on a medical task trainer only. Total Missed_________


IV Insertion Checklist 


Please rate the examinee on the following items 

1. Checked that all necessary equipment is available and prepared to __Correct __Incorrect __Not Done 

use. 


2. Washed hands ___Done __Not Done 

3. Put on gloves ___Done __Not Done 

4. Cleaned insertion point. Must use at least 3 wipes, as shown on the 

training video, for credit. 

5. Applied tourniquet (may be done prior to cleaning if necessary to 

locate appropriate site.) 

6. Inserted needle superficially with bevel side up; if blow-out 

occurred, removed needle and starts procedure over in a different vein 

with a clean needle 

7. Removed tourniquet to release pressure in vein. 

8. Using one finger to put pressure at the end of the catheter to stop 

blood flow, removed the needle. (If using needleless device, retracted 

needle first.) 

Assessment based on ability to perform skills on a medical task trainer only. 

__Correct 

Technique 

__Correct 

Technique 

__Correct 

Technique 

__Correct 

Technique 

__Correct 

Technique 

9. Disposed of needle in Sharps container without recapping. __Correct 

Technique 

10. Attached IV tubing to hub of catheter and opened IV line to ensure 

proper flow of fluids. 

11. Thoroughly secured cannula and tubing with tagaderm & tape. At 

least two pieces of tape must be used with the tagaderm for credit. 

12. Labeled work with the minimum of initials, date, and size of 

needle. For credit, information must be recorded on piece of tape or on 

the tagaderm before it is placed on patients’ hand. 

13. Used proper removal technique: removed tape, applied 2x2 gauze 

pad with pressure at removal point, disposed of cannula and attached 

one band-aid. Note: All steps required for credit; if any are missing 

or incorrect, item is to be marked “incorrect technique” 

__Correct 

Technique 

__Correct 

Technique 

__Correct 

Technique 

__Correct 

Technique 

__Incorrect 

Technique 

__Incorrect 

Technique 

__Incorrect 

Technique 

__Incorrect 

Technique 

__Incorrect 

Technique 

__Incorrect 

Technique 

__Incorrect 

Technique 

__Incorrect 

Technique 

__Incorrect 

Technique 

__Incorrect 

Technique 

Total Missed______ 


__Not Done 

__Not Done 

__Not Done 

__Not Done 

__Not Done 

__Not Done 

__Not Done 

__Not Done 

__Not Done 

__Not Done 

14. Placed biohazard materials in proper containers. __Yes __No 

15. Patient comfort was a priority ___Yes ___No 

16. Maintained sterility appropriately throughout the procedure. __Yes __No 



__Done __Not Done


Lumbar Puncture Checklist 

Instruct the Examinee: You are permitted to re-adjust by retracting the needle to the subcutaneous 

tissue. If no fluid is present on the second attempt or if the needle is completely removed while trying to 

readjust the angle, you must begin process over at a new insertion site starting with sterilization. 


1. Clean Hands. 


2. Checked that all necessary equipment is available and ready 

to use. 

3. Put on Mask. ___Done 

4. Identified correct puncture site (midline at L4-L5-S1. L4 is 

at the level of the iliac crest). 

5. Open LP kit carefully to maintain sterility. ___Correct 

Technique 

6. Open sterile glove package. ___Correct 

Technique 

7. Put on sterile gloves maintaining sterile environment. ___Correct 

Technique 

8. Prepped “skin” over proposed puncture site. ___Correct 

Technique 



___Not Done 


___Incorrect 

Technique 

___Incorrect 

Technique 

___Incorrect 

Technique 

___Incorrect 

Technique 

9. Place sterile drapes around site maintaining sterile 

___Correct ___Incorrect 

environment. 


10. Properly administered a local anesthetic. Must anesthetize ___Correct ___Incorrect 

four different tissue levels using smaller needle for initial levels 

and larger needle for deeper levels. 


11. Verified proper fit of the stylette in the spinal needle. ___Done 

12. Inserted the spinal needle with stylette into the puncture 

site w/bevel toward the iliac crest and at the proper angle. (10 

degrees toward the umbilicus). 

13. Advanced the needle into the subarachnoid space; if bony 

resistance was felt, backed needle out to the subcutaneous 

tissue, changed angle and re-advanced the needle. Ask: If 

boney tissue is felt, what would you do? Response should be 

as stated above. 

14. Tested for presence of spinal fluid. Note: Credit given 

even if no fluid present. Ask: “How much fluid is 

collected?” Answer: “3 – 4 ml” 

15. If no fluid seen, examinee states they would back needle 

out to the subcutaneous tissue, changed angle and re-advanced 

the needle. 

16. Stylette placed into needle. Placed gauze over puncture 

site and removed needle. (Must use gauze every time needle is 

removed for credit and stylette MUST be reinserted into needle 

before removal.) 

___Correct 

Technique 

___Correct 

Technique 

___Correct 

Technique 

___Correct 

Technique 

17. Disposed of needle assembly in Sharps container ___Correct 

Technique 

___Done 

___Incorrect 

Technique 

___Incorrect 

Technique 

___Incorrect 

Technique 

___Incorrect 

Technique 

___Incorrect 

Technique 

___Not Done 

___Not Done 

___Not Done 

___Not Done 

___Not Done 

___Not Done 

___Not Done 

___Not Done 

___Not Done 

___Not Done 

___Not Done 

___Not Done 

___Not Done

18. Disposed of soiled or bloodied gauze into biohazard 

container. 

19. When asked “What would you now advise the patient to 

do?” Correctly answered, “To stay supine/laying down flat 

for at least several hours.” 

___Correct 

Technique 

___Correct 

Technique 

___Incorrect 

Technique 

___Incorrect 

Technique 


___Not Done 

___Not Done 

20. Ask: “What must you do once the procedure is 

completed?” Answer: “Document in the patient 

chart.” 

____Yes ____No 

21. Patient comfort was a priority. ___Done ___Not Done 

22. Maintained sterility appropriately throughout the 

procedure. 

Assessment based on ability to perform procedure on medical task trainer only. 

____Done ___Not Done 

Total Missed ____________________

Procedural Skills Instruction Arterial Blood Gas (ABG) Checklist

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