Procedural Skills Instruction Arterial Blood Gas (ABG) Checklist

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Procedural Skills Instruction Basic Airway #2: Oxygen Delivery (NC, Simple Mask, NRB) Checklist ASSESSORS: PLEASE DO NOT LEAVE ANY ITEM UNRATED 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 ___Done ___Not Done ___Incorrect Technique ABG 3/20/2012 ___Not Done ___Not Done 4. Patient comfort was a priority. _________Done ___Not Done SIMPLE MASK 1. Connect end of tubing to Oxygen Regulator (flowmeter) ___Done ___Not Done 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 ___Done ___Not Done ___Done ___Not Done ___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_________
Procedural Skills Instruction IV Insertion Checklist ASSESSORS: PLEASE DO NOT LEAVE ANY ITEM UNRATED Please rate the examinee on the following items 1. Checked that all necessary equipment is available and prepared to __Correct __Incorrect __Not Done use. Technique Technique 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______ 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. 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 17. Ask: “What must you do once the procedure is completed?” Answer: “Document in the patient chart.” __Done __Not Done
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Procedural Skills Instruction Arterial Blood Gas (ABG) Checklist

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