OSCE 2
Years 3-5
Venepuncture
IV cannulation
Male catheterisation
Examination of hernial orifices
Testicular exam
Measurement of peak flow
Interpretation of arterial blood gas
Carrying out a 12 lead ECG
Examination of murmurs
Instruct patients on the use of inhalers/spacers and assess technique
Airway management and oxygen prescription
Examination of a rash- pigmented lesion and non-pigmented/rash
Cerebellar exam
Diabetic foot exam
Nasal exam
Foot/ankle exam
Tremor/gait disorder/ataxia/Parkinson’s assessment
Peripheral vascular exam (rewatch Mr. Baker video and ensure to learn Buerger’s)
Dermatology history
ENT history- vertigo, hearing loss, epistaxis
Dix hallpike test (ENT)
ECG interpretation
Ophthalmology history
Haematology history
Interpretation of haematology screen
Jaundice history
LFT interpretation
Emergencies: AKI + hyperkalaemia, DKA, recognising and treating sepsis, recognition
and treatment of acute STEMI, hypoglycaemia, anaphylaxis, hyponatraemia,
Basic counselling of diseases and medications
1) Venepuncture
,INTRODUCTION
- Wash hands, introduce self and confirm patient’s name, DOB and H&C number
- Explain the procedure and gain consent
- Check for allergies, including chlorhexidane
- Ask their preferred arm (usually non-dominant) and avoid bruised, excoriated or areas with
arteriovenous fistulae.
PREPARATION
- Wash hands
- Clean equipment tray
- Gather equipment (gloves, tourniquet, skin cleansing wipe, butterfly needle, vacutainer
holder, required blood tubes, sterile gauze and tape).
- Attach vacutainer to butterfly needle
- Return to patient with tray and a sharps box
PROCEDURE
A) Vein identification
- Expose the arm and place a pillow underneath
- Place tourniquet around the patient’s arm 4-5 finger lengths
above the vein site (usually antecubital fossa)
- Identify a bouncy vein (not necessarily one you can see)
- Remove tourniquet
B) Venepuncture
- Wash hands
- Put on gloves
- Sterilise the area with a skin cleansing wipe
- Reapply tourniquet
- Anchor the vein with your non-dominant hand and insert the needle with the other hand at
an angle of 10-30 degrees, once flashback is observed you are in the correct position.
- Fill blood bottles in the correct order, inverting them after filling
- Remove the tourniquet after the last bottle
- Place gauze loosely over the puncture site whilst removing the needle
- Place needle into the sharps pain and secure the gauze with tape
TO COMPLETE
- Thank the patient
- Discard waste and clean the tray, then discard gloves and wash hands
- Attach patient stickers to bottles (opposite the fill line) and fill out request forms
- Document procedure
NB: Always take U+Es first to reduce risk of pseudo-hypokalaemia
2) Intravenous cannulation
,INTRODUCTION
- Wash hands, introduce self, confirm patient’s name, DOB and H&C number
- Explain procedure and gain consent
- Check for allergies including Chlorhexidane
- Ask preferred arm
PREPARATION
- Wash hands
- Clean tray
- Gather equipment (gloves, tourniquet, skin cleansing wipe, pink 20G cannula unless patient
needs urgent fluid resus, sterile gauze, cannula dressing, posi-flush, cannula IV extension set
and tape)
- Neatly place equipment in the tray ensuring it remains inside its packaging
- Prime cannula set: Don PPE, flush each lumen with 1ml of sterile saline and place set back
into its packets
- Don apron and wash hands
- Return to patient with tray and sharps bin
PROCEDURE
- Vein identification
- Wash hands and place on gloves
- Reapply tourniquet
- Anchor the skin distal to the vein with your non-dominant hand and insert the cannula at a
10-30 degree angle
- When you observe flashback, advance the tubing a further 2mm without moving the needle
- Hold the cannula in place with your dominant hand and place a square of gauze underneath,
using your non-dominant hand remove the needle of the cannula
- Attach the cannula extension set to the end of the cannula and remove the gauze, cleaning
any spilt blood
- Secure the cannula with dressing and if there is a third stripe attach with date and time of
insertion
- Unlock the lumen of the extension site and flush each lumen with 5mls of saline
- Re lock the lumen
TO COMPLETE
- Thank the patient
- Discard waste and clean the tray the discard gloves and wash your hands
- Complete a peripheral venous cannulation observation chart
, 3) Male catheterisation
Indications: Acute urinary retention or obstruction, peri operative use in selected surgeries,
measurement of urinary output in acutely ill patients.
INTRODUCTION
- Wash hands, introduce self and check patient details (name, DOB and H&C number)
- Explain the procedure and gain consent
- Get a CHAPERONE
- Ask the patient to remove their clothing from the waist down and maintain dignity with a
sheet until the procedure begins
PREPARATION
- Wash hands and put on an apron
- Clean trolley
- Gather equipment: Sterile catheterisation pack (varies between trusts) but usually includes:
2 pairs of sterile gloves
Sterile drape with a hole in the centre
Sterile gauze
Sterile cotton balls
Waste bag
Sterile water to soak cotton
Sterile anaesthetic lube gel (instilagel), male catheter (usually begin with a 12 french), 10ml
sterile water the inflate catheter balloon, equipment for outside the sterile field (kidney dish to
collect spillage and catheter draining bag with tubing)
- - Walk to patient
- Wash hands
- Open sterile catheterisation pack
- Pick up waste bag and attach to side of the trolley
- Open sterile equipment and drop on top the sterile field
- Pour sterile water into the sterile bowel
PROCEDURE
Part 1
- Expose the patient and position them supine
- Place incontinence pad under the patient’s buttocks
Part 2
- Wash hands and apply gloves
- Using your left hand, hold the penis and retract the foreskin with the sterile gauze
- Wet the cotton wool balls with sterile water using your right hand and tweezers
- Clean around the urethral meatus, allowing only one down stroke per cotton ball
- Place sterile drape over the penis with your right hand
Part 3
