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DR MO SOBHY ACADEMY
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Table of Contents
Subject
Page
Overview of blood procedures
3
Blood sampling
7
Blood culture
14
IV cannulation
20
Arterial blood gas
26
Female urethral catheterisation
32
Male urethral catheterisation
35
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Overview of Blood Procedures
- Remember that in Blood Procedure stations, you are not the rst line of
contact with the patient (except in catheter station).
- Your task is to do the procedure itself, so take focused history relevant to the
procedure. Do not dwell on the patient’s condition itself.
- If you are provided with gloves then wear them. If not, then assume you are
wearing gloves just before touching the mannequin.
- If you fail to withdraw blood, do not panic, Discard every thing and repeat
the procedure all over again. Do not reuse the same equipment, collect new
equipment. Select another part of the vein or another vein altogether.
- Touch the mannequin only after preparing your equipment.
- Tie the tourniquet very late and loosen it very early. Tie it after preparing
your equipment and loosen it once you see a ashback.
- Leave the table very tidy and the mannequin clean. The only thing that
should remain in your tray once you are done is the sample you took.
- Needles are discarded into the sharps bin. Others are discarded into the
waste bin.
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General structure of blood procedure stations
Introduction:
1. Introduce yourself
2. Con rm the patient’s identity.
3. Start the station well. You already know the issue, so start with that. Do not
say ''how may I help you?’’.
4. Explain why you are here and why you are taking the blood sample: (My
consultant has asked me to take a blood sample from you to ……).
Data Gathering:
1. Take focused History relevant only to your procedure.
* P1 ( Chief concern + Associated symptoms)
* P2 ( Past Hx of concern + general).
* P3 ( DESA).
* P4 ( Pregnancy- Pills- Partner- Pap smears)
2. Red ags - relating to condition.
3. MMA.
4. Contraindications - relating to procedure.
5. Psychosocial & Family history.
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Examination and procedure:
1. Start with thanking the patient for answering your questions
2. Ask to record blood pressure, heart rate, temperature, respiratory rate and
oxygen saturation and perform general physical examination.
3. Ask for speci c examination depending on the case.
4. Take consent for the procedure:
• PPEC
• P:
1. Purpose (why-Why); ‘I would like to take a blood sample from you
in order to nd out the cause of your symptoms’.
2. Procedure(Explain): “ This will involve me using a small needle and
inserting it into one of the vessels (vein/artery) in your arm”.
3. Pain (Re ect): “the procedure won’t be painful but could be
uncomfortable, but I will be as quick and gentle as possible”.
• P:
Position: Explain how you want the patient to be positioned; ‘Can you please
straighten your elbow/ wrist for me’.
• E:
Exposure: Explain how you want the patient to be exposed; ‘Can you please
roll up your sleeves for me’.
• C
Consent: Finally gain consent by asking; ‘ Do I have your consent to
proceed?’
Ask about any arm soreness and any arm preference
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Procedure: ( Clean -Collect - Prepare - Begin)
1. Verbalising cleaning your tray “I will clean the tray and this is my sterile
eld”, before collecting your equipment.
2. Collect your equipment.
3. Wash hands
4. Don Glove/ Don Apron.
5. Inspect/Feel for suitable vein/ Artery.
6. Apply the tourniquet.
7. Clean the area with one single stroke/30 seconds in circular motion and
verbalise’ I should wait for it to dry’.
8. Prick with the bevel pointing up and warn the patient about the sharp scratch.
9. Collect the blood.
10. Put a cotton on the prick site.
11. If there is a plaster, offer it to the patient.
12. Verbalise labelling the sample with the patient’s details and verbalise
sending it to the lab.
Management:
1. Thank the patient for letting you take the sample.
2. Ask the patient (Do you feel ok?)
3. Sit down and discuss with the patient the management details speci c to each
station.
4. Safety net about the procedure itself; any bleeding, swelling or soreness.
5. Safety net about the patient’s chief complaint.
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Blood Sampling (Venipuncture)
Who are you?
- You are the F2 in the A&E department.
Who is the patient?
- Adam Elkady, 26-year-old male has taken some paracetamol tablets.
Special notes:
- Your consultant has asked you to take a blood sample from the patient to test
for the level of paracetamol in his blood.
What you must do:
- Take focused history, perform the relevant procedure and manage the patient
accordingly.
Introduction:
1. Con rm the patient’s identity
2. Start the station well; ‘I can see from my notes that you are here as you
have taken some paracetamol tablets’.
3. Pick up on non-verbal cues; if the patient is looking at the ground or avoiding
eye contact.
4. Build Rapport: Show sympathy and empathy and remember to be extrasensitive since this is a suicidal patient.
5. Reassure by giving con dentiality.
6. Rephrase the stem; ‘My consultant has asked me to take a blood sample
from you to test for the level of paracetamol in your blood’.
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History:
• P1:
• Chief concern (overdose):
• What, how many, when, with what (do not ask why, this is not a
psychiatry station).
• Associate symptoms:
• vomiting, drowsiness, jaundice, tummy pain, not passing urine
• P2:
• Past Hx
• P3:
• DESA
• Red ags: nausea, vomiting, abdominal pain, confusion, lethargy, jaundice,
reduced urine output.
• MMA: specify any bleeding disorder, Liver or kidney conditions and specify
any blood thinners.
• Contraindications - relating to procedure.
• Psychosocial & Family history
Examination and procedure:
1. Start with thanking the patient for answering your questions
2. Ask to record blood pressure, heart rate, temperature, respiratory rate and
oxygen saturation and perform general physical examination.
3. Ask for abdominal examination.
4. Take consent for the procedure: PPEC
• P:
1. Purpose (why-Why); ‘I would like to take a blood sample from you
in order to nd out the level of paracetamol in you blood’.
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2. Procedure(Explain): “ This will involve me using a small needle
and inserting it into one of the veins in you arm”.
3. Pain (Re ect): “the procedure won’t be painful but could be
uncomfortable, but I will be as quick and gentle as possible”.
• P:
Position: Explain how you want the patient to be positioned; ‘Can you please
straighten your elbow for me’.
• E:
Exposure: Explain how you want the patient to be exposed; ‘Can you please
roll up your sleeves for me’.
• C:
Consent: Finally gain consent by asking; ‘ Do I have your consent to
proceed?’
Ask about any arm soreness and any arm preference
Procedure: ( Clean -Collect - Prepare - Begin)
1. Clean your tray.
2. Verbalize sterile area.
3. Collect your equipment (please collect only what you need, don’t collect
extra equipment):
- Tourniquet
- Yellow tube is the rst choice for toxicology, second choice is the red
tube.
- Alcohol swab
- Vaccutainer and needle
- Cotton piece
- Gloves
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4. Prepare your equipment in your clean area:
- Partially open the alcohol swab.
- Remove the grey (white) cap from the needle and discard it, then attach
the needle to the vaccutainer.
- Loosen up the other cap (the green cap) slightly and keep it aside
- Once the equipment is prepared, put them in your tray.
5. Wash hands
6. Don Glove/ Don Apron.
7. Inspect/Feel for suitable vein/ Artery.
8. Apply the tourniquet.
9. Clean the area with one single stroke/30 seconds in circular motion and
verbalise’ I should wait for it to dry’.
10. Remove the green cap to reveal the needle, and discard the cap.
11. Prick with the bevel pointing up and warn the patient about the sharp
scratch.
12. Keep the needle xed and secure all the time.
13. Collect 3ml up to the mark given in the tube.
14. Once blood is collected, turn the tubes upside down and swirl it around 5-6
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times to ensure full mixing.
15. Loosen the tourniquet once you get your sample.
16. Put a cotton on the prick site and withdraw the needle carefully.
17. If there is a plaster, offer it to the patient.
18. Dispose the needle attached to the vacutainer holder into the sharps bin.
19. Verbalise labelling the sample with the patient’s details and verbalise
sending it to the lab.
20. Verbalise sending blood tests for full blood count, kidney function tests, and
liver function tests.
Management:
1. Thank the patient for letting you take the sample.
2. Keep the patient in the observation unit.
3. Interpret the results of the paracetamol concentration on the paracetamol
chart and if above the treatment line then advice the patient that they will
need N-acetyl cysteine over 21 hours.
4. If <8 hours, wait 4 hours post ingestion. 8-24 hours- Take levels
immediately- if >150 mg/kg, Unkown or symptomatic ; Start NAC. If >24
hours, take levels immediately, if >150mg/kg, Unkown or symptomatic, start
NAC, otherwise wait for results and treat if ALT raised and INR >1.3.
5. Once the patient is medically t, they will be seen by the psychiatry liaison
team.
6. Safety net about the procedure itself; any bleeding, swelling or soreness.
7. Safety net about the patient’s general condition; tummy pain, vomiting,
confusion, drowsiness, yellowish discolouration of skin or the eyes.
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Time (hours)
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Phlebotomy Teaching Station
-
Venipuncture can come as a teaching station. Follow the teaching structure
as taught in the teaching session and follow the procedure technique as
taught above.
-
The student might ask you about managing patients with needle phobia.
Advice the following
-
Acknowledge and reassure the patient; phobia is common.
-
Assess severity and past experiences.
-
Use distraction (music, conversation) and calming techniques (deep
breathing).
-
Apply topical anaesthetic (e.g. EMLA cream).
-
Offer control: explain steps, give signal option to pause.
-
Allow lying down to prevent fainting.
-
Refer to CBT if severe or interfering with care.
-
Document the phobia for future planning.
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Blood Culture
Who are you?
- You are the F2 in the surgery department.
Who is the patient?
- Tom Henderson, 35-year-old male had an appendectomy 3 days ago. He has
now developed a fever.
Special notes:
- Your consultant has asked you to take a blood culture from the patient.
What you must do:
- Take focused history, perform relevant procedure and manage the patient
accordingly.
Introduction:
1. Con rm the patient’s identity
2. Start the station well; ‘I can see from my notes that you have been admitted
here for an operation to remove your appendix 3 days ago’.
3. Pick up on non-verbal cues; if the patient is in pain or looking unwell.
4. Build Rapport: Ask about the hospital stay.
5. Rephrase the stem; ‘My consultant has asked me to take a blood sample
from you to send it for culture to test for the speci c bug causing your
symptoms’.
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History:
• P1:
• Chief concern (Operation - operation site- Hospitalisation):
• Fever
• Previous symptoms - how was the operation?
• How is your stay?
• Any Pain / bleeding / discharge from the operation site?
• Did you open you bowels? pass wind?
• Oral intake?
• Associate symptoms (complications):
• confusion, decreased urine output, difficulty breathing, palpitations
• P2:
• Past Hx
• P3:
• DESA
• Red ags: abdominal pain, drowsiness, confusion, vomiting, bleeding or
discharge from the operation site, constipation, decreased urine output.
• MMA: specify any bleeding disorder, Liver or kidney conditions and specify
any blood thinners.
• Contraindications - relating to procedure.
• Psychosocial & Family history
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Examination and procedure:
1. Start with thanking the patient for answering your questions
2. Ask to record blood pressure, heart rate, temperature, respiratory rate and
oxygen saturation and perform general physical examination.
3. Ask to examine the abdomen and the surgery site.
4. Take consent for the procedure: PPECC
• P:
• Purpose (why-Why); ‘I would like to take a blood sample from you in
order to nd the speci c bug causing your symptoms so we can start
you on the most suitable antibiotic’.
4. Procedure(Explain): “ This will involve me using a small needle and
inserting it into one of the veins in you arm”.
5. Pain (Re ect): “the procedure won’t be painful but could be
uncomfortable, but I will be as quick and gentle as possible”.
• P:
Position: Explain how you want the patient to be positioned; ‘Can you please
straighten your elbow for me’.
• E:
Exposure: Explain how you want the patient to be exposed; ‘Can you please
roll up your sleeves for me’.
• C:
Consent: Finally gain consent by asking; ‘ Do I have your consent to
proceed?’
Ask about any arm soreness and any arm preference
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Procedure: ( Clean - Collect - Prepare - Begin)
1. Clean your tray.
2. Verbalize sterile area.
3. Collect your equipment:
- Tourniquet.
- 2 Blood culture bottles (aerobic and anaerobic).
Extra
Clean!
- Alcohol swab.
- 2 (2% Chlorhexidine 70% ispropyl) alcohol wipes
- Butter y needle.
- Cotton piece.
- Gloves.
4. Prepare your equipment in your clean area:
- Partially open the alcohol swabs.
- Remove the grey (white) cap from the needle and discard it, then attach
the needle to the vacutainer.
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- Loosen up the clear plastic cap of the butter y needle slightly and keep
it aside ready for the procedure.
- Check the expiry date on the culture bottles then ip off the caps and
wipe the tops of the bottles each with a different chlorhexidine wipes (if
chlorhexidine isn’t available then use alcohol swabs).
5. Once the equipment is prepared, put them in your tray.
6. Wash hands
7. Don Glove/ Don Apron.
8. Inspect/Feel for suitable vein/ Artery.
9. Apply the tourniquet.
10. Clean the area with one single stroke/30 seconds in circular motion and
verbalise “I should wait for it to dry’.
11. Remove the clear plastic cap to reveal the needle, and discard the cap.
12. Prick with the bevel pointing up and warn the patient about the sharp
scratch.
13. Keep the needle xed and secure all the time.
14. Collect 8-10ml of blood. Not more than 10ml.
15. After collecting the blood sample, gently invert the bottle 8-10 times to mix
the blood with the culture medium. Avoid shaking or swirling the bottle
vigorously.
16. Loosen the tourniquet as soon as you see the ashback.
17. Put a cotton on the prick site and withdraw the needle carefully.
18. If there is a plaster, offer it to the patient.
19. Dispose the needle attached to the vacutainer holder into the sharps bin.
20. Attach the label stickers to the culture bottles.
21. Verbalise sending bloods for full blood count, in ammatory markers,
kidney function tests, lactate and liver function tests.
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Management:
1. Thank the patient.
2. Keep the patient in the observation unit.
3. Paracetamol for fever.
4. Start on broad spectrum antibiotics until culture results are back.
5. Safety net about the procedure itself; any bleeding, swelling or soreness.
6. Safety net about the patient’s general condition; tummy pain, vomiting,
drowsiness, bleeding from the operation site, constipation.
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IV Cannulation
Who are you?
- You are the F2 in the surgery department.
Who is the patient?
- Jamie Smith, 28-year-old male had an appendectomy 3 days ago. His
cannula is blocked.
Special notes:
- Your consultant has asked you to change his cannula. The patient is on 5mg
IV morphine 4 hourly. His last dose was 1hr ago.
What you must do:
- Take focused history, perform relevant procedure and manage the patient
accordingly.
Introduction:
1. Con rm the patient’s identity.
2. Start the station well; ‘I can see from my notes that you have been admitted
here for an operation to remove your appendix a few hours ago’.
3. Pick up on non-verbal cues; if the patient is in pain or looking unwell.
4. Build Rapport: Ask how the operation went.
5. Rephrase the stem; ‘My consultant has asked me to change your cannula to
be able to give you medications and uids’.
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History:
• P1:
• Chief concern: (Pain (SOCRATES)-Operation - operation siteHospitalisation ):
• Previous symptoms - how was the operation?
• How is your stay?
• Any Pain / bleeding / discharge from the operation site?
• Did you open your bowels? pass wind?
• Oral intake?
• Associate symptoms (complications):
• confusion, decreased urine output, difficulty breathing, palpitations
• P2:
• Past Hx
• P3:
• DESA
• Red ags: confusion, decreased urine output, bleeding, signs of infection.
• MMA: specify any bleeding disorder, Liver or kidney conditions and specify
any blood thinners.
• Contraindications: any recent skin infections in the arm
• Psychosocial & Family history
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Examination and procedure:
1. Start with thanking the patient for answering your questions
2. Ask to record blood pressure, heart rate, temperature, respiratory rate and
oxygen saturation and perform general physical examination.
3. Ask to examine the abdomen.
4. Take consent for the procedure: PPECC
• P:
• Purpose (why-Why); ‘I would like to change your cannula in order to
give you the medications (Morphine- antibiotics - uids)’.
• Procedure(Explain): “ This will involve me inserting a thin needle
into one of the veins of your forearm”.
• Pain (Re ect): “the procedure won’t be painful but could be
uncomfortable, but I will be as quick and gentle as possible”.
• P:
Position: Explain how you want the patient to be positioned; ‘Can you please
straighten your elbow for me’.
• E:
Exposure: Explain how you want the patient to be exposed; ‘Can you please
roll up your sleeves for me’.
• C
Consent: Finally gain consent by asking; ‘Do I have your consent to
proceed?’
Ask about any arm soreness and any arm preference
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Procedure:( Clean - Collect - Prepare - Begin)
1. Remove the blocked cannula, discard it into the waste bin and ask the patient
to press the cotton down.
2. Clean your tray.
3. Verbalize sterile area.
4. Collect your equipment:
- Tourniquet.
- Cannula.
- Tegaderm.
- 2 cc syringe lled with saline
- Alcohol swab.
- Gauze.
- Cotton piece.
- Gloves.
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5. Prepare your equipment in your clean area:
- Partially open the alcohol swabs.
- Prepare the cannula by removing the stopper, loosen the cap on top, and
loose the cap covering the needle and place it in your tray.
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- Prepare the Tegaderm: Take the 3 stickers off and stick them on the side
of the tray.
6. Once the equipment is prepared, put them in your tray.
7. Wash hands
8. Don Glove/ Don Apron.
9. Feel the vein.
10. Apply the torniquet.
11. Clean the area with one single stroke/30 seconds in circular motion and
verbalise “I should wait for it to dry’.
12. Insert the cannula with the bevel facing upwards. Flashback of blood is seen
in the hub at the back of the cannula- advance the needle into the vein at 15
degrees and progress the entire cannula a further 2mm to ensure it is in the
vein.
13. Fix the needle by holding the end of the needle steady with your nondominant hand and slide the rest of the cannula forwards slightly.
14. Withdraw the needle slightly so that its sharp point is inside of the plastic
tubing.
15. Advance cannula fully into vein – The needle still inside the tubing will stop
the plastic from kinking.
16. Loosen the tourniquet as soon as you see the ashback.
17. Place some gauze directly underneath the cannula. Then remove the needle
fully and dispose it into the sharps bin.
18. Put the stopper back to the cannula.
19. Put two of the stickers on both sides of the cannula. Then ush the cannula
and close the cannula port.
20. Fix the Tegaderm on securely and verbalise labelling the date and time
21. Discard your waste in the clinical waste bin.
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Management:
1. Thank the patient.
2. Review the patient’s vital signs; blood pressure, heart rate, respiratory rate,
oxygen saturation and temperature.
3. Perform general physical examination and abdominal examination.
4. Request full blood count, kidney function, liver function, in ammatory
markers and coagulation pro le.
5. Monitor the urine output.
6. Manage the pain according to the patient’s charts and the last dose of
morphine: If he is on 5 mg IV morphine 4 hourly and his last dose was 1
hourago, then no morphine but you can offer instead 1g IV paracetamol.
7. If the patient is still in pain: Encourage to wait for some time and reassess in
10-15mins.
8. Manage the Nausea: IV Metoclopramide 10mg.
9. Paracetamol for fever.
10. Safety net about the procedure itself; any bleeding, swelling or soreness.
11. Safety net about the patient’s general condition; tummy pain, vomiting,
drowsiness, bleeding from the operation site, constipation.
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Arterial Blood Gases
Who are you?
- You are the F2 in the A&E department.
Who is the patient?
- Peter Fey, 49-year-old male who has been previously diagnosed with COPD
has now presented with shortness of breath.
Special notes:
- Your consultant has asked you to take an ABG sample from the patient.
What you must do:
- Take focused history, perform relevant procedure and manage the patient
accordingly.
Introduction:
1. Con rm the patient’s identity.
2. Start the station well; ‘I can see from my notes that you are here as you
have been having some shortness of breath’.
3. Check if the patient is on oxygen.
4. Pick up on non-verbal cues; if the patient is in pain or looking unwell.
5. Rephrase the stem; ‘My consultant has asked me to take a sample of blood
from your wrist to test for the level of gases in your blood’.
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History:
• P1:
• Chief concern: (SOB: ODIPARA):
• Associate symptoms:
• chest pain, fever, cough, difficulty breathing, heart racing
• P2:
• Past Hx
• P3:
• DESA
• Red ags: - respiratory distress.
• MMA: specify any bleeding disorder, Liver or kidney conditions and specify
any blood thinners.
• Contraindications: AV stula, cellulitis, PVD
• Psychosocial & Family history
**You might have to explain how ABG is different from venous sampling**
Examination and procedure:
1. Start with thanking the patient for answering your questions
2. Ask to record blood pressure, heart rate, temperature, respiratory rate and
oxygen saturation and perform general physical examination.
3. Take consent for the procedure: PPECC
• P:
• Purpose (why-Why); ‘I would like to take a blood sample from you in
order to check your blood gases and oxygen levels’.
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• Procedure(Explain): “ I will be inserting a thin needle into one of the
arteries of your wrist. It will feel like a sharp scratch”.
• Pain (Re ect): “the procedure won’t be painful but could be
uncomfortable, but I will be as quick and gentle as possible”.
• P:
Position: Explain how you want the patient to be positioned; ‘Can you please
straighten your elbow for me’.
• E:
Exposure: Explain how you want the patient to be exposed; ‘Can you please
roll up your sleeves for me’.
• C
Consent: Finally gain consent by asking; ‘Do I have your consent to
proceed?’
Ask about any arm soreness and any arm preference
Procedure:( Clean -Collect - Prepare - Begin)
1. Perform the modi ed Allen’s test:
- I'm going to check the blood supply of your hands
- Ask the patient to make a st and then (on the mannequin), press with each
hand on radial and ulnar arteries
- Ask the patient to release the st, and release the ulnar artery.
- If the re-perfusion time is less than 7 seconds, you can continue with the
procedure.
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2. Clean your tray.
3. Verbalize sterile area.
4. Collect your equipment:
- ABG needle.
- Alcohol swab.
- Cotton piece.
- Gloves.
5. Prepare your equipment in your clean area:
- Partially open the alcohol swabs.
- Loosen up the cap slightly and keep it aside ready for the procedure.
- Keep the green stopper in the tray.
6. Once the equipment is prepared, put them in your tray.
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7. Wash hands
8. Don Glove/ Don Apron.
9. Feel the artery.
10. Locate the radial pulse by palpating over the artery using 3 ngers of your
left hand (index, middle and ring ngers).
11. Sterilise the area: Put 3 ngers of your left hand over the radial artery then
remove only your middle nger and clean the area using an alcohol swab
with a single stroke. Keep that hand xed.
12. With the other hand, remove the cap to reveal the needle, and discard the
cap.
13. Warn the patient and prick at a degree between 45 to 90 degrees holding the
needle like a pen. Keep the needle xed and secure all the time.
14. Once inside the artery, the syringe should begin to self- ll. The arterial
pressure will cause the blood to ll the syringe automatically. Do not pull the
plunger.
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15. Withdraw the needle carefully. Once the needle is out, press the cotton down
rmly on the puncture site, and ask the patient to do so for at least 5 minutes.
16. Lock the protective needle sleeve by pushing it down against the table. Do
not use your hand to lock the protective needle sleeve.
17. Remove the needle from the syringe and discard it into the sharps bin.
18. Apply the stopper onto the syringe.
19. Verbalise labelling the sample with the patient’s details including oxygens
concentration and verbalise sending it to the ABG machine by yourself
immediately.
Management :
1. Thank the patient.
2. Review the patient’s vital signs; blood pressure, heart rate, respiratory rate,
oxygen saturation and temperature.
3. Verbalise examining the chest, lungs and heart.
4. Keep the patient in the observation unit on oxygen.
5. Safety net about the procedure itself; any bleeding, swelling or soreness.
6. Safety net about the patient’s general condition; chest pain, cough, fever.
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Female Urethral Catheterisation
Who are you?
- You are the F2 in the Urology department.
Who the student is:
- Tony Samson, a 3rd year medical student wants to learn how to perform
female urethral catheterisation.
What you must do:
- Teach Tony how to perform female urethral catheterisation and address his
concerns.
Approach:
- Follow the teaching approach as taught in the teaching session.
Procedure:
1. Clean your tray.
2. Verbalize sterile area.
3. Collect your equipment:
- 2 kidney trays.
- 3 cotton pieces.
- Sterile forceps.
- Antiseptic solution / Normal saline.
- Anaesthetic jelly lled syringe (1%).
- Normal distilled water lled syringe(10mls).
- Urine bag
- Foley catheter – 12-14 French size.
- Urine bag.
- 2 Sterile gloves.
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4. Prepare your equipment in your clean area:
- Keep the catheter ready by removing outer packaging.
- Place the kidney tray between the patient’s thighs
5. Once the equipment is prepared, put them in your tray.
6. Wash hands
7. Don DOUBLE Glove/ Don Apron.
8. Separate the labia with your non-dominant hand.
9. Using your right hand and with the help of a sterile forceps pick up a cotton
piece, soak it into normal saline/antiseptic solution and clean the the urethral
meatus and the surrounding areas (the two labia from inside) from upward to
downwards (Use 3 cotton pieces)
10. Dispose the plastic forceps and the cotton pieces into clinical waste bin.
11. Explain to the patient that you are going to insert some anaesthetic gel to
make the procedure more comfortable.
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12. Pick up the syringe labelled as anaesthetic gel. Separate the labia, and place
the nozzle of the syringe of anaesthetic gel into the urethral meatus. Slowly
expel the contents into the urethra.
13. Verbalise giving the gel 3-5 minutes to take full effect.
14. Assume to take one pair of the sterile gloves off.
15. Take the tip of catheter few centimetres out from the inner packaging using
non-touch technique.
16. Place the draining end of the catheter in the kidney tray. Warn the patient
that you are going to insert the catheter.
17. While you are holding the labia with your left hand, insert the exposed
catheter tip into the urethral meatus with your right hand.
18. Advance the catheter by slowly removing the wrapper to expose more
catheter, using a non-touch technique by touching only the packaging, i.e.
insert without taking the catheter completely out of the packaging.
19. Continue to advance the catheter until it is fully inserted up to the Yjunction.
20. Once fully inserted, attach the distilled water syringe to the balloon port of
the catheter. Insert about 5ml of distilled water slowly while looking at the
patient’s face to check for any pain or resistance. Then inject the rest of
distilled water, ensuring that it does not cause any pain.
21. Dispose the syringe into the clinical waste bin. Once the balloon is fully
in ated, gently pull on the catheter until resistance is felt.
22. Remove the cap from the tubing and plug the plastic tube end into the
catheter, ensuring a tight seal.
23. Place the urine bag below the level of the patient.
24. Tear the drape and dispose it into the clinical waste bin. However, in the
exam you will be asked not to do so.
25. Dispose of equipment into the clinical waste bin.
26. Record the date and time of insertion, size of catheter and volume and
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colour of urine drained.
27. Take the patient’s observations again after the procedure as the blood
pressure might fall after draining the urine.
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Male Urethral Catheterisation
Who are you?
- You are the F2 in the A&E department.
Who is the patient?
- Tony Samson, 41-year-old male who has presented with abdominal
discomfort.
What you must do:
- Take focused history, perform the emergency management, and address the
patient’s concerns
Introduction:
1. Con rm the patient’s identity.
2. Start the station well; ‘I can see from my notes that you are here as you
have pain in your tummy’.
3. Pick up on non-verbal cues; if the patient is in pain or looking unwell.
History:
• P1:
• Chief concern (Pain: SOCRATES):
• Associate symptoms: ( Urinary #)
• Burning sensation - Frequency - Urgency- Last time passed urine
• P2:
• Past Hx
• P3:
• DESA
• Red ags: back pain, confusion.
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• MMA: specify any Kidney problem- Prostate problem-Latex allergy.
• Contraindications: recent instrumentation, trauma, bleeding, discharge from
meatus.
• Psychosocial & Family history
Examination:
1. Ask for the observations; blood pressure, heart rate, respiratory rate, oxygen
saturation and temperature.
2. Verbalise GPE and abdominal examination.
Provisional diagnosis:
1. Start by summarising the positive indings in the history and examination:
“Thank you Mr. X for letting me examine you. You have told me that you
have severe abdominal pain for the last X days. This is associated with
inability to pass urine. On my examination, I could ind that your
abdomen is tender. This raises the suspicion that you have a condition
called urinary retention”.
Patient preparation:
• PPECC
• P:
• Purpose (why-Why); ‘I will insert a urinary catheter to empty the
bladder. This will help with the pain. Are you ok with this?’.
• Procedure(Explain): “ I will be inserting a thin rubber tube into your
penis”.
• Pain (Re ect): “the procedure won’t be painful but could be
uncomfortable, but I will be as quick and gentle as possible”.
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• P:
Position: Explain how you want the patient to be positioned; ‘I would like
you to lie at on your back with your legs slightly separated’.
• E:
Exposure: Explain how you want the patient to be exposed; ‘I would like
you to be undressed from the waist below and take your undergarments
off’.
• C:
Chaperone: Explain that one of the medical colleagues will be here as a
chaperone. ‘And I will maintain your privacy’
• C:
Consent: Finally gain consent by asking; ‘Do I have your consent to
proceed?’
Procedure:
1. Clean your tray.
2. Verbalize sterile area.
3. Collect your equipment:
- 2 kidney trays.
- Sterile gauze.
- 3 cotton pieces.
- Sterile forceps.
- Antiseptic solution / Normal saline.
- Anaesthetic jelly lled syringe (1%).
- Normal distilled water lled syringe(10mls).
- Urine bag
- Male Foley catheter – 12-14 French size.
- Urine bag.
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- Sterile gloves.
4. Prepare your equipment in your clean area:
- Keep the catheter ready by removing outer packaging.
- Place the kidney tray between the patient’s thighs
5. Once the equipment is prepared, put them in your tray.
6. Wash hands
7. Don DOUBLE Glove/ Don Apron.
8. With the help of a sterile forceps place a piece of gauze over the shaft of the
penis.
9. Dispose the plastic forceps into clinical waste bin.
10. Hold the penis with your left (non-dominant) hand and make sure that you
do not leave it until you have fully inserted the catheter. This hand is
contaminated and should now not touch the aseptic trolley.
11.Using your right hand and with the help of a sterile forceps pick up a cotton
piece, soak it into normal saline/antiseptic solution and clean the penis in
concentric circles beginning at the glans penis, and moving progressively
outwards (Use 3 cotton pieces, make each circle with one swab to clean the
glans and the whole area around the glans).
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12. Dispose the plastic forceps and cotton pieces into the clinical waste bin.
13. Explain to the patient that you are going to insert some anaesthetic gel to
make the procedure more comfortable.
14. Pick up the syringe labelled as anaesthetic gel. Holding the glans, pull
rmly upward and place the nozzle of the syringe of anaesthetic gel into the
urethral meatus. Slowly expel the contents into the urethra.
15. Verbalise giving the gel 3-5 minutes to take full effect.
16. Assume to take one pair of the sterile gloves off.
17. Take the tip of catheter few centimetres out from the inner packaging using
non-touch technique.
18. Place the draining end of the catheter in the kidney tray. Warn the patient
that you are going to insert the catheter.
19. While you are holding the base of the glans with your left hand, apply
gentle upward traction to the penis and insert the exposed catheter tip into the
urethral meatus with your right hand.
20. Advance the catheter by slowly removing the wrapper to expose more
catheter, using a non-touch technique by touching only the packaging, i.e.
insert without taking the catheter completely out of the packaging.
21. To remove the wrapper without also pulling the catheter back out, ensure a
good grip on the penis as you pull back on the wrapper.
22. Continue to advance the catheter until it is fully inserted up to the Yjunction.
23. Once fully inserted, attach the distilled water syringe to the balloon port of
the catheter. Insert about 5ml of distilled water slowly while looking at the
patient’s face to check for any pain or resistance. Then inject the rest of
distilled water, ensuring that it does not cause any pain.
24. Dispose the syringe into the clinical waste bin. Once the balloon is fully
in ated, gently pull on the catheter until resistance is felt.
25. If the mannequin had foreskin, replace/reposition the patient’s retracted
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foreskin and discard the gauze you were using to hold the shaft of the penis
into the clinical waste bin. Hold the Y junction with your lefthand.
26. Remove the cap from the tubing and plug the plastic tube end into the
catheter, ensuring a tight seal.
27. Place the urine bag below the level of the patient; “Ideally I would place
the urine bag below the level of my patient and I will stick the catheter on
the thigh.”
28. Tear the drape and dispose it into the clinical waste bin. However, in the
exam you will be asked not to do so.
29. Dispose of equipment into the clinical waste bin.
30. Clean the patient and ensure his dignity by making sure that he is
comfortable and covered
31. Thank the patient and ask him to dress up.
32. Record the date and time of insertion, size of catheter and volume and
colour of urine drained.
33. Take the patient’s observations again after the procedure as the blood
pressure might fall after draining the urine.
Management:
1. Thank the patient.
2. Keep the patient in the observation.
3. Request full blood count, kidney function, liver function and in ammatory
markers.
4. Request US abdomen.
5. Offer paracetamol for pain.
6. Offer IV uids if needed.
7. Offer antibiotics if there is a suspicion of a UTI.
8. Safety net: any blood in the catheter bag, pain, fever.
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