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Table of Contents

Subject Page

Overview of blood procedures 3

Blood sampling 6

Blood culture 11

IV cannulation 15

Arterial blood gas 20

Male urethral catheterisation 25

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Overview of Blood Procedures

- Remember that in Blood Procedure stations, you are not the irst 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, wear them, If not, assume you are wearing
gloves.
- If you fail to withdraw blood, do not panic, and repeat the procedure. 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 lashback.
- 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

History Taking:
1. Con irm the patient’s identity.
2. Start the station well. You already know the issue, so start with that. Do not say
''how may I help you?’’.
3. 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 ……).
4. Take focused History relevant only to your procedure.
5. Red lags - relating to condition.
6. Contraindications - relating to procedure.
7. Remember to always ask MMA as long as there is a patient involved.

Patient preparation:
1. Start with thanking the patient for answering your questions
2. For the patient: Explain why are you performing the procedure; ‘I would like
to take a blood sample from you in order to ind out the cause of your
symptoms’
3. For the patient: Explain that the procedure won’t be painful but could be
uncomfortable. Do not forget to inform the patient that if you fail, you may
need to repeat theprocedure.
4. For the patient: Explain what you are going to do during the procedure; ‘I
will be inserting a thin needle into one of the blood vessels (veins/
arteries) of your (forearm/ wrist). It will feel like a sharp scratch, but I
will be as quick and gentle as possible’

5. For you: Explain how you want the patient to be positioned; ‘Can you please
straighten your elbow/ wrist for me’.
6. For you: Explain how you want the patient to be exposed; ‘Can you please
roll up your sleeves for me’.

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7. For you: Explain the contraindications of the procedure if present. Ask about
any arm soreness and any arm preference.
8. For both of you: Inform the patient that you will maintain their privacy
9. For both of you: Finally gain consent by asking; ‘ Do I have your consent to
proceed?’

Procedure:
1. Collect your equipment.
2. Prepare your equipment in your clean area. Once the equipment is prepared,
put them in your tray.
3. Gloves: Assume you are wearing gloves, or if you ind a gloves you should wear
it.
4. Feel the vein/ Artery.
5. Apply the tourniquet.
6. Clean the area with one single stroke.
7. Prick with the bevel pointing up and warn the patient about the sharp scratch.
8. Collect the blood.
9. Put a cotton on the prick site.
10. Verbalise labelling the sample with the patient’s details and verbalise sending
it to the lab.

Management :
1. Wind up everything you talked about and did.
2. Sit down and discuss with the patient the management details speci ic to each
station.
3. Safety net about the procedure itself; any bleeding, swelling or soreness.
4. Safety net about the patient’s general condition.

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Blood Sampling (Venipuncture)

Scenario:
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 relevant examination and manage the patient
accordingly.

History Taking:
1. Con irm 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 extra-
sensitive since this is a suicidal patient.
5. Reassure by giving con identiality.
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’.
7. What, how many, when, with what (do not ask why, this is not apsychiatry
station).

8. Red lags - vomiting, drowsiness, jaundice, tummy pain, not passing urine

9. MMA: specify any bleeding disorder, Liver or kidney conditions and specify
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any blood thinners.

Patient preparation:
1. Start with thanking the patient for answering your questions
2. For the patient: Explain why are you performing the procedure; ‘I would like
to take a blood sample from you in order to check the paracetamol level in
your blood’.
3. For the patient: Explain that the procedure won’t be painful but could be
uncomfortable. Do not forget to inform the patient that if you fail, you may
need to repeat theprocedure.
4. For the patient: Explain what you are going to do during the procedure; ‘I
will be inserting a thin needle into one of the veins of your forearm. It will
feel like a sharp scratch, but I will be as quick and gentle as possible’

5. For you: Explain how you want the patient to be positioned; ‘Can you please
straighten your elbow for me’.
6. For you: Explain how you want the patient to be exposed; ‘Can you please
roll up your sleeves for me’.

7. For you: Explain the contraindications of the procedure if present. Ask about
any arm soreness and any arm preference.
8. For both of you: Inform the patient that you will maintain their privacy
9. For both of you: Finally gain consent by asking; ‘ Do I have your consent to
proceed?’
10.Ask about any arm soreness and any arm preference.

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Procedure:
1. Collect your equipment:
- Tourniquet
- Yellow tube is the irst choice for toxicology, second choice is the red
tube.
- Alcohol swab
- Vacutainer and needle
- Cotton piece
- Gloves

2. 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 vacutainer.
- Loosen up the other cap (the green cap) slightly and keep it aside ready
for the procedure.
3. Once the equipment is prepared, put them in your tray.
4. Gloves: Assume you are wearing gloves, or if you ind a gloves you should wear
it.
5. Feel the vein.
6. Apply the torniquet.
7. Clean the area with one single stroke.
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8. Remove the green cap to reveal the needle, and discard the cap.
9. Prick with the bevel pointing up and warn the patient about the sharp scratch.
10. Keep the needle ixed and secure all the time.
11. Loosen the tourniquet as soon as you see the lashback.
12. Once blood is collected, turn the tubes upside down and swill it around a bit
to ensure full mixing.
13. Put a cotton on the prick site and withdraw the needle carefully.
14. Dispose the needle attached to the vacutainer holder into the sharps bin.
15. Verbalise labelling the sample with the patient’s details and verbalise sending
it to the lab.

Management :
1. Wind up everything you talked about and did.
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. Once the patient is medically it, they will be seen by the psychiatry liaison
team.
5. Safety net about the procedure itself; any bleeding, swelling or soreness.
6. Safety net about the patient’s general condition; tummy pain, vomiting,
confusion, drowsiness, yellowish discolouration of skin or the eyes.

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Blood Culture
Scenario:
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.

History Taking:
1. Con irm 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 ic bug causing your
symptoms’.
6. Ask about any bleeding, pain, or discharge from the operation site. Ask about
bowel motion since after the operation.
7. Red lags: confusion, decreased urine output, difficulty breathing, palpitations
8. MMA

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Patient preparation:
1. Start with thanking the patient for answering your questions
2. For the patient: Explain why are you performing the procedure; ‘I would like
to take a blood sample from you in order to ind the speci ic bug causing
your symptoms so we can start you on the most suitable antinbitoic’.
3. For the patient: Explain that the procedure won’t be painful but could be
uncomfortable. Do not forget to inform the patient that if you fail, you may
need to repeat theprocedure.
4. For the patient: Explain what you are going to do during the procedure; ‘I
will be inserting a thin needle into one of the veins of your forearm. It will
feel like a sharp scratch, but I will be as quick and gentle as possible’

5. For you: Explain how you want the patient to be positioned; ‘Can you please
straighten your elbow for me’.
6. For you: Explain how you want the patient to be exposed; ‘Can you please
roll up your sleeves for me’.

7. For you: Explain the contraindications of the procedure if present. Ask about
any arm soreness and any arm preference.
8. For both of you: Inform the patient that you will maintain their privacy
9. For both of you: Finally gain consent by asking; ‘ Do I have your consent to
proceed?’
10.Ask about any arm soreness and any arm preference.

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Procedure:
1. Collect your equipment:
- Tourniquet.
- Blood culture bottles.
Extra
- Alcohol swab. Clean!
- 2 (2% Chlorhexidine 70% ispropyl) alcohol wipes
- Vacutainer and needle.
- Cotton piece.
- Gloves.

2. 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.
- Loosen up the other cap (the green cap) slightly and keep it aside ready
for the procedure.
- Check the expiry date on the culture bottles then lip off the caps and
clean the tops of the bottles each with a different chlorhexidine wipes.

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3. Once the equipment is prepared, put them in your tray.
4. Gloves: Assume you are wearing gloves, or if you ind a gloves you should wear
it.
5. Feel the vein.
6. Apply the torniquet.
7. Clean the area with one single stroke.
8. Remove the green cap to reveal the needle, and discard the cap.
9. Prick with the bevel pointing up and warn the patient about the sharp scratch.
10. Keep the needle ixed and secure all the time.
11. Loosen the tourniquet as soon as you see the lashback.
12. Once blood is collected, turn the tubes upside down and swill it around a bit
to ensure full mixing.
13. Put a cotton on the prick site and withdraw the needle carefully.
14. Dispose the needle attached to the vacutainer holder into the sharps bin.
15. Verbalise labelling the sample with the patient’s details and verbalise sending
it to the lab.

Management :
1. Wind up everything you talked about and did.
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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I V Cannulation
Scenario:
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.

History Taking:
1. Con irm 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 luids’.
6. Explore the pain though SOCRATES.
7. Ask about any bleeding, pain, or discharge form the operation site. Ask about
bowel movement since the operation.
8. Red lags: confusion, decreased urine output, bleeding, signs of infection.
9. MMA

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Patient preparation:
1. Start with thanking the patient for answering your questions
2. For the patient: Explain why are you performing the procedure; ‘I would like
to change your cannula to be able to give you antibiotics and luids’.
3. For the patient: Explain that the procedure won’t be painful but could be
uncomfortable. Do not forget to inform the patient that if you fail, you may
need to repeat theprocedure.
4. For the patient: Explain what you are going to do during the procedure; ‘I
will be inserting a thin needle into one of the veins of your forearm. It will
feel like a sharp scratch, but I will be as quick and gentle as possible’

5. For you: Explain how you want the patient to be positioned; ‘Can you please
straighten your elbow for me’.
6. For you: Explain how you want the patient to be exposed; ‘Can you please
roll up your sleeves for me’.

7. For you: Explain the contraindications of the procedure if present. Ask about
any arm soreness and any arm preference.
8. For both of you: Inform the patient that you will maintain their privacy
9. For both of you: Finally gain consent by asking; ‘ Do I have your consent to
proceed?’
10.Ask about any arm soreness and any arm preference.

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Procedure:
1. Remove the blocked cannula, discard it into the waste bin and ask the patient
to press the cotton down.
2. Collect your equipment:
- Tourniquet.
- Cannula.
- Tegaderm.
- 2 cc syringe illed with saline
- Alcohol swab.
- Vacutainer and needle.
- Cotton piece.
- Gloves.

3. 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.
- Prepare the Tegaderm: Take the 3 stickers off and stick them on the side
of the tray.
4. Once the equipment is prepared, put them in your tray.
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5. Gloves: Assume you are wearing gloves, or if you ind a gloves you should wear
it.
6. Feel the vein.
7. Apply the torniquet.
8. Clean the area with one single stroke.
9. 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.
10. Fix the needle by holding the end of the needle steady with your non-
dominant hand and slide the rest of the cannula forwards slightly.
11.Withdraw the needle slightly so that its sharp point is inside of the plastic
tubing.
12. Advance cannula fully into vein – The needle still inside the tubing will stop
the plastic from kinking.
13. Loosen the tourniquet as soon as you see the lashback.
14. Place some gauze directly underneath the cannula. Then remove the needle
fully and dispose it into the sharps bin.
15. Put the stopper back to the cannula.
16. Put two of the stickers on both sides of the cannula. Then lush thecannula
and close the cannula port.
17. Fix the Tegaderm on securely and verbalize labeling the date and timeand
discard your waste.

Management :
1. Wind up everything you talked about and did.
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.

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4. Request full blood count, kidney function, liver function, in lammatory
markers and coagulation pro ile.
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 hour
ago, 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

Scenario:
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.

History Taking:
1. Con irm 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. Build Rapport: Ask how the operation went.
6. 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’.
7. Ask about any chest pain, fever, cough, inhalers for COPD.
8. Red lags: respiratory distress.
9. MMA
**You might have to explain how ABG is different from venous sampling**

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Patient preparation:
1. Start with thanking the patient for answering your questions
2. For the patient: Explain why are you performing the procedure; ‘I would like
to take a blood sample from you in order to check your blood gases and
oxygen levels’.
3. For the patient: Explain that the procedure won’t be painful but could be
uncomfortable. Do not forget to inform the patient that if you fail, you may
need to repeat theprocedure.
4. For the patient: Explain what you are going to do during the procedure; ‘I
will be inserting a thin needle into one of the arteries of your wrist. It will
feel like a sharp scratch, but I will be as quick and gentle as possible’

5. For you: Explain how you want the patient to be positioned; ‘Can you please
straighten your wrist for me’.
6. For you: Explain how you want the patient to be exposed; ‘Can you please
roll up your sleeves for me’.

7. For you: Explain the contraindications of the procedure if present. Ask about
any arm soreness and any arm preference.
8. For both of you: Inform the patient that you will maintain their privacy
9. For both of you: Finally gain consent by asking; ‘ Do I have your consent to
proceed?’
10. Ask about any arm soreness and any arm preference.

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Procedure:
1. Perform the modi ied Allen’s test:
- I'm going to check the blood supply of your hands
- Ask the patient to make a ist and then (on the mannequin), press with each
hand on radial and ulnar arteries
- Ask the patient to release the ist, 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. Collect your equipment:
- ABG needle.
- Alcohol swab.
- Cotton piece.
- Gloves.

3. 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.
4. Once the equipment is prepared, put them in your tray.
5. Gloves: Assume you are wearing gloves, or if you ind a gloves you should wear
it.
6. Feel the artery.
7. Locate the radial pulse by palpating over the artery using 3 ingers of your left
hand (index, middle and ring ingers). If you do not feel the pulse inform the
examiner, as the mannequin has a palpable pulse inthe exam. Simply say: “I
can’t feel the Radial pulse.”
8. Sterilise the area: Put 3 ingers of your left hand over the radial artery then
remove only your middle inger and clean the area using an alcohol swab with
a single stroke. Keep that hand ixed.
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9. With the other hand, remove the cap to reveal the needle, and discard the cap.
10. Warn the patient and prick at a degree between 45 to90 degrees holding the
needle like a pen. Keep the needle ixed and secure all the time.
11.Once inside the artery, the syringe should begin to self- ill. The arterial
pressure will cause the blood to ill the syringe automatically. Do notpull the
plunger.
12. Withdraw the needle carefully. Once the needle is out, press the cotton down
irmly on the puncture site, and ask the patient to do so for at least 5 minutes.
13. Lock the protective needle sleeve by pushing it down against the table. Do
not use your hand to lock the protective needle sleeve.
14. Remove the needle from the syringe and discard it into the sharps bin.
15. Place some gauze directly underneath the cannula. Then remove the needle
fully and dispose it into the sharps bin.
16. Apply the stopper onto the syringe.
17. Verbalize labeling the sample with the patient’s details including oxygens
concentration and verbalize sending it to the ABG machine by yourself
immediately.

Management :
1. Wind up everything you talked about and did.
2. Review the patient’s vital signs; blood pressure, heart rate, respiratory rate,
oxygen saturation and temperature.
3. Keep the patient in the observation unit on oxygen.
4. Safety net about the procedure itself; any bleeding, swelling or soreness.
5. Safety net about the patient’s general condition; chest pain, cough, fever.

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Male Urethral Catheterisation

Scenario:
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 withan abdominal
discomfort.
What you must do:
- Take focused history, perform the emergency management, and address the
patient’s concerns

History Taking:
1. Con irm 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.
4. Assess the pain through SOCRATES. Ask about when he last passed urine.
5. Ask about contraindications for urinary catheter such recent instrumentation.
6. MMA: ask speci ically about kidney stones and prostate problems. Ask about
any allergy to latex.

Examination:
1. Verbalise GPE and abdominal examination.
2. Ask for the observations; blood pressure, heart rate, respiratory rate, oxygen
saturation and temperature.

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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:
1. Start with thanking the patient for answering your questions
2. For the patient: Explain why are you performing the procedure; ‘I will insert
a urinary catheter to empty the bladder. This will help with the pain. Are
you ok with this?’.
3. For the patient: Explain that the procedure won’t be painful but could be
uncomfortable.
4. For the patient: Explain what you are going to do during the procedure; ‘I
will be inserting a thin rubber tube into your penis. It will be a bit
uncomfortable, but I will be as quick and gentle as possible’.

5. For you: Explain how you want the patient to be positioned; ‘I would like you
to lie lat on your back with your legs slightly separated’.
6. For you: 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’.

7. For you: Explain the contraindications of the procedure if present. Ask about
any arm soreness and any arm preference.
8. For both of you: Inform the patient that you will maintain their privacy
9. For both of you: Inform the patient that a chaperone will be present
10.For both of you: Finally gain consent by asking; ‘ Do I have your consent to
proceed?’

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Procedure:
1. Collect your equipment:
- 2 kidney trays.
- Sterile gauze.
- 3 cotton pieces.
- Sterile forceps.
- Antiseptic solution / Normal saline.
- Anaesthetic jelly illed syringe (1%).
- Normal distilled water illed syringe(10mls).
- Urine bag
- Male Foley catheter – 12-14 French size.
- Urine bag.
- Gloves.

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2. Prepare your equipment in your clean area:
- Keep the catheter ready by removing outer packaging.
- Place the kidney tray between the patient’s thighs
3. Once the equipment is prepared, put them in your tray.
4. Gloves: Assume you are wearing double sterile gloves.
5. With the help of a sterile forceps place a piece of gauze over the shaft of the
penis.
6. Dispose the plastic forceps into clinical waste bin.
7. 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.
8. 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).
9. Dispose the plastic forceps and cotton pieces into the clinical waste bin.
10. Explain to the patient that you are going to insert some anesthetic gel tomake
the procedure more comfortable.
11. Pick up the syringe labelled as anaesthetic gel. Holding the glans, pull irmly
upward and place the nozzle of the syringe of anaesthetic gel into the urethral
meatus. Slowly expel the contents into the urethra.
12. Verbalize giving the gel 3-5 minutes to take full effect.
13. Assume to take one pair of the sterile gloves off.
14. Take the tip of catheter few centimetres out from the inner packaging using
non-touch technique.
15. Place the draining end of the catheter in the kidney tray. Warn the patient
that you are going to insert the catheter.
16.While you are holding the base of the glans with your left hand, apply gentle

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upward traction to the penis and insert the exposed catheter tip into the
urethral meatus with your right hand.
17. 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.
18. 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.
19. Continue to advance the catheter until it is fully inserted up to the Y-junction.
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 lated, gently pull on the catheter until resistance is felt.
22. If the mannequin had foreskin, replace/reposition the patient’s retracted
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.
23. Remove the cap from the tubing and plug the plastic tube end into the
catheter, ensuring a tight seal.
24. 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.”
25. Tear the drape and dispose it into the clinical waste bin. However, in the exam
you will be asked not to do so.
26. Dispose of equipment into the clinical waste bin.
27. Clean the patient and ensure his dignity by making sure that he is
comfortable and covered
28. Thank the patient and ask him to dress up.
29. Record the date and time of insertion, size of catheter and volume and colour
of urine drained.

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30. Take the patient’s observations again after the procedure as the blood
pressure might fall after draining the urine.

Management :
1. Wind up everything you talked about and did.
2. Keep the patient in the observation.
3. Request full blood count, kidney function, liver function and in lammatory
markers.
4. Request US abdomen.
5. Offer paracetamol for pain.
6. Offer IV luids if needed.
7. Offer antibiotics if there is a suspicion of a UTI.
8. Safety net about the procedure itself; any blood in the catheter bag, pain.
9. Safety net about the patient’s general condition; fever.

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