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Subject Page

General map 2-6

Venipuncture ( PCM level) 6-12

Blood Culture 12-15

IV Cannula 15-20

ABG 20-25

Urinary Catheter 26-31

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Blood procedure

•Blood Sampling
•Blood Culture
•IV Cannulation
•ABG

Overview of Blood Procedures:

• Remember that in Blood Procedure stations, you are not the first 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.
• Assume you are wearing gloves, not actually wear them.
If you fail to withdraw blood, do not panic, and repeat the procedure:
Do not reuse the same equipment.
Select another part of the vein or another vein altogether
• Touch the mannequin only after preparing your equipment
• Tie the torniquet very late and loosen it very early. (Tie it after
preparing your equipment and loosen it once you see a
flashback).
• 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:

Confirm the patient’s identity.

Start the station well (You already know the issue. So start with that. Do
not say ''how may I help you?’').

Why? & Why?

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 ……).

Take focused History relevant only to your procedure

Red flags - relating to condition, Contraindications - relating to
procedure

Remember to always ask MMA as long as there is a patient involve

Explain the PPECC (Procedure, Position, Exposure, Chaperone,
Consent)

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Patient preparation:
.

Pa ent:
Bene t ( I would like to take a blood sample from you in order to nd out the cause
of your ( complain).
Risk: It should not be painful, but if you feel uncomfortable at any me let me know.
Explain: explain exactly what you are going to do: (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

Doctor:
Position : Can you please straighten your elbow/ wrist for me.
Exposure: Can you please roll up your sleeves for me.
Please be observant. (Notice whether the patient has short sleeves, or has
rolled up the sleeves already, and comment on it accordingly).

Both:
Privacy: I will ensure your privacy.
Chaperon: Blood procedures do not require a chaperone.
Consent: Do I have your consent to proceed.

Ask about any arm soreness and any arm preference.

Do not forget to inform the patient that if you fail, you may need to repeat the
procedure.

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Procedure:
1. Collect
2. Open (everything you are going to use before going to the manikin)
3. Start the procedure.

Collect your equipment

Prepare your equipment in your clean area.
- Once the equipment is prepared, put them in your tray

Gloves: Assume you are wearing gloves(mostly), or if you

find a gloves you should wear it.

Feel the vein/ Artery

Torniquet (above the cubital fossa)

Clean Prick Collect

• Clean the area with one single stroke
• Prick with the bevel pointing up and warn the patient about the
sharp scratch.
• Collect the blood.

Cotton and Label

• Put a cotton on the prick site
• Verbalize labeling the sample with the patient’s details and verbalize
sending it to the lab.

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Management :
• Wind up everything you talked about and did
• Sit down and discuss with the patient the management details specific to
each station.

Safety net
1. about the procedure itself (any bleeding, swelling or soreness)
2. about the patient’s general condition.

Blood Sampling (Venipuncture)

Who you are

You are FY2 in A&E department
Who the patient is
Adam Elkady, 26-year-old male has taken some
paracetamol tablets
Other information
Your consultant has asked you to take a blood sample from
the patient to test for the level of paracetamol in her blood
What you must do
- Take focused history, do the relevant procedure, and manage the
patient accordingly

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History Taking:

Confirm the patient’s identity

Start the station well (I can see from my notes that you are here as you
have taken some PCM tablets)
• IPS:
Pick up on non-verbal cues (if the patient is looking at the ground or
avoiding eye contact)
Build Rapport. Show sympathy and empathy. Remember to be extra-
sensitive since this is a suicidal patient.
Reassure by giving confidentiality

Why? & Why?

My consultant has asked me to take a blood sample from you to test
for the level of PCM in your blood

Focused History
- What, how many, when, with what (do not ask why, this is not a
psychiatry station)

Red flags - vomiting, drowsiness, jaundice

MMA
- Medical Conditions (specify any bleeding disorder, Liver or kidney
conditions)
- Medications (specify any blood thinner)

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Patient preparation:

Pa ent:
Bene t ( I would like to take a blood sample from you in order to check the level of
paracetamol in your blood.
Risk: It should not be painful, but if you feel uncomfortable at any me let me know.
Explain: explain exactly what you are going to do: (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

Doctor:
Position : Can you please straighten your elbow/ wrist for me.
Exposure: Can you please roll up your sleeves for me.
Please be observant. (Notice whether the patient has short sleeves, or has
rolled up the sleeves already, and comment on it accordingly).

Both:
Privacy: I will ensure your privacy.
Chaperon: Blood procedures do not require a chaperone.
Consent: Do I have your consent to proceed.

Ask about any arm soreness and any arm preference.

Do not forget to inform the patient that if you fail, you may need to repeat the
procedure.

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Procedure
1- Collect.
2- Open (everything you are going to use before going to the manikin).
3- Start the procedure.

Collect your equipment:

- Gloves.
- Tourniquet , Yellow tube is the first choice for toxicology, Second
choice is the red tube.
- 1 Alcohol swab
- Vacutainer and needle
- Blood Tube
- Cotton piece

Prepare your equipment in your clean area, then put them on your tray:
- 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.

Gloves: Assume you are wearing gloves

Feel the vein
Torniquet (Tie the torniquet above the cubital fossa)
Clean Prick Collect
- Clean the area with one single stroke
- Remove the green cap to reveal the needle, and discard the
cap. Then warn the patient and prick with the bevel
pointing up.
- Keep the needle fixed and secure all the time.
Loosen the tourniquet as soon as you see the flashback.

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- Once in the vein, while holding the vacutainer holder firm and still with
your left hand, attach the vacutainer and let it fill.
- Once blood is collected, turn the tubes upside down and swill it around
a bit to ensure full mixing.

Cotton and Label

- Withdraw the needle carefully. Once the needle is out, press the
cotton down on the puncture site.
- Dispose the needle attached to the vacutainer holder into the sharps
bin.
- Verbalize labeling the sample with the patient’s details and verbalize
sending it to the lab.

Management
- Sit down and discuss with the patient the management details:
- Keep in the observation unit
You will be given a plasma PCM concentration (a value that will require
action)
Treatment
Interpret the results of the PCM concentration on the PCM chart
- If above the t.t line: N-acetyl cysteine- takes about 21 hours
- After medical fitness, refer to Psychiatry colleagues for support,
relief of stress and improving mood

Safety net
- About the procedure itself (any bleeding, swelling or soreness) .
- About the patient’s general condition (Tummy pain, vomiting,
confusion, drowsiness, yellowish discoloration...) .

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Blood Culture
(extra-clean)
Who you are
- You are FY2 in Surgery Department
Who the patient is
Tom Henderson, 35-year-old male has had an appendectomy 3 days
ago. He has now developed a fever.
Other information
Your consultant has asked you to take a blood culture sample from the
patient
What you must do
- Take focused history, do the relevant procedure, and address the
patient’s concerns

History Taking:

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)
• IPS:
Pick up on non-verbal cues (if the patient is in pain or looking unwell)
Build Rapport. Ask about the hospital stay.

Why? & Why?

My consultant has asked me to take a blood sample from you to
send it for culture to test for the specific bug causing your
symptoms.

Take focused History relevant only to your procedure

Ask about any bleeding, pain, or discharge from the operation site.
Ask about bowel motion since after the operation.

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Red Flags - features of sepsis (confusion, urine output. etc.)

MMA
Medical Conditions (specify any bleeding disorder) - Medications
(specify any blood thinner)

Patient preparation:
Pa ent:
Bene t ( I would like to take a blood sample from you in order to know the bacteria
Risk: It should not be painful, but if you feel uncomfortable at any me let me know.
Explain: explain exactly what you are going to do: (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

Doctor:
Position : Can you please straighten your elbow/ wrist for me.
Exposure: Can you please roll up your sleeves for me.
Please be observant. (Notice whether the patient has short sleeves, or has
rolled up the sleeves already, and comment on it accordingly).

Both:
Privacy: I will ensure your privacy.
Chaperon: Blood procedures do not require a chaperone.
Consent: Do I have your consent to proceed.

Ask about any arm soreness and any arm preference.

Do not forget to inform the patient that if you fail, you may need to repeat the
procedure.

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Procedure: (Remember to be extra-clean)

❖ Collect your equipment:

Tourniquet
Alcohol swab
Vacutainer and needle
Blood culture bottles
2 (2% Chlorhexidine 70% ispropyl) alcohol wipes
- Cotton piece.

❖ Prepare your equipment in your clean area, then put them on your tray:
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.
Culture Bottles: * Check the expiry date
* Flip off the caps
*Clean the tops of the bottles each with a different
chlorhexidine wipes

Gloves: Assume you are wearing gloves

Feel the vein
Torniquet (Tie the torniquet above the cubital fossa)

Clean Prick Collect

Clean the area with one single stroke
Remove the green cap to reveal the needle, and discard the cap.
Then warn the patient and prick with the bevel pointing up.
Keep the needle fixed and secure all the time.
Loosen the tourniquet as soon as you see the flashback.
Once in the vein, while holding the vacutainer holder firm and still with
your left hand, attach the vacutainer and let it fill.

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Once blood is collected, swirl the bottles 180 degrees and put them on
the tray.

Cotton and Label

Withdraw the needle carefully. Once the needle is out, press the cotton
down on the puncture site.
Dispose the needle attached to the vacutainer holder into the sharps
bin.
Verbalize labeling the sample with the patient’s details and verbalize
sending it to the lab.

Management :
Sit down and discuss with the patient the management outline:
Keep in the observation unit
Monitor Urine output

Treatment
PCM for the fever
Start on Broad Spectrum Antibiotic and change it once the results of the
culture come back.

❖ Safety net
about the procedure itself (any bleeding, swelling or soreness)
about the patient’s general condition (Tummy pain, discharge, bleeding
from the operation site, constipation, if fever does not resolve…)

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I V Cannulation

Who you are

- You are FY2 in Surgery Department
Who the patient is
- Jamie Smith, 28-year-old male has had an appendectomy few hours ago.
His cannula is blocked
Other information
- Your consultant has asked you to change his IV cannula
Special Note
- The patient is on 5mg IV morphine 4 hourly. His last dose was 1hr ago
What you must do
- Take focused history, do the relevant procedure, and address the patient’s
concerns

History Taking:

Start the station well (I can see from my notes that you have been
undergone an operation to remove your appendix a few hours ago)
• IPS:
Pick up on non-verbal cues (the patient will be in pain) - Build
Rapport.
Ask how the operation went.
Why? & Why?
My consultant has asked me to change your blocked cannula to
give medications and fluids

Focused History relevant only to your procedure

Explore the Pain (SOCRATES)
Ask about any bleeding, pain, or discharge from the operation site.
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Ask about bowel motion since after the operation.

Red flags - bleeding, signs of infection

MMA
Medical Conditions (specify any bleeding disorder) - Medications
(specify any blood thinner)

Patient preparation:
Pa ent:

Bene t : I would like to change your cannula in order to be able to give you uids
and medica ons through it.
Risk: It should not be painful, but if you feel uncomfortable at any me let me know.
Explain: explain exactly what you are going to do: (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

Doctor:
Position : Can you please straighten your elbow/ wrist for me.
Exposure: Can you please roll up your sleeves for me.
Please be observant. (Notice whether the patient has short sleeves, or has
rolled up the sleeves already, and comment on it accordingly).

Both:
Privacy: I will ensure your privacy.
Chaperon: Blood procedures do not require a chaperone.
Consent: Do I have your consent to proceed.

Ask about any arm soreness and any arm preference.

Do not forget to inform the patient that if you fail, you may need to repeat the
procedure.
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Procedure:
Remove the blocked cannula, discard it into the waste bin and ask the
patient to press the cotton down.

Collect your equipment:

Tourniquet
Alcohol swab
Cannula
Tegaderm - 2 cc syringe filled with saline The syringe will be
already prefilled with saline
Gauze piece - Cotton piece.

Prepare your equipment in your clean area, then put them in your
tray: - Partially open the alcohol swabs
Make cannula ready to use, remove the stopper, loosen the cap on top
and loosed the cap covering the needle and place in your tray.
Prepare the Tegaderm: Take the 3 stickers off and stick them on the
side of the tray.

Gloves: Assume you are wearing gloves

Feel the vein

Torniquet (Tie the torniquet above the cubital fossa)

Clean Prick Collect

Clean the area with one single stroke
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 (Lower) and progress the entire cannula a
further 2mm to ensure it is in the vein.

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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.
Withdraw (Retract) the needle slightly so that its sharp point is inside of
the plastic tubing.
Advance cannula fully into vein – The needle still inside the tubing will
stop the plastic from kinking.
Loosen the tourniquet
Place some gauze directly underneath the cannula. Then remove the
needle fully and dispose it into the sharps bin.
Put the stopper back to the cannula.
Put two of the stickers on both sides of the cannula. Then flush the
cannula and close the cannula port.

Label
Fix the Tegaderm on securely and verbalize labeling the date and time
and discard your waste.

Management
Sit down and discuss with the patient the management details:
Examination:
Vitals- respiratory depression (because of Morphine)
GPE- shock/dehydration
Operation site
Abdominal examination- internal bleeding

Investigations
FBC, LFT, RFT
Coagulation profile
Monitor Urine output
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Treatment
For the pain: according to the patient’s charts and the last dose of
morphine
o If he is on 5 mg IV morphine 4 hourly and his last dose was 1 hour
ago, then no morphine but we give instead 1g IV PCM o Check
vitals- RR before giving morphine

If still in pain: o Encourage to wait for some time- reassess in 10-15

mins

For the Nausea: IV Metoclopramide 10mg

Safety net
about the procedure itself (any bleeding, swelling or soreness)
about the patient’s general condition (Tummy pain, discharge, bleeding
from the operation site, constipation, if pain does not resolve…)

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Arterial Blood Gases

( ModifiedAllen test)

Who you are

You are FY2 in A&E department
Who the patient is
Peter Fey, 49-year-old male who has been previously diagnosed with
COPD has now presented with shortness of breath.
Other information
Your consultant has asked you to take an ABG sample from the
patient
What you must do
- Take focused history, do the relevant procedure, and manage the
patient accordingly

History Taking:

Start the station well (I can see from my notes that you are here as you
have been having some shortness of breath.)

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* Check if the patient is on oxygen already

• IPS:
- Pick up on non-verbal cues (if the patient is looking is SOB) -
Build Rapport.

Why? & Why?

- My consultant has asked me to take a sample to test for the level of
gases of your blood.

Take focused History relevant only to your procedure

Ask about any chest pain.
Ask about fever.
Any cough.
Ask about compliance to medications for COPD.

Red flags - features of respiratory distress

MMA
- Medical Conditions (specify any bleeding disorder) -
Medications (specify any blood thinner)

**You might have to explain how ABG is different from venous sampling**

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Patient preparation:
Pa ent:
Bene t ( I would like to take a blood sample from you in order to check your blood
gases and O2 level in your blood.
Risk: It could be painful, but if you feel uncomfortable at any me let me know.
Explain: explain exactly what you are going to do: (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

Doctor:
Position : Can you please straighten your elbow/ wrist for me.
Exposure: Can you please roll up your sleeves for me.
Please be observant. (Notice whether the patient has short sleeves, or has
rolled up the sleeves already, and comment on it accordingly).

Both:
Privacy: I will ensure your privacy.
Chaperon: Blood procedures do not require a chaperone.
Consent: Do I have your consent to proceed.

Ask about any arm soreness and any arm preference.

Do not forget to inform the patient that if you fail, you may need to repeat the
procedure.

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Procedure:
Perform the modified Allen’s test:
- I'm going to check the blood supply of your hands
- Ask the patient to make a fist and then (on the mannequin), press with
each hand on radial and ulnar arteries
- Ask the patient to release the fist, and release the ulnar artery

If the reperfusion time is less than 7 seconds, I will continue with the
procedure.

Collect your equipment:

1 Alcohol swab
ABG Needle (with the stopper)
Cotton piece

Prepare your equipment in your clean area, then put them on your tray:
Partially open the alcohol swab
Loosen up the cap slightly and keep it aside ready for the procedure.
Keep the green stopper in the tray.
Gloves: Assume you are wearing gloves
Feel the artery
Clean Prick Collect
Locate the Radial pulse by palpating over the artery using 3 fingers of
your left hand (index, middle and ring fingers). If you do not feel the
pulse inform the examiner, as the mannequin has a palpable pulse in
the exam. Simply say: “I can’t feel the Radial pulse.”
Sterilize the area: Put 3 fingers of your left hand over the Radial artery.
Then remove only your middle finger (backwards) and clean the area
using an alcohol swab with a single stroke. Keep that hand fixed.
With the other hand, remove the cap to reveal the needle, and discard
the cap. Then warn the patient and prick at a degree between 45 to
90 degrees holding the needle like a pen.
Keep the needle fixed and secure all the time.

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Once inside the artery, the syringe should begin to self-fill. The arterial
pressure will cause the blood to fill the syringe automatically. Do not
pull the plunger.

Cotton and Label

Withdraw the needle carefully. Once the needle is out, press the cotton
down firmly on the puncture site, and ask the patient to do so for at
least 5 minutes.
Lock the protective needle sleeve by pushing it down against the table.
Do not use your hand to lock the protective needle sleeve. Remove
the needle from the syringe and discard it into the sharps bin.
Apply the stopper onto the syringe.
Verbalize labeling the sample with the patient’s details (Mention oxygen
saturation) and verbalize sending it to the ABG machine by yourself
immediately.

Management

Keep in the observation unit

Take the patient’s observations including the O2 saturation

Treatment
- Oxygen

- Safety net
about the procedure itself (any bleeding, swelling or soreness)
about the patient’s general condition (chest pain, cough, fever,...)

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Male Urethral Catheterization

Who you are
You are FY2 in A&E department
Who the patient is
Tony Samson, 41-year-old male who has presented with
an abdominal discomfort
What you must do
Take focused history, perform the emergency
management, and address the patient’s concerns

• History talking

Start the station well (I can see from my notes that you are here as you
are having some abdominal discomfort.)
• IPS:
Pick up on non-verbal cues (if the patient is holding his tummy in pain)
Build Rapport.
• P1 Explore the main complaint
Pain: SOCRATES
Ask about waterworks (and when was the last time he has passed
urine)
C/I:

Bleeding from down below

Discharge (UTI)
Any trauma or recent instrumentation
P2 (start with an open question, then specify)

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Medical Conditions (specify any history of stones, problems in the male

gland, and bleeding disorders)
Medications (specify any blood thinners)
Allergies (ask about any allergy to latex)

Examination (do not forget to verbalize this)

Vitals
GPE- blood on the meatus
Abdominal examination

Provisional Diagnosis
From the information you have given me and according to my examinations
(Always briefly mention the positive findings you have found in history and
Examination), I am suspecting that you have a urinary retention.

Patient preparation:
Pa ent:
Benefit in order to relieve the patient’s pain or discomfort, you will need to
insert a catheter.
Risk: It will be a bit uncomfortable, but I will be as quick and gentle as
possible.
Explain: For the purpose of that 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.
Doctor:
Position : I would like you to lie flat on your back with your legs slightly
separated
Exposure: I would you to undress yourself from waist down below and to take
your undergarments off.
Both:
Privacy: I will ensure your privacy.
Chaperon: one of the medical stuff will be presented at the time of the
examination as a chaperon.
Consent: Do I have your consent to proceed.

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Procedure:

Collect your equipment

2 kidney trays
Sterile gauze
3 cotton pieces
Sterile forceps
Antiseptic solution / Normal saline
Anesthetic jelly filled syringe (1%)
Normal distilled water filled syringe
(10mls)
Urine bag
Male Foley catheter – 12-14 French size

Prepare your equipment

Keep the catheter ready for insertion: Remove outer packaging and take
the tip of catheter few centimeters out from the inner packaging using
non-touch technique.
Place the kidney tray between the patient’s thighs.

Assume you are wearing double sterile gloves

Cleaning:
With the help of a sterile forceps place a piece of gauze over the shaft
of the penis. Dispose the plastic forceps into clinical waste bin.
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.

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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). Dispose the plastic forceps and cotton pieces into the
clinical waste bin.

**Assume to take one pair of the sterile gloves off.

Insert the anesthetic gel

Explain to the patient that you are going to insert some anesthetic gel to
make the procedure more comfortable
(apply it with a syringe, not on the catheter)

Pick up the syringe labelled as anesthetic jelly. Holding the glans, pull
firmly upward and place the nozzle of the syringe of anesthetic gel
into the urethral meatus. Slowly expel the contents into the urethra.
Verbalize giving the gel 3-5 minutes to take full effect.

Inserting the catheter:

Place the draining end of the catheter in the kidney tray.
Warn the patient that you are going to insert the catheter.
(Right hand only touch the wrapper, left hand only
touch the gauze, and the penis will only touch the catheter)

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.

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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.

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.
Continue to advance the catheter until it is fully inserted up to the Y-
junction.

Inflating the catheter balloon:

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.
Dispose the syringe into the clinical waste bin. Once the balloon is fully
inflated, gently pull on the catheter until resistance is felt.
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 left
hand.

Attaching the urine bag:

Remove the cap from the tubing and plug the plastic tube end
into the catheter, ensuring a tight seal.

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.”

Ensure area and patient is clean:

Tear the drape and dispose it into the clinical waste bin. However, in the
exam you will be asked not to do so.

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Dispose of equipment into the clinical waste bin.

Clean the patient and ensure his dignity by making sure that he is
comfortable and covered: Thank the patient and ask him to dress up.
Label:
Record the date and time of insertion, size of catheter and volume and
color of urine drained. After evacuating the urine, the Blood pressure
may fall .
** Take the patient’s observations again after the procedure

Management
Shift to the observation unit
Senior
Investigations: (Bloods :RFT ), Imaging : Ultrasound
Symptomatic treatment:
PCM if still in pain after the procedure
IV fluids if blood pressure after the procedure is low
Medication to relax the neck of bladder
Antibiotics if there is a UTI
Specialist (Urologist)

Safety net:
Any pain, burning sensation or fever
Blockage of the catheter
If blood is noticed in the catheter.
If the catheter is full.

DR MO SOBHY ACADEMY Page 32 of 32