Done

12 Lead EKG
1. Demonstrates proper lead placement for 12 Lead ECG
a. V1 – 4th ICS; right sternal border
b. V2 – 4th ICS; left sternal border
c. V3 – Midway between location of V2 and V4
d. V4 – 5th ICS; mid-clavicular line
e. V5 - 4th ICS; to the right of V4 (anterior axillary line)
f. V6 – 4th ICS; mid-axillary line
g. Right arm, left arm, right leg, and left leg
2. Verbalizes steps to include in proper skin preparation for lead placement

a. Clean area with alcohol swab

b. Clip excess hair as necessary
3. Demonstrate ability to obtain a 12 lead ECG using the ECG machine.
a. Apply electrodes as described above.
b. Turn ECG machine on with ON/
c. Enter Pt name – Last, First – then hit F1 to enter
d. Enter Age, then F1 to enter
e. Enter Sex – M=male, F=female, then F1 to enter
f. Review ECG/Alert Physician of completed ECG

Done
IV INSERTION
1. Confirms correct patient (student states)
2. Obtain informed consent
● Indication for IV
● Complications – pain, bleeding, nerve damage, fainting
3. Check that all necessary equipment is available
4. Flush saline lock
5. Wash hands
6. Apply tourniquet.
7. Identify insertion site
8. Put on gloves
9. Clean insertion point. Must use at least 3 wipes with swab.
10. Insert needle superficially with bevel side up; with flashback of blood advances the catheter over the
needle.
11. Remove tourniquet to release pressure on vein.
12. Using one finger to put pressure at the end of the catheter to stop blood flow, removed the needle.
(if using needleless device, retracted the needle first).
13. Disposed of needle in Sharps container without recapping.
14. Attach saline lock.
15. Flush IV with saline to ensure patency.
16. Thoroughly secure cannula with tape.
17. Documents procedure in patient’s chart (examinee can state this) including location of IV and any
complications.
18. Patient comfort was priority
19. Maintained sterility appropriately throughout the procedure.
 Done
INSERTION OF AN INTERMITTENT OR INDWELLING CATHETER
1. Verify physician order for catheter insertion. Assess for bladder fullness and pain by palpation or by
using a bladder scanner.
2. Position patient with knees raised; apply gloves; and inspect perineal region for erythema, drainage,
and odour. Also assess perineal anatomy.
3. Remove gloves and perform hand hygiene.
4. Gather supplies:
● Sterile gloves
● Catheterization kit
● Cleaning solution
● Lubricant (if not in kit)
● Prefilled syringe for balloon inflation as per catheter size
● Urinary bag
● Foley catheter
5. Check for size and type of catheter, and use smallest size of catheter possible.
6. Place waterproof pad under patient.
7. Positioning of patient depends on gender.
● Female patient: On back with knees flexed and thighs relaxed so that hips rotate to expose
perineal area. Alternatively, if patient cannot abduct leg at the hip, patient can be side-lying with
upper leg flexed at knee and hip, supported by pillows.
● Male patient: Supine with legs extended and slightly apart.
8. Place a blanket or sheet to cover patient and expose only required anatomical areas.
9. Apply clean gloves and wash perineal area with warm water and soap or perineal cleanser according
to agency policy.
10. Ensure adequate lighting.
11. Perform hand hygiene.
12. Add supplies and cleaning solution to catheterization kit, and according to agency policy.
13. If using indwelling catheter and closed drainage system, attach urinary bag to the bed and ensure that
the clamp is closed.
14. Apply sterile gloves using sterile technique.
15. Drape patient with drape found in catheterization kit, either using sterile gloves or using ungloved
hands and only touching the outer edges of the drape. Ensure that any sterile supplies touch only the
middle of the sterile drape (not the edges), and that sterile gloves do not touch non-sterile surfaces.
Drape patient to expose perineum or penis.
16. Lubricate tip of catheter using sterile lubricant included in tray, or add lubricant using sterile
technique.
17. Check balloon inflation using a sterile syringe.
18. Place sterile tray with catheter between patient’s legs.
19. Clean perineal area as follows.

Female patient: Separate labia with fingers of non-dominant hand (now contaminated and no longer
sterile). Using sterile technique and dominant hand, clean labia and urethral meatus from clitoris to anus,
and from outside labia to inner labial folds and urethral meatus. Use sterile forceps and a new cotton
swab with each cleansing stroke.

Male patient: Gently grasp penis at shaft and hold it at right angle to the body throughout procedure
with non-dominant hand (now contaminated and no longer sterile). Using sterile technique and
dominant hand, clean urethral meatus in a circular motion working outward from meatus. Use sterile
forceps and a new cotton swab with each cleansing stroke.
20. Pick up catheter with sterile dominant hand 7.5 to 10 cm below the tip of the catheter.
21. Insert catheter as follows.
Female patient:
● Ask patient to bear down gently (as if to void) to help expose urethral meatus.
● Advance catheter 5 to 7.5 cm until urine flows from catheter, then advance an additional 5 cm.
Male patient:
● Hold penis perpendicular to body and pull up slightly on shaft.
● Ask patient to bear down gently (as if to void) and slowly insert catheter through urethral
meatus.
● Advance catheter 17 to 22.5 cm or until urine flows from catheter.

Note: If urine does not appear in a female patient, the catheter may be in the patient’s vagina. You may
leave catheter in vagina as a landmark, and insert another sterile catheter.
Note: If catheter does not advance in a male patient, do not use force. Ask patient to take deep breaths
and try again. If catheter still does not advance, stop procedure and inform physician. Patient may have
an enlarged prostate or urethral obstruction.

22. Place catheter in sterile tray and collect urine specimen if required.

23. Slowly inflate balloon for indwelling catheters according to catheter size, using prefilled syringe.
Note: If patient experiences pain on balloon inflation, deflate balloon, allow urine to drain, advance
catheter slightly, and reinflate balloon.

24. After balloon is inflated, pull gently on catheter until resistance is felt and then advance the catheter
again.
25. Connect urinary bag to catheter using sterile technique.
26. Secure catheter to patient’s leg using securement device at tubing just above catheter bifurcation.

Female patient: Secure catheter to inner thigh, allowing enough slack to prevent tension.

Male patient: Secure catheter to upper thigh (with penis directed downward) or abdomen (with penis
directed toward chest), allowing enough slack to prevent tension. Ensure foreskin is not retracted.

27. Dispose of supplies following agency policy.

28. Remove gloves and perform hand hygiene.
29. Document procedure according to agency policy, including patient tolerance of procedure, any
unexpected outcomes, and urine output.
INSERTING A NASOGASTRIC TUBE DONE

1. Perform hand hygiene and gather supplies.

2. Visually inspect condition of patient’s nasal and oral cavities.
3. Assess for the best nostril before you begin.
Do this by occluding one side and asking the patient to sniff. Ask the patient about previous injuries or
history of a deviated septum.
4. Palpate patient’s abdomen for distension, pain, and/or rigidity.
Auscultate for bowel sounds.
5. Assess patient’s level of consciousness and understanding of procedure.
6. Check doctor’s orders for type of NG tube to be placed and reason for placement.
7. Check doctor’s orders to determine whether the NG tube is to be attached to suction or a drainage
bag.
8. Position patient sitting up at 45 to 90 degrees (unless contraindicated by the patient’s condition), with
a pillow under the head and shoulders.
9. Raise bed to a comfortable working height.
10. Agree on a signal the patient can use if they wish you to pause during the procedure.
11. Place a towel on the patient’s chest and provide facial tissues and an emesis basin.
12. Provide patient with drinking water and a straw if the patient is not fluid restricted.
13. Stand on patient’s right side if you are right-handed and the left side if you are left-handed.
14. Measure distance of the tube from
● The tip of the nose, to…
● The earlobe, to…
● The xiphoid process
and then mark the tube at this point.
15. Lubricate NG tube tip according to your agency policy.
16. Put on clean non-sterile gloves.
17. Curve 10 to 15 cm of the end of the NG tube around your gloved finger, and then release it.
18. Have patient drop head forward and breathe through the mouth.
19. Insert NG tube tip slowly into the patient’s nostril and advance it steadily, in a downward direction,
along the bottom of the nasal passage, with the curved end pointing downward in the direction of the
ear on the same side as the nostril.
20. You may feel slight resistance as you advance along the nasal passage. Twist the tube slightly, apply
downward pressure, and continue trying to advance the tube. If significant resistance is felt, remove the
tube and allow the patient to rest before trying again in the other nostril.
21. If there is difficulty in passing the NG tube, you may ask the patient to sip water slowly through a
straw unless oral fluids are contraindicated. If oral fluids are not allowed, ask the patient to try dry
swallowing while you advance the tube.
22. Continue to advance NG tube until you reach the mark/tape you had placed for measurement.
23. Temporarily anchor the tube to patient’s cheek with a piece of tape until you can check for correct
placement.
24. Once the tube placement has been confirmed, mark (with a permanent marker) and record the
length of tubing extending from the nose to the outer end of the tube.
25. Secure the tube to the patient’s gown with a safety pin, allowing enough tube length for
comfortable head movement.
26. Document the procedure according to agency policy, and report any unexpected findings to the
appropriate health care provider.
 Done
SUTURING
1. Check that all necessary equipment is available
Chooses appropriate sized suture
2. Confirms correct patient (student states)
3. Obtain informed consent
● Indication for test; Complications – pain, bleeding, infection, scar
4. Wash hands
5. Cleans area to be sutured
6. Put on sterile gloves
7. Holds needle driver properly: Thumb and long/ring finger with index as stabilizer
8. Loads the needle properly: At tip of jaws, 1/3 to 2/3 from point
9. Needle enters perpendicular to skin
10. Equal sized bites on both sides
11. Passes needle through tissue without sawing, following curve of needle
12. No gap between wound edges
13. No dog ears
14. First throw placed square, may be double throw
15. Maximum of two further single knots
16. Appropriate tension on wound edges (does not tighten knot excessively)
17. Documents procedure in patient’s chart (examinee can state this) including location of puncture,
result of Allen’s test, and any complications.
18. Patient comfort was priority
19. Maintained sterility appropriately throughout the procedure.

Done
Changing a Pouching System/Ostomy Appliance (Ileostomy or Colostomy)
1. Perform hand hygiene.
2. Gather supplies.
3. Identify the patient and review the procedure. Encourage the patient to participate as much as
possible or observe/assist patient as they complete the procedure.
4. Create privacy. Place waterproof pad under pouch.
5. Apply gloves. Remove ostomy bag, and measure and empty contents. Place old pouching system in
garbage bag.
6. Remove flange by gently pulling it toward the stoma. Support the skin with your other hand. An
adhesive remover may be used. If a rod is in situ, do not remove.
7. Clean stoma gently by wiping with warm water. Do not use soap.
8. Assess stoma and peristomal skin.
9. Measure the stoma diameter using the measuring guide (tracing template) and cut out stoma hole.
Trace diameter of the measuring guide onto the flange, and cut on the outside of the pen marking.
10. Prepare skin and apply accessory products as required or according to agency policy.
11. Remove inner backing on flange and apply flange over stoma. Leave the border tape on. Apply
pressure. Hold in place for 1 minute to warm the flange to meld to patient’s body. Then remove outer
border backing and press gently to create seal. If rod is in situ, carefully move rod back and forth but do
not pull up on rod.
12. Apply the ostomy bag. Attach the clip to the bottom of the bag.
13. Hold palm of hand over ostomy pouch for 2 minutes to assist with appliance adhering to skin.
14. Clean up supplies, and place patient in a comfortable position. Remove garbage from patient’s room.
15. Perform hand hygiene.
16. Document procedure.