Ward procedures

Step-by-step guides to the procedures every house officer does: cannula, catheter, NG tube, ABG and more.

• Arterial blood gasFeel the radial pulse, go in at 45 degrees towards it, let the syringe fill by itself, press for 5 minutes, and run the sample within 15 minutes.
• Ascitic tap and paracentesisTap every cirrhotic admitted with ascites. Neutrophils over 250 means SBP. For large drains, give albumin 8 g per litre removed when more than 5 litres come off.
• Blood transfusionTransfuse for a reason, one unit at a time in stable patients, check identity at the bedside, and stop the moment a reaction starts.
• IV cannulationPick the right size for the job, find a straight vein you can feel, anchor it, go in shallow and advance the plastic, not the needle.
• Lumbar punctureCheck for reasons not to (raised pressure, clotting, infection at the site), position well, aim for the umbilicus at L3/4 or L4/5, and send the right bottles in the right order.
• Nasogastric tubeMeasure nose–ear–xiphisternum, pass it with the patient swallowing, and confirm the position with pH under 5.5 or an X-ray before anything goes down it.
• Pleural aspiration and chest drainUltrasound-guided, in the safe triangle, above the rib. Send protein, LDH, pH, glucose, cytology and culture. Don't drain more than 1.5 litres at once.
• Recording and reading an ECGGet the leads right first. Then read every ECG the same way: rate, rhythm, axis, intervals, ST and T waves, and compare with the old one.
• Urinary catheterisationAseptic technique, plenty of lidocaine gel, wait for urine before inflating the balloon, and always pull the foreskin back down.
• Venepuncture and blood culturesClean, let it dry, cultures first, then tubes in the right order. Label at the bedside. Two sets from two sites before antibiotics.
• Verifying and certifying deathObserve for 5 minutes, check pupils, response, heart sounds, breathing and pulse, record the time, then write the cause in a logical sequence.