CDC Medical Procedures Instructions PDF

Complete the content above before moving on. The Papanicolaou Test The Pap smear is a test used to detect early cancer of the cervix. To perform the Pap, the physician uses a spatula, swab, or brush to obtain cells from the cervical opening (os). The cells are then placed into a solution or gently s...

Complete the content above before moving on. The Papanicolaou Test The Pap smear is a test used to detect early cancer of the cervix. To perform the Pap, the physician uses a spatula, swab, or brush to obtain cells from the cervical opening (os). The cells are then placed into a solution or gently smeared on a glass slide, then sprayed with a fixative. Another smear is also taken of the floor of the vagina below the cervix and also placed on a glass slide and sprayed with fixative. The aerospace medical service journeyman ensures proper labeling of the specimen with the date, time, patient’s full name and date of birth, DoD ID, and the type of collection. The Exam It is important to follow your local procedures to ensure all information has been gathered so that the patient will not have to return pre-maturely for another exam due to a mistake. Click through the slides for a general overview of a pelvic examination. Step 1 Step 1 To start the procedure since you have already gathered supplies you first need to perform hand hygiene, verify correct identification of the patient and label the specimen container at the patient’s bedside. Step 2 Step 2 Identify whether patient is familiar with the procedure or not. If not, explain in plain language what is about to take place and what your role will be. If familiar, describe what your role for the procedure entails and answer any lingering questions or concerns. Step 3 Step 3 Set up the tray table and equipment based on the provider’s preference. Step 4 Step 4 Give the patient a gown and instruct to remove all clothing from below the waist if no breast exam is being performed. If a breast exam will be included, then instruct the patient to get fully undressed and wear the gown with the opening to the front. Next, provide a drape for covering and pull the privacy curtain and return when the patient is ready. Step 5 Step 5 Don gloves and assist the provider by passing equipment as necessary. Step 6 Step 6 Once the procedure is complete (and if a ThinPrep container was used), close the labeled container and place in a biohazard bag. If using a slide, prepare it by generously spraying with 95% ethyl alcohol or spraying with a cytology fixative in accordiance with (IAW) the directions on the manufacturers’ label. Fixative spray must be applied to the slide smear within 10 seconds post collection in order to maintain normal appearance of cells and to prevent exposure and/or contamination. Spray lightly from left to right and then right to left. Allow the slide to dry for at least 5 minutes before packaging to send to lab. Step 7 Step 7 Once the exam is over, ensure the patient has a paper towel or wipe to remove excess secretions and lubricant; as well as an absorbent pad to help with any residual spotting or bleeding. Assist the patient, if necessary, in removing their feet from the stirrups and getting off the exam table. Step 8 Step 8 Take the labeled specimen(s) to the lab or whatever unit policy and procedures dictate. Step 9 Step 9 Document and/or report any significant observations. C O NT I NU E Paracentesis Paracentesis is the withdrawal of excess fluid from the abdominal or peritoneal cavity. This procedure is performed by a physician to obtain fluid for diagnostic examination, to remove excess fluid, or to prepare the patient for other procedures (e.g., surgery or peritoneal dialysis). Your job will be to prepare the patient for the procedure and assist the physician throughout the procedure. Prior to the procedure, ensure a consent form has been signed, the patient has voided, and vital signs are taken. The patient will be placed in a Fowler’s position, but some physicians may prefer to have the patient sit on the side of the bed. The items needed for the procedure will include: paracentesis tray, anesthetic injectable medication (which may be included in the kit), and skin preparation solution. Most kits will have collection bottles or bags and specimen bottles. If not, ensure you provide these supplies prior to the start of the procedure. Here are the tools needed to complete Thoracentesis/Paracentesis. Equipment Needed to Perform A Paracentesis Sterile paracentesis tray and gloves Local anesthetic Drape or cotton blankets Collection bottle (vacuum bottle) Skin prep tray with antiseptic Speciman bottles, laboratory forms, and labels PR E - PR O C E DUR E PH A SE PE R F O R MA N C E PH A SE R E C O V E R Y PH A SE 1. Verify patient’s full name, date of birth (DOB), and provider’s orders. 2. Identify any patient allergies prior to the procedure. 3. Ensure collection bottle and tubing is available and ready with supplies for labeling. Be prepared to provide the labeled collection bottle and tubing upon request from the provider. 4. Explain the procedure, step-by-step, to the patient and ensure all questions are answered. 5. Ensure the witnessed and informed consent has been administered and signed. 6. Take and record patient’s vital signs. 7. Ensure the patient empties their bladder and/or bowels before the procedure starts. 8. Instruct the patient to get into the Fowler’s position with back, arms, and feet supported. 9. Drape the patient with the sheet, while leaving the appropriate area exposed (lateral lower abdominal quadrant). PR E - PR O C E DUR E PH A SE PE R F O R MA N C E PH A SE R E C O V E R Y PH A SE 1. Assist the provider in skin preparation, using an antiseptic solution. 2. Open the sterile tray and package of sterile items included while maintaining the sterile field. 3. Ensure collection bottle and tubing is available and ready with supplies for labeling. 4. Monitor the patient’s pulse and respiratory status throughout the procedure; observe for pallor, cyanosis, or syncope. 5. Be prepared to assist the provider at any moment while he or she is conducting the procedure. PR E - PR O C E DUR E PH A SE PE R F O R MA N C E PH A SE R E C O V E R Y PH A SE 1. Assist the patient to a comfortable position after the procedure. 2. Continue to monitor the patient’s vital signs every half hour for two hours, and then every four hours for 24 hrs. Frequency may vary with each physician. 3. Document the amount of fluid removed, along with the characteristics of the fluid. 4. Document number of specimens sent to lab and the patient’s condition during the procedure. 5. Observe the puncture site for leakage or scrotal edema (indicates a complication and must be reported immediately); acknowledging that there may be minor pain at the incision site. C O NT I NU E Thoracentesis is the surgical puncture or tapping of the chest wall to remove fluid or air from the pleural space. The physician may perform this procedure as part of the treatment for pneumothorax (i.e., air in the pleural space), hemothorax (i.e., blood in the pleural space), or emphysema (i.e., pus in the pleural space). It may be done to confirm the diagnosis of fluid in the pleural space, to obtain a culture of organisms present, or to relieve respiratory symptoms. The procedure is performed with a surgical aseptic technique. Equipment Needed to Perform A Thoracentesis Thoracentesis tray – if available 5, 20, 50-mL syringes Needles: 22 G, 26 G, or 16 G (3 inches long) Sterile gloves Sterile specimen container Sterile towels and drape Sterile guaze pads Local anesthetic Germicide solution Biopsy needle Hemostat Three-way stopcock or tubing PR E - PR O C E DUR E PH A SE PE R F O R MA N C E PH A SE R E C O V E R Y PH A SE It’s important to engage with the provider prior to the procedure to identify what he or she expects before, during, and after the procedure. This is a good time to determine ahead of time if the provider ordered chest x-rays or any other tests. If tests were ordered and completed in advance, ensure those are made available to the provider as necessary. 1. Verify patient’s full name, DOB, procedure, and label containers at bedside. 2. Ensure the witnessed and informed consent has been completed and signed. 3. Identify any patient allergies prior to the procedure. 4. Explain the procedure step-by-step to the patient. 5. Position the patient as directed by the provider and help the patient to maintain this position for the duration of the procedure. PR E - PR O C E DUR E PH A SE PE R F O R MA N C E PH A SE R E C O V E R Y PH A SE First, expose aspiration site. Affected side, midaxillary line if the procedure is being performed in the supine position Affected side, posterior midscapular line if being performed in the upright or seated position Perform hand hygiene and don PPE. Next, actively support and reassure the patient throughout the procedure. Finally, be prepared to assist the provider at any moment while he or she is conducting the procedure. PR E - PR O C E DUR E PH A SE PE R F O R MA N C E PH A SE R E C O V E R Y PH A SE 1. Ensure the patient remains on bed rest (a chest x-ray is commonly taken after a thoracentesis in order to confirm no evidence of pneumothorax). 2. Obtain and document vital signs every 15 minutes for 1 hour. 3. If directed by the provider, administer oxygen. 4. Document the total amount of fluid withdrawn – include type of fluid, color, viscosity. 5. If ordered, prep fluid samples for lab and send when appropriate. 6. Monitor the patient for any signs of increasing respirations, faintness, vertigo, tightness in the chest, uncontrollable cough, bloodtinged mucus, and rapid pulse or signs of hypoxemia. 7. Encourage the patient to take deep breaths. Thoracentesis Video Transcript.pdf 137.5 KB Multiple Choice What is the main difference between paracentesis and thoracentesis? Paracentesis is the withdrawal of excess fluid from the abdominal or peritoneal cavity whereas abdomencentesis is the surgical puncture or tapping of the chest wall to remove fluid or air from the pleural space. Thoracentesis is the withdrawal of excess fluid from the abdominal or peritoneal cavity whereas paracentesis is the surgical puncture or tapping of the chest wall to remove fluid or air from the pleural space. Paracentesis is the withdrawal of excess fluid from the abdominal or peritoneal cavity whereas thoracentesis is the surgical puncture or tapping of the chest wall to remove fluid or air from the pleural space. Hemothorax is the withdrawal of excess fluid from the abdominal or peritoneal cavity whereas thoracentesis is the surgical puncture or tapping of the chest wall to remove fluid or air from the pleural space. SUBMIT Complete the content above before moving on. Lumbar Puncture/Spinal Tap The lumbar puncture (LP) is the insertion of a needle into the subarachnoid space, usually between the third and fourth lumbar vertebrae, to aspirate cerebrospinal fluid (CSF). This procedure is also referred to as a spinal tap or spinal puncture. The spinal tap provides important information about intracranial pressure and the composition of the CSF. It is widely used in the diagnosis of bacterial and viral infections, such as spinal meningitis, along with the evaluation of seizure disorders. Keep in mind, the physician does this procedure. Your responsibility involves room and patient preparation and to assist the provider with collection and labeling of specimen tubes or as otherwise needed. Ensure each collection tube is sealed and labeled with correct information. A spinal tap is normally performed for analysis of CSF or to measure CSF pressure to aid in the evaluation of some underlying condition. If an aircrew or special operational member requires a LP for diagnosis, the flight surgeon will likely ground the individual from flying or operational duty for 24 hours or until a diagnosis is made. The equipment needed for this procedure are: Sterile lumbar puncture set Skin antiseptic (avoid the use of chlorhexidine) Sterile gloves Adhesive bandage Xylocaine 1% to 2% PR O C E DUR A L PH A SE R E C O V E R Y PH A SE 1. Ensure patient empties bladder and/or bowels prior to the procedure. Explain the procedure to the patient step-by-step. 2. Position the patient on their side with a small pillow both under their head and between the legs. Patient needs to be lying on a firm surface. 3. You or the provider should instruct the patient to arch the lumbar segment of their back and draw their knees up to their abdomen, chin to chest, clasping both knees with their hands. 4. You will assist the patient in keeping this position for the duration of the procedure by supporting behind the knees, upper back, and neck areas. 5. If the provider decides on a sitting position, you will instruct the patient to straddle a straight back chair, rest head against the arms, which should be folded on the back of the chair. PR O C E DUR A L PH A SE R E C O V E R Y PH A SE 1. Once the procedure is over, instruct the patient to remain flat for approximately two hours. 2. Ensure the patient is adequately hydrated, either with oral or parenteral fluids (this assists in replacing the patient’s CSF and prevents a spinal headache). Skills Lumbar Puncture Assisting Video Transcript.pdf 134.5 KB True or False: The spinal tap provides important information about intracranial pressure and the composition of the CSF. It is widely used in the diagnosis of bacterial and viral infections, such as spinal meningitis, along with the evaluation of seizure disorders. True False SUBMIT