Equipment and Procedures

Chest drain insertion

Procedure station

Video loop of real - time US scan showing arterial puncture and post - procedure CXR showing malposition of dialysis catheter .

These images were taken during the insertion of a dialysis catheter.

What may have happened here?

You have been asked to assist with the intubation of a patient with respiratory failure related to influenza infection.

What are the infection control measures that you and the nursing staff need to take for this patient in this situation?

A 76-year-old male presents following a fall down stairs. He is found to have multiple (>5) fractured ribs on the right side of his chest. Otherwise he has no other injuries.

A 65 year old woman is in your ICU post left pneumonectomy. She was admitted overnight for HDU care. You are called to see her  by the nurse looking after her as she has become haemodynamically unstable during her shift.

Equipment OSCE

Procedure: The procedure examined in this station was an intra-aortic balloon pump, focussing on identifying the position, timing, complications, balloon rupture and contra- indications.

Equipment station consisted of answering questions relating to a conventional and a reinforced percutaneous tracheostomy tube.

Equipment station 

Displayed pieces of equipment included Medical Air pressure regulator, Ayre's T-piece, PF 95 duck billed mask and a temperature probe.

Equipment station.
Candidates were expected to describe or discuss advantages or problems with devices presented.
Examples included a Head box, a Halo brace, a plasma exchange-filter and an oxygen cylinder.
Twelve out of twenty-seven candidates passed this station.

Monitoring.
Candidates were asked to identify 3 devices used for haemodynamic monitoring (Swan Ganz Catheter, PiCCo Machine, SCVO2 monitor) and list relevant obtained variables.

Twenty-four out of twenty-seven candidates passed this station.

Procedure station 2.

Equipment station.

Equipment.

Candidates were expected to describe or discuss advantages or problems with devices presented.  Examples included an under water seal drain, a Laerdal resuscitator with inside valve missing, and a Red cell leucodepletion filter.

Procedure station:   Candidates were expected to provide a systematic approach to the principles of insertion and management of a Minnesota tube.

Central line insertion

 Equipment. Examples included anaerobic and aerobic blood culture bottles, a tracheostomy tube with supraglottic suction port, 3 different personal protective respiratory devices, a jejunal (oro- or naso-) enteric feeding tube, and an angle tip tracheal suction catheter.

Equipment. Examples included a McCoy blade, a blood filter, a biphasic defibrillator and an intra-aortic balloon pump.
Sixteen out of twenty-three candidates passed this section

Procedure  station.   Candidates were expected to demonstrate a safe technique for radial artery cannulation.  Additional requested information included local anatomy and performance characteristics of the monitoring system.

Miscellaneous  Equipment.     Examples  included  a  self-inflating  paediatric resuscitation device, a calibrated drainage system with an underwater seal, a vacuum drain bottle, a fenestrated tracheostomy tube and a Passey-Muir valve.

Miscellaneous  Equipment  including  a   non-invasive  blood   pressure   cuff,   an intubating laryngeal mask, a Wright’s spirometer and an emergency cricothyrotomy kit.

Procedure  station.  Involving chest drainage for a tension pneumothorax

What is this device? What are the indications for its use?

The endotracheal tube.

Equipment
Griggs forceps, antibiotic impregnated CVC, codman ICP monitor, pulmonary artery catheter, high flow haemodialysis catheter.

Miscellaneous  Equipment  including   an   underwater   seal drainage   system,   pads  for pacing/defibrillation,  activated charcoal with sorbitol, and a heat & moisture exchanger. Roles, advantages and disadvantages were requested.

Miscellaneous Equipment 
Included questions on a tracheostomy kit, Evac tube and flask of Dextran 40.