Credentialing
All procedures must be supervised by an appropriately credentialed resident or attending
Core Floor Procedures Requiring Credentialing
- Arterial puncture (5)
- Nasogastric tube placement (5)
- Paracentesis (5)
After you finish, have supervisor review your performance and complete entry in your ABIM logbook.
- Turn your slips into Sappherin Miranda in the medicine office
Off-service rotators may not be credentialed for procedures on Medicine, and cannot perform procedures unsupervised.
Pre-procedure Verification / Time Out
Perform prior to every procedure
Notify the patient's nurse and perform a time-out before starting.
Verify with patient
- Name, DOB
- Procedure and Site
- Allergies
- Laterality R/L
Verify with proceduralist
- Consent completed
- Labs reviewed
- Imaging diagnostic reports show name, DOB, laterality
- Pregnancy test negative
- Implants, supplies present, and expiration dates checked
Nasogastric tube
Only non-styleted NG tubes may be used on Medicine floors
- Please see our full policy: NG Tube Policy
Diagnostic paracentesis
Consent patient (consent found in PatientWorks on Desktop). Major risks include:
- Bleeding, infection, perforation (use ultrasound to avoid)
Supplies (Kit available on 9C, talk to nurse manager, or assemble the following:
- Ultrasound with abdominal probe
- Chucks
- Sterile drapes (x3)
- Pink bucket to gather supplies
- 3-5 chlorapreps
- Sterile gloves (get extra)
- 4x4 gauze sponges
- 1% Lidocaine without epi
- 20G needle (medium) to draw up lido
- 25G needle (small) for injecting lido
- 5-12cc syringe for lidocaine
- 18-22G (med-large) needle for tap
- 30-60cc syringe for tap
- extra syringes for transferring fluid
- tegaderm
Laboratory tubes:
- 2 lavender top tubes for cell count & diff
- 2 yellow (urine) top tubes for gram stain/culture, LDH, protein, albumin
- Blood culture bottles (more sensitive for organisms)
- specimen bags to send tubes (tube to station 91)
Labs to Order (on ascitic fluid):
- Cell count & diff
- Gram stain & culture
- Albumin (make sure there is a serum albumin from that day)
- LDH
- Protein