OSCE Checklist: Neonatal Resuscitation

Neonatal Resuscitation
STEP/TASK
Know the environment
1 Getting ready:
1. (Equipment check), Prepared and checked the necessary equipment (warm towels,
suction catheters. stethoscope, oxygen equipment and pulse oximeter, face masks,
resuscitation bag, continuous positive air pressure (CPAP), endotracheal tubes,
laryngoscope, umbilical venous catheter and drugs.
2. Wash hands with soap and water. Dried Them and wore disposable gloves.
2 Ask 3 Assessment Questions (Term? Breathing? Tone?)
Initial steps of resuscitation (30 Seconds) (warm, dry, stimulate, position airway, suction if
needed , Pulse oximeter):
1. After delivery, wrapped the baby in dry warm cloth.
2. Placed the baby on his / her back on a clean, warm surface and kept covered except
for the face and chest.
3. Dried the baby, removed the wet cloth and put another dry warm cloth.
4. If the baby is not breathing spontaneously, stimulated the baby by rubbing the palm
of the hand, slapping the soles or rubbing the back.
5. Positioned the head in a slightly extended position to open the airway.
6. If needed clear the airway by suctioning the mouth first and then the nose.
x Introduced catheter 5 cm into the baby's mouth and suction while
withdrawing catheter, Introduced catheter 3cm into each nostril and suction
while withdrawing catheter.
7. If the baby has labored breathing or cyanosed (monitored by pulsed oximeter).
administered free flow oxygen by face mask, cupping or continuous positive airway
pressure (CPAP).
8. Evaluated respiration, heart rate and color.
3 Resuscitation using bag and mask ventilation (30seconds) PPV:
1. If after previous steps, the baby is not breathing and heart rate less than 100 bpm.
started positive pressure ventilation using bag and mask.
2. Placed the mask on the baby’s face so that it covers the chin, mouth and nose to
form a seal.
3. Squeezed the bag with three fingers only.
4. Checked the seal by ventilating two or three times and observing the rise of the
chest:
a) If the baby's chest was rising
Ventilated at a rate of 40-60 breaths per minute.
b) If the baby's chest was not rising
Did the ventilation corrective steps (MR. SOPA) are: Mask adjustment,
Reposition the head and neck, Suction the mouth and nose, Open the mouth,
Pressure increase and Alternative airway (laryngeal mask or endotracheal
tube).
5. Ventilated for 30 seconds (observe for spontaneous breathing) and then assess the
baby's heart rate (umbilical/apical).
6. Identified need to start chest compressions (Heart rate< 60 bpm despite 30 seconds
of effective positive pressure ventilation).
4 Resuscitation using bag and mask ventilation and chest compression (45-60 seconds):
1. Assessed correct finger or thumb placement (lower third of the sternum), compress
one third of the anterior- posterior diameter of the chest.
2. Demonstrated correct rate and coordination with ventilation (three compression: one
ventilation).
5 Identified need for drugs
(Heart rate<60 bpm despite positive pressure ventilation and chest compressions:
1. Prepared correct dose of epinephrine (1/10000)
(0.2 ml/kg IV , 1 ml/kg ET).
2. Prepared umbilical venous catheter for insertion.
3. Inserted umbilical venous catheter.
4. Administered epinephrine via umbilical venous catheter and/or endotracheal tube
(optional).
5. Identified need for volume expanders administration, calculate the dose (10 ml/kg of
normal saline over 5-10 minutes).
6. Identified when to discontinue resuscitation efforts.
STEP/TASK
Routine care of well-being newborn
x dry the baby, place him on mother's abdomen for skin to skin contact.
x Clamp and cut the umbilical cord and apply ethyl alcohol 70%
x Administer vitamin K
x Wipe the baby's eyes, Apply Eye prophylaxis.
x Weigh and measure the baby
x Encourage breast feeding
 OSCE Checklist: Lumbar Puncture

Lumbar Puncture
STEP/TASK
1 Introduction:
x Wash your hands.
x Introduce yourself to the patient including your name and role.
x Confirm the patient’s name and date of birth.
x Explain what the procedure will involve using patient-friendly language.
x Gain consent to perform a lumbar puncture.
x Ask the patient if they have any pain before continuing with the clinical procedure.
2 Identify insertion site:
x With the patient standing, mark out L4 by joining a line between the highest points of
the iliac crests.
Palpate above for L3 and below for L5.
The insertion site can be marked out either between L3/4 or L4/5 depending on the
patient’s anatomical features
3 Patient position:
x Position the patient lying on their side in a fetal position: ask the patient to flex
forwards whilst bringing their knees up towards their chest
4 Prepare insertion site:
x Clean the insertion site and the surrounding area thoroughly
using chlorhexidine solution and allow to dry.
x Wash your hands and don sterile gloves
x Apply a sterile drape with an opening over the site of insertion
x Draw up the local anaesthetic and then replace the drawing needle with a new one
for the injection
x Inject local anaesthesia around the site and allow time for it to take effect (at least a
few minutes
5 Perform lumbar puncture:
x Press the lumbar puncture needle to the patient’s skin over the insertion site.Wash
your hands and don sterile gloves
x Advance the lumbar puncture needle through the insertion site slowly, tilted slightly
cranially. The bevel of the needle should face laterally as you insert it..
x As the needle passes (sudden reductions in resistance) will normally be felt and CSF
should begin to flow through the lumen of the lumbar puncture needle
6 Removal of needle:
x Slowly remove the lumbar puncture needle and compress the site with some sterile
gauze until you apply a dressing.
x Immediately dispose of the lumbar puncture needle into a sharps bin
 Intravenous (IV) Injection
OBJECTIVE: To administer an intravenous (IV) drug to an appropriately selected vein.
MATERIALS: IV drug, syringe, clean gloves, alcohol swab, sterile gauze, adhesive tape, tourniquet.
D: Appropriately done PD: Partially done ND: Not done/Incorrectly done
STEP/TASK D PD ND
Preparation
1. Introduce yourself to the patient.
2. Confirm patient’s ID.
3. Explain the procedure and reassure the patient.
4. Get patient’s consent.
5. Wash hands.
6. Prepare the necessary materials.
(Medication should be drawn up into the syringe beforehand and expiration dates checked.)
7. Check the doctor’s order with the drug to be administrated to ensure correct drug and
dosage
8. Put on a pair of clean gloves.
9. Position the patient in a lying or sitting position and uncover the arm completely.
The procedure
10. Apply tourniquet 10 cm above injection site.
(Make sure it is not too loose or too tight. When necessary, check if pulse is still present.)
11. Select the site and appropriate vein for injection.
12. Visualize and palpate the vein using the pads of the fingertips.
(If veins are not visible ask patient i) to close and open the hand ii) apply gentle taps
iii) apply warm/hot pad to selected site to help dilate the veins.)
13. Clean the site with an alcohol swab using an expanding circular motion or a single wiping
from distal to proximal. Do this 3 times with separate swabs. Let it air dry.
14. Take the syringe and open its cap.
15. Stabilize the vein and apply counter tension to the skin.
16. Insert the needle through the skin at an angle of 30-45 degrees and ensure the bevel is up.
17. Reduce the angle of the needle and advance approximately 3-5 mm further into the vein.
18. Aspirate and make sure venous blood appears in the syringe.
(If not, re-adjust position of the needle and aspirate again.)
19. Release the tourniquet.
20. Inject the drug very slowly. (Check for pain, swelling, hematoma. If present; withdraw the
needle and repeat the procedure at another site with a new needle.)
21. Withdraw the needle swiftly. Apply pressure with sterile gauze on the opening, secure it
with an adhesive tape and have patient maintain the pressure.
After the procedure
22. Dispose of sharps and waste material according to infection control standards.
23. Ensure that the patient is comfortable.
24. Remove the gloves and wash hands.
25. Document the procedure.
 Intravenous (IV) Cannulation
OBJECTIVE: To apply an intravenous (IV) cannulation to an appropriately selected vein
MATERIALS: IV solution or drug, IV set, IV catheter or cannula, clean gloves, alcohol swab,
transparent dressing or tape, tourniquet.
D: Appropriately done PD: Partially done ND: Not done/Incorrectly done
STEP/TASK D PD ND
Preparation
1. Introduce yourself to the patient.
2. Confirm patient’s ID.
3. Explain the procedure and reassure the patient.
4. Get patient’s consent.
5. Wash hands.
6. Prepare the necessary materials.
7. Check the doctor’s order and the reason for cannulation.
8. Put on a pair of clean gloves.
9. Position the patient in a lying or sitting position and uncover arm completely.
The procedure
10. Apply tourniquet 10 cm above injection site.
(Make sure it is not too loose or too tight. When necessary, check if pulse is still present.)
11. Select the site and appropriate vein for injection.
12. Visualize and palpate the vein using the pads of the fingertips.
(If veins are not visible ask patient i) to close and open the hand ii) apply gentle taps
iii) apply warm/hot pad to selected site to help dilate the veins.)
13. Clean the site with an alcohol swab using an expanding circular motion or a single wiping
from distal to proximal. Do it for 3 times with different swabs. Let it air dry.
14. Prepare and inspect the catheter.
Slightly pull the needle from the cannula, turn, and inspect for any defects.
15. Stabilize the vein and apply counter tension to the skin.
16. Insert the stylet through the skin at an angle of 30-45 degrees and make sure the bevel is up.
17. Observe for "flash back" of blood in the chamber of the stylet to confirm a successful entry.
18. Reduce the angle of the needle and advance approximately 1 cm further into the vein.
19. Slowly advance the catheter over the needle and into the vein while keeping tension on the
vein and skin.
20. Release the tourniquet and quickly remove the needle over the catheter while pressing at
least 0.5 cm above the insertion site to prevent backflow of blood.
Connect the intravenous tubing immediately and open the regulator.
After the procedure
21. Anchor the catheter firmly in place by the use of transparent dressing or tape.
DO NOT interrupt the flow rate.
22. Regulate the rate of flow according to the doctor’s order.
23. Ensure that the patient is comfortable.
24. Dispose of sharps and waste material according to infection control standards.
25. Remove the gloves and wash hands.
26. Document the procedure.
 Intramuscular (IM) Injection
OBJECTIVE: To administer an intramuscular (IM) drug to dorsogluteal region.
MATERIALS: Intramuscular drug, syringe, clean gloves, alcohol swab, sterile gauze, adhesive tape.
D: Appropriately done PD: Partially done ND: Not done/Incorrectly done
STEP/TASK D PD ND
Preparation
1. Introduce yourself to the patient.
2. Confirm patient’s ID.
3. Explain the procedure and reassure the patient.
4. Get patient’s consent.
5. Wash hands.
6. Prepare the necessary materials.
(Medication should be drawn up into the syringe beforehand and expiration dates checked).
7. Check the doctor’s order with the drug to be administrated to ensure correct drug and
dosage
8. Put on a pair of clean gloves.
9. Position the patient in a prone position and expose the gluteal (buttock) region.
(Maintain the patient’s privacy and dignity).
The procedure
10. Identify the injection site* (Select a site free of skin lesions, swelling, tenderness and one
that has not been used frequently).
11. Clean the site with an alcohol swab using an expanding circular motion or a single wiping
from distal to proximal. Do this 3 times with separate swabs. Let it air dry.
12. Take the syringe and open its cap.
13. Hold the syringe (from its barrel) like a pencil or dart with your dominant hand and place a
sterile gauze between 4th and 5th finger.
14. With your non-dominant hand, taut the gluteal muscle at the site of injection.
15. Insert the needle at a 90 degree angle to the patient’s skin in a quick, firm motion.
16. With your non-dominant hand, pull on the syringe's plunger to ensure that you have not
entered a blood vessel. (If you aspirate blood, withdraw the needle and repeat the
procedure at another site with a new needle.)
17. Inject the drug very slowly.
18. With your non-dominant hand, take the cotton wool and quickly remove the needle while
applying pressure with the sterile gauze, maintain gentle pressure for a minute.
19. Observe your patient at least 15 min. for any possible adverse effects of the injected drug.
After the procedure
20. Dispose of sharps and waste material according to infection control standards.
21. Ensure that the patient is comfortable.
22. Remove the gloves and wash hands.
23. Document the procedure.
Identifying Intramuscular (IM) injection sites*
Drug injection sites vary with the administration route. The instructions below describe proper
identification of injection sites for Intramuscular (IM) drugs.
You can administer an IM injection into the muscles shown below. In these illustrations, specific
injection sites are shaded.
Deltoid site Vastus lateralis and rectus femoris sites
x Locate the lower edge of the acromial process.
x Find the lateral quadriceps muscle for the
x Insert the needle 1" to 2" below the acromial
vastus lateralis, or the anterior thigh for the
process at a 90-degree angle.
rectus femoris.
Insert the needle at a 90-degree angle into the
middle third of the muscle, parallel to the skin
surface.

Dorsogluteal site Ventrogluteal site

x Draw an imaginary line from the posterior x With the palm of your hand, locate the greater
superior iliac spine to the greater trochanter. trochanter of the femur.
x Insert the needle at a 90-degree angle above x Spread your index and middle fingers
and outside the drawn line. posteriorly from the anterior superior iliac
spine to the furthest area possible. This is the
correct injection site.
Remove your fingers and insert the needle at a 90-
degree angle.

You can administer a Z-track injection through this

site. After drawing up the drug, change the
needle, displace the skin lateral to the injection
site, withdraw the needle, and then release the
skin.
* http://books.mcgraw-hill.com/medical/NursesDrugHandbook/safe_drug_admin/identifying_injection_sites/IdentifyingInjectionSites.php
 Subcutaneous (SC) Injection
OBJECTIVE: To administer a subcutaneous (SC) drug to upper arm region.
MATERIALS: Subcutaneous drug, syringe, needle (26-30 G, 13-16 mm), clean gloves, alcohol swab,
sterile gauze, adhesive tape.
D: Appropriately done PD: Partially done ND: Not done/Incorrectly done
STEP/TASK D PD ND
Preparation
1. Introduce yourself to the patient.
2. Confirm patient’s ID.
3. Explain the procedure and reassure the patient.
4. Get patient’s consent.
5. Wash hands.
6. Prepare the necessary materials.
(Medication should be drawn up into the syringe beforehand and expiration dates checked).
7. Check the doctor’s order with the drug to be administrated to ensure correct drug and dosage.
8. Put on a pair of clean gloves.
9. Position the patient in a sitting position and expose her/his upper arm.
(Maintain the patient’s privacy and dignity).
The procedure
10. Identify the injection site* (Select a site free of skin lesions, swelling, tenderness and one
that has not been used frequently).
11. Clean the site with an alcohol swab using an expanding circular motion or a single wiping
from distal to proximal. Do this 3 times with separate swabs. Let it air dry.
12. Take the syringe and open its cap.
13. Hold the syringe (from its barrel) like a pencil or dart with your dominant hand and place a
sterile gauze between 4th and 5th finger.
14. Grasp the skin between the thumb and index finger with your non-dominant hand and
pinch up*.
15. Insert the needle at a 45-90 degree angle to the patient’s skin in a quick, firm motion.
(for thin or muscular people insert the needle at a 45 degree angle to avoid injecting into muscle).
16. Release the skin that you are grasping.
With your non-dominant hand, pull on the syringe's plunger to ensure that you have not
entered a blood vessel. (If you aspirate blood,
withdraw the needle and repeat the procedure at another site with a new needle.)
17. Inject the drug very slowly.
18. With your non-dominant hand, take the cotton wool and quickly remove the needle while
applying pressure with the sterile gauze, maintain gentle pressure for a minute.
19. Observe your patient at least 15 min. for any possible adverse effects of the injected drug.
After the procedure
20. Dispose of sharps and waste material according to infection control standards.
21. Ensure that the patient is comfortable.
22. Remove the gloves and wash hands.
23. Document the procedure.
Identifying subcutaneous (SC) injection sites*
Drug injection sites vary with the administration route. The instructions below describe proper
identification of injection sites for subcutaneous (SC) drugs. Subcutaneous injections can be given in the
arms, legs, or abdomen -shown below. In these illustrations, specific injection sites are shaded.

Fig.1*: A subcutaneous injection into the fatty layer of tissue (pinched up to give the injection) under
the skin.

Arm
To locate injection sites on
the arms, fold one arm
across the chest. Place your
hand on the shoulder and
draw an imaginary line
below your hand. Place
another hand on the
elbow. Draw an imaginary
line down the outer side of
the arm and down the
center front of the arm,
starting at the elbow. The
area inside these imaginary
lines is where injections are
given.
(If you are injecting imagine
the hand placement.)
Fig.2*: Injection sites on the side and on the back of the arm
Thigh
To locate injection sites on the thighs, sit down, place
your hand above the knee, and draw an imaginary line
above it. Place your hand at the uppermost part of the
thigh and draw an imaginary line below your hand.
Draw an imaginary line down the outer side of the leg
and down the center front of the leg. The area within
these imaginary lines is where injections may be given.

Fig.3*: Injection sites on the front of the thigh.

Abdomen
To locate injection sites on the abdomen, place your
hands on the lower ribs and draw an imaginary line
them. Use this area below your hands for injections, as
far around as you can pinch up fatty tissue. use a 1inch
(2,5 cm) area around the navel.

Fig.4*: Injection sites on the abdomen.

* www.cc.nih.gov/ccc/patient_education/pepubs/subq.pdf
 OSCE Checklist: Using MDIs
(M
MDI: Metered dose inhaler)

MDIs
STEP/TASK
1 If the canister is cold, warm it in your hand.

2 Take the mouthpiece cover off and make sure there are not any loose parts inside the
mouthpiece.
3 Shake the MDI for 5 seconds.

4 Prime the MDI into the air according to the MDI instructions.

5 Sit up straight or stand up.

6 Breathe all the way out and hold the MDI so the mouthpiece is at the bottom and the canister
is sticking out of the top of the MDI.
7 Put the MDI mouthpiece between your lips.
Make sure that your tongue is flat under the mouthpiece and does not block the outlet of the
MDI.
8 Seal your lips around the mouthpiece.

9 Press down on the canister as you begin to slowly take in a breath.

10 Breathe all the way in, slow and deep.

11 Hold your breath for 10 seconds. If you cannot hold your breath for 10 seconds, then for as
Long as you can.
12 Wait 30–60 seconds if another puff of medicine is needed.

13 Repeat steps 2–11 until you have breathed-in all the puffs you are supposed to.

14 If taking an inhaled corticosteroid, rinse your mouth after the last puff of medicine and spit
the water out — do not swallow.
15 Put the mouthpiece cover back on.
 OSCE Checklist: Using Nebulizers

Nebulizers
STEP/TASK
1 Wash and dry your hands.

2 Gather the compressor (with tubing), jet nebulizer, and mouthpiece (or face mask).

3 Open the medication cup.

4 Twist the top off the medication container and empty all the contents into the medication
cup.
5 Close the medication cup.

6 Connect one end of the plastic tubing to the medication cup and the other end to the
compressor.
7 Plug the compressor’s power cord into an electrical outlet.

8 Turn on the compressor’s power button. Mist should appear.

9 Sit in an upright position and put the mouthpiece into your mouth and breathe normally.
Remember to also keep the medication cup in the upright position during use.
10 Occasionally take a deep breath and hold it for 5–10 seconds.

11 If the treatment must be interrupted, turn off the compressor to avoid medication waste.

12 Continue these steps until the jet nebulizer starts to sputter or rattle.

13 Turn off the nebulizer compressor and store properly.

 OSCE Checklist: Nasogastric Tube Insertion
Introduction
1 Introduce yourself to the patient including your name and role

2 Confirm the patient's name and date of birth

3 Briefly explain what the procedure will involve using patient-friendly language

4 Gain consent to proceed with nasogastric tube insertion

5 Check if the patient has any allergies

6 Ask the patient if they have any pain before continuing with the clinical procedure

7 Position the patient so that they are sitting comfortably

8 Wash your hands using alcohol gel. If your hands are visibly soiled, wash them with soap and
water.
9 Gather and prepare equipment

Measurement of the insertion length

10 Position the patient sitting upright with their head in a neutral position

11 Don a pair of non-sterile gloves

12 Estimate how far the NG tube will need to be inserted: measure from the bridge of the nose
to the ear lobe and then down to 5cm below the xiphisternum

Insertion of the NG tube

13 Lubricate the tip of the NG tube

14 If available, a local anaesthetic should be sprayed towards the back of the patient's throat

15 Warn the patient you are about to insert the NG tube

16 Insert the NG tube through one of the patient's nostrils

17 Gently advance the NG tube through the nasopharynx

18 Continue to advance the NG tube down the oesophagus

19 Once you reach the desired nasogastric tube insertion length, fix the NG tube to the nose
with a dressing

Aspiration of the NG tube

20 Attempt to aspirate gastric contents

21 Once the NG tube is deemed safe for use, the radiopaque guidewire can be removed

22 Dispose of the used clinical equipment into a clinical waste bin

23 Wash your hands

To complete the procedure…

24 Explain to the patient that the procedure is now complete and reassure them that the NG
tube will become more comfortable over the next few hours
25 Thank the patient for their time
26 Offer the patient paper towels to clean their face and nose

27 Let the nursing staff know if the NG tube is currently safe to use

28 Document the details of the procedure in the patient's notes