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Anyone want a message just so I know and then we can get started even a thumbs up in the chat. OK? I think I'll start now. People should probably just trickle in as we go on. I would like this to be slightly interactive. So please, oh, someone put a message in the chat. Oh, thank you, Rosanna. Great. Um I'm gonna try uh share my screen now. I want to be able to look at the chat. So just unmute if you can't see the slides. OK? OK. I'm hoping you can see this so I can't see the chat. So please unmute um to answer my questions. OK. So hi everyone. My name's Kumo. I'm 1/5 year medic. Today we are gonna be talking through how to do venipuncture and cannulation. So you're gonna start with the boring bits, which is just the learning objective. So it's effectively communicate with patients throughout the venipuncture and cannulation process to develop efficiency and procedure, accuracy and technique, ensure patient safety and adherence to guidelines and reflect on personal performance and identify areas for improvement. Other boring bit is just the key skills covered, which is communication and professionalism prior to your knowledge and procedure, accuracy, ability to work under pressure, and then most importantly, safety and responsibility. Now I think to get the most out of this hour, it's best to give a general overview of the OS, how to practice the clinical skills and then focus on each procedure. Um step by step, then covering the communication before, during and after the procedure as we go along, if you do have any questions, like I say, I can't actually see the chat. So please just unmute yourself. Um I really want this to be engaging. I have a few questions um, throughout the presentation. So please answer. I don't care if you get it wrong or right. It's just for your learning. Ok. So lots of people will give you lots of different advice and like everyone says, you gotta find something that works for you. So someone got a high mark and they did it one way and that's not working for you don't just keep doing it because they got the high mark, change it and find what works for you. So I'll just give you three of my, um, top tips. So, firstly, if you haven't started already, I'd recommend once a week for a few hours practicing your oy. Then I think next term you could do it twice a week. And then, um, after Easter, I'd probably do like one examination a day. I remember me and my flatmates. Um, what we would do is we do an examination, a history and a skill each day after um after Easter. So just make sure you keep up with it regularly. Also make you sign up to a ta tutor scheme. Um As old years are the best to help me with AYS as they all pass them. Also recommend getting a group together for your ay, I got, I was in a group of three which I think is the most efficient number. Someone can be the examiner, someone can be the candidate and then someone could be the patient once again little and often is the best. As once you know how to do a station, it's just about making sure you don't forget it and then you just get more thicker and just better at it. The next thing is to write down your communication parts, of course, you don't want to sound like a robot, but writing a script really makes sure that you're confident with your communication and to make sure you include all that you need to say yes. At first, like I said, it will become robotic, but it will become more natural and it will look really good. I think presenting is definitely one of the hardest um things you need to do as you need to try and be concise, but also cover enough detail. So it's definitely important to have a general script for that and then you can adapt to it on your findings. And the last tip is to practice on patients and nonmedical students. Patients are great as they are people that you don't know which means you'll feel some sort of pressure and nervousness that will be similar to the exams. And of course, in the exam, your um patient will be I think a real patient or an actor. I'm not really sure which one but similar to a patient. If it's, if it's an actor and practicing with nonmedical students is great. As if you ask a medical student, for example, um can you form your fingers together like this? They'll know what you mean and they know you're asking for clubbing, whereas if you ask a nonmedical student, they'll have no idea. So you really got to practice explaining what you're doing. So for example, I would say to a non er patient um to explain how to do ca um not telling you how to do clubbing is stick your fingers up, bend them down and then push them together. I'm not sure if you can see me. I hope you can, but if you can fingers up, bend them and then push them together, that's just one way to explain things. Just practice explaining. Um And that will come with nonmedical students. If you don't have any nonmedical student, friends to practice with, with a medical students, just make sure that you change your age and your presentation. And this once again replicate your scheme. OK. Now how to practice the clinical skills specifically? Of course, you wanna practice the actual skill, make sure you can do that. So just in your clinical skill sessions and placement on patients, I know societies do things like the o arts Day, you've got the slimes do um a different skill each week, which is really great and then also mocks then also if you, if you can't always practice on the models, just speaking through, um, the station is the best way to do things. So what I would do is I would settle at the timer. So the 10 minute timer and then I would just speak through it pretending I had a patient there speaking for the patient and then just running through the station with my imagination. I think that's the most effective thing as a skill is such a small amount of the station. So if you can do all the talking around it and you get all the marks for that, you're in a good place. I just want to make a disclaimer. Um that every time in medical school, you will get lots of different advice. And what I'm gonna tell you today, someone else might tell you something a little bit different. But the most important thing is to ensure that you're a safe and you're a caring doctor. As long as you can confidently explain why you're doing something a certain way that's different from your peers. You'll be OK. Also, I think it's really important when you go into your third year is a step away from memorizing, just for the sake of memorizing. Making sure you understand why you're asking a question or why you're doing something will really help you in the long run. Now, what I'm gonna be teaching you today is how to aim for the top marks. Um Some of the things may seem a bit extra but I know this is what the examiners and the patients like if you wanna pass and just focus on the safety and know how to carry a procedure. But if you want the opportunity to score highly and this is what you should do. OK. Now, first question, what place on the body do they recommend you take bloods or cannulas from? Does anyone wanna unmute that specific area? Let me know also share bank. If someone, if someone does message in the chat, can you let me know anyone? Yeah, I'm just having a look at chat. Nothing at the moment. Yeah, that's fine. I'll just tell you. So it's the anterior cubital fossa. Um It's the best for taking bloods in count 11 person said bloods from antecubital fossa. Can you try home? Yep. Great. That's good. Yeah. So like I say, it's the anterior cubital fossa. Um It's great because it's low risk as it's not near any important structures. And also you've got a, a few veins to select from, they're large. I want you to be aware though that, um, there are variations to this. So don't go in thinking all the arms look the same and that's why it's really important to know which veins to pick. Um, so best veins to pick, they should be large bouncy straight and superficial. Um, this is just to ensure you'll get the, you're most likely to get the bloods. And regardless if you can see the vein or not, it's really important to palpate it, especially on darker skin tones, you won't be able to see it. So just really get into the habit of feeling from the vein, not just looking at it. I also want you to be aware that if patients elderly or they're chronically ill, um they often have rolling veins. So this makes it a little difficult um to take blood from. Um I don't know if you can see me, but you just gotta make sure you like anchor. So you've gotta pull down on your my arm like this just to anchor the vein, it'll keep it in place and it will stop it from rolling. Also, if you have an elder patient with excess skin, also making sure you're holding it back as well and pulling it down will help you get the bloods if you can't access. This is another question. If you can't access the anterior interior cubital fossa, what are other two locations you can try? I'll give you a bit longer cos some did answer Haman's Vein. Houseman's Vein. I actually don't know where Houseman's Vein is just a general location. I mean, it could be where I'm thinking of but you don't know what the vein that is. I can, you lose non doom hand. I don't know. Yes. Your hand. Yeah. Great hand is the next thing. So the dorsum of the hand and then if not the hand, then they also go for the feet. Well done. Ok. So now I'm gonna move on to venipuncture specifically. So we're gonna focus on the equipment. So I hope you can see my cursor. Yeah, hope you can see it. So I'm just gonna talk through the equipment in the tray. So, first of all, here's the pink band which is a, a tourniquet to the patient. I call it a band to try to avoid any medical jargon. And this is what you use to tie around the arm to make it more visible. Then you've got the um, needle here, which is a 23 g one and it's a blue one, this one or the green one, which is the 21 g one. are the most common ones you use for taking bloods. The smaller the g, the um, larger the needle. Ok. Right off the needle is the gauze and you'll use this and the medical tape. Um, once you remove the needle to stop the bleeding, then you got the alcohol wipe to clean in the site before you insert the needle. Then you've got this barrel here, which is also called a vacuum and you'll attach this to this, um, gray bit here. It's also important to know that this gray part here is actually a needle. So do not touch it as it is a safety hazard. Ok. So, make sure you touch this to that without touching, um, this great needle. And then what you'll do is you'll put the blood tubes into the barrel here and it will pierce the vacuum and then you'll get blood flow and then these are just your non sterile gloves. Now, outside of this tray here is, this is the specimen bag. Now, it's not important in your oy, but I think it's important to know how to take bloods outside of the osk setting. Um, there's a plastic bag that you'll put the blood bottles in when they're labeled and then very, very important. This is, um, this is your sharps bin, ok? And you gotta make sure this is nearby you as if you have your needle and you're just wandering around like this, it's a safety hazard, ok? And it's dangerous. So make sure you have the, um, sharps bin right next to you. So you can dispose it quickly. Ok. Now, moving on to the blood bottles. So I'm not gonna spend too much time on this as you can just look at the slides later and learn about this. But you need to know what type of, um, blood test is for each color bottle. Now, the most common ones is the blue one here, which is the clotting and you've got the yellow, which has got a lot of different uses. So you've got yours, um, LFT ST FT S and then you've got the purple, which is the full, um, blood count. Average each of the bottles, you've gotta invert them a different amount of times which was shown in the last column. Just to make it easier. You could, you could just invert them all um 8 to 10 times instead. So you don't have to memorize this, but it's important to invert them. So you mix the anticoagulants with preservatives. So then it stops it um from preventing it from clotting. It's also with this blue one. So with all of them, except for the blue one, you can fill them up around halfway. But with the blue, you've gotta make sure you fill up to basically, um all the way and you'll see like a faint line on it. That's why this, this order is really important as say that patients really dehydrated. If you did the blue bottle last, you wouldn't be able to get a result from that because it could be half full. So this is also the order. So you gotta know the color of the bottle, the order and then how many times you invert it. I think it might ask you the examiner asked me, um, can you take a full blood count? They didn't tell me what color bottle you use. So that's why it's really important to know what test is for each bottle. Ok? If this video doesn't work, I'm gonna have to go on to youtube, but this is just the gi gi medics video. I thought it, it's a bit pointless. Me just speaking through it. So I thought if I show you the video and then speak with the video, it's a lot more easier to understand and then I'll give you a summary page afterwards to go through what I've spoken about. I wanna make it clear that some of the things that they're doing, um I'm gonna tell you slightly differently, but I'll make that clear. So let's see if this video works just, ok, let me know if you can't hear anything. It looks good to me. Hold off for your mind. Ok? I hope everyone can hear this unmute if you can't. So I'm just gonna continue. Ok? So I'm gonna skip the introduction and I'll talk about that later. So what you're gonna do is is you're gonna grab your blue tray and you're gonna wipe it from the inside outwards. The reason why you do it this way is if you had, if you started cleaning from the outside and there was some dirt on it that wipe would have some dirt on it already and then you'd be contaminating the inner bit, which is the most important part to be sterile. Ok. So make sure you wipe from inside to outside like they've done there and you're gonna collect your equipment. Now, as you would collect your equipment, it's really important to check the expiry dates. So, what I would do is as you put the equipment into the tray, just make it really extra and just um I don't know if you've seen me but make a really extra and just look at the expiry dates. And then once you've looked at all the expiry dates, just say out loud, everything's in date. So then you and the examiner know as I know my mock osk, all the equipment was out of date, whereas in my actual osk was all in date. So you just don't wanna get caught out I can. So just putting everything into the tray, then you can wash your hands. Now I wash my hands a lot of times. It's kind of like your driving test where you look at your mirrors, loads of times rather do more than this. Ok? Wash your hands when you walk into the room, wash your hand after you've got the equipment, just keep washing your hands. Yeah. So then you're gonna put your tourniquet on and you're gonna warn the patient that it might be a bit tight. So you'll say I'm gonna put the band on let me know it's gonna be tight but let me know if it's too tight. Ok? And then you're gonna feel for the day and like I said before, it needs to be bounced and straight. Yeah. Now one thing with the imperial osk is that they want you to take the tourniquet off, you can't leave it on for the whole time in hospital. You'll see they leave it on the whole time for the Imperial osk. You have to take it off. So what I recommend you do is once you've found the vein and you've cleaned the site, then take the tourniquet off. Ok? And then you put your gloves on, get your needle ready and then put the band back on. Ok? That's just a really important thing for the Imperial scheme as you can see here. Um, they're cleaning the site. So I'd say I make sure you clean it for 30 seconds and then you let it dry for 30 seconds. A lot of the time they ask you to have time to do everything to the full length. So you just gotta say, ideally, so, examine it ideally, I clean for 30 seconds and I let it drive for 30 seconds and you don't have to worry. Ok. So now they're gonna hold the needle and you can see they're holding it by the wings, the green wings there and then they're gonna anchor the vein by holding down. Ok? And then you're gonna go in at um a 30 degree angle and make sure the devil's facing upwards. I'll show you that later. Also, at this point, I recommend signposting to the patient. Um I'm going to insert the needle. Now, if you want to look away, you might feel a sharp scratch, da sharp scratch. You can see it's going in and then you'll observe some flashback here and that means it's in the right place. Ok? That's great. Then you're gonna grab your blood bottles and then you're gonna put it into the vaccine and then we don't have to fill up all the way. And that's just the blue bottle. Definitely doing that, doing the FBC in the right order as you can see. And then the next important thing is to take the tourniquet off before you take the needle out. Now, this is really important because if you take the needle out before you take the tourniquet off, the arm still has a high pressure. So the blood will just squirt out or lots of blood will just form on the skin. I've seen this happen in placement before one of my placement partners and it was just like it was really fast blood. It was actually like, oh my God, my God. Um Just always make sure you take the tourniquet off first and it prevents scaring you and the patient, which you'll see they do now and then you're gonna take the needle out, cover it with the gauze and then you gotta safety lock the needle. They don't show this in this video, but I'll talk about it later and they get the patient to hold down the gauze and then dispose the needle in the shower bin. Now, it's important before you tape down the gauze to check that the patient's not bleeding excessively. Ok. So they'll do this. Now they'll check no, no excessive bleeding and then they'll taper down and then you just take your gloves off. Ok? I'll talk about the communication at the end afterwards. But let me know if there's any questions about that at all. Um If not, I'll just continue. Mm. Been. Ok? Ok. Now, these are the really important steps, ok? These are kind of like the ones that could potentially fail you. So if you don't care about the top, top nitty gritty stuff, this is what you really need to remember. Ok. Firstly, like I said the tourniquet, make sure you're taking it off at least once. Ok. So like I said, find the vein, clean, torn it off, put your gloves on, wash your hands, wash your hands, gloves on, get your needle ready and put it back on. Ok? The next, this is the bevel, this is what I was talking about. So you're gonna make sure that you're inserting the needle with the bevel um to the flat side against the skin. If you do the other way, it can cause more pain and trauma to the skin. So I always recommend you do it this way. Next is a flashback. If you don't get a flashback, don't attach the blood bottles. That means you're not in the right place. OK? I don't want you to panic. If you don't get a flashback. As, as you can see in this photo too, sometimes you can put your needle in too far and it can nick the side of the vein wall. So all you have to do is pull it out slightly and then you enter the vein lumen and lower the hand will get a flashback. Another thing could be maybe the, the veins not exactly straight. So you need to just wiggle your needle side to side and that might help as well. Now, if none of those work, don't worry, take the needle out, put it in the sharp spin and just start again and grab your equipment. And what I'd recommend is like if you haven't got flashback once, definitely redo the whole thing again. Get your equipment, say to examine it, I'm gonna try again if you've done it twice and it still doesn't work due to the time you don't wanna miss out on the other marks. I would just say to the examiner, examiner unable to get a flashback. Ideally, I'd get another healthcare professional involved. But for the sake of timings, is it ok if I continue and then you can just collect your blood samples, pretend to collect your blood samples and just carry on. So don't worry if you don't get the flashback again. Now, this is the um safety locking I was talking about. So you gotta make sure when you put the um needle in the sharp spin that it's safety locked. So you just gotta pull down this tube here and then pull this part up and it will safely knock. You'll hear a little click, lightheartedness. And then once again, the most important thing is sharp spin, make sure it's nearby. You might even try to put it in the corner and hide it a bit as part of your equipment. You've gotta make sure you've got it next to you. OK? Now, this is just step by step. Um summary slide on how to do um venipuncture. So when I write signpost is just what I was talking about before is just warning the patient that I might be tight or when I'm cleaning, it might be a bit cold or I'm going to insert the needle now. So you might look away just stuff like that. OK. I'm gonna move on to cannulation. Does anyone have any questions about venipuncture? We just wait and then if not, we can continue. I OK, I'm gonna move on you to ask questions at the end as well. OK. So I'm gonna follow the same structure I did for can um for puncture. So I want to talk about the equipment first. So like venipuncture with cannulation, you've got the tourniquet band, you've got a pair of non sterile gloves, you've got the alcohol swab to wipe the site and then you've got the sterile gauze. But this time it's not used at the end, it's used once you remove the introducer needle and you'll see that later on. New equipment. Here is the Cannula. This is the blue one, the 22 g one. You can also use a pink one. And then you've got this extension set here which you add to the end of the Cannula and you've gotta make sure you flush this with Saline before you even touch the patient. Ok? And what I recommend is actually keeping this in the packet it comes with and then just touching the syringes to the ends without touching it as it just remains sterile. If you do take out the packet, I would recommend putting a second pair of gloves on. Ok. So bring another pair of gloves with you and then change that um, before you put the Cannula in. Ok. Now, I think in the sy you should have a prefilled saline syringe, but you can never say never. They might make you draw up your own um Saline. So you just get your blood needle, attach it to the syringe and then draw it up and this is one of your clinical skills anyway. So you should know how to do this, but don't be shocked if they expect you to draw it up. Ok. And then the last thing you have is your cannula dressing unless we quite fidgety. So I definitely recommend practicing this. And then you've got, um, of course, your sharp spin once again, really important, make sure this is nearby. The, and then these are the different types of cannulas for different purposes. The smaller ones, yellow and purple. They're for pediatrics and these are the pink and blue that I was talking about, which are the most common. And then you've got the larger ones which are for more trauma and if you need any rapid fluid replacement. Ok? And you just see the recommended uses for these here. I don't think I'll have all of these to select from. I think I'll just have one or the other of these two. So don't worry. So now I'm gonna show another video. Let's hope this works. Just move for your mind. Once again, let me know if you can't hear me. I'm assuming you can. I mean if you can't hear the video. So once again, we're gonna skip the introduction and we're gonna gather our equipment, wiping the tray from like I said inside out and then you're gonna collect your equipment. So that's the prefilled Saline there. That's the Cannula the blue one and that's your extension set and you got your gloves. We doubt you need that draping. Ok? And then you're gonna prepare your flush. So you're gonna twist it onto the extension set. So he's got gloves on because he hasn't kept it in the sterile bag. So you can either do it this way or you can just keep it in the sterile bag. Saves you from getting, um, other equipment and then you're gonna push it through and it would drip out the other end and that means it's been flushed. You're good to go like before you're gonna try to find your vein. So you're gonna, your arms for me, James, you're gonna put the tourniquet on and then, um, you're gonna find the vein. Remember? Signposts tell the patient it's gonna be tight. Think they're using the hand this time, they're gonna clean the site. I do like cleaning for 30 seconds or let it dry for 30 seconds. Remember with the Imperial Oy, take the tourniquet off at this point, get your gloves ready, get your cannula prepped and then put the tourniquet on again. So he say he's putting his gloves on, getting the cannula ready, just getting ready to hold it also, just moving the introduced needle a little bit. So it's not stiff and then they're ready to go. So ma to goes back on. Now they once again, sign posts, warn the patient and then you get ready. You look at the, um, the hand placement, you can see this hand here is anchoring, the thumb is covering the cannula end and then you can see that the cannulas in between the four finger and the index finger. Ok? And then with the can you scratch, you wanna go at a slightly lower angle. So I recommend going in at 10 degrees. Ok? You can see it needle goes in and you're looking for the flashback, which you can see that you can see that there's also a thing called a second flashback. So once you've got the first one, if you pull out the introducer needle slightly, which you'll see they'll do in a minute, you'll see the second flashback here. You'll see this follow up of blood and that just means, yep, I'm 100% in the right place. Sometimes you see this straight away and they're like, yeah, I'm good to go. And what you've gotta do is you've got to push now the cannula into the vein. Ok? Once you've done that, remember, take the tourniquet off before you remove the needle. And this is what the gauze is used for. Now, sometimes when you take this needle out, a lot of blood can drip out. So this is just a friend of getting on the patient and one way to help stop the blood flowing um out quickly is to just hold, put your thumb just above the cannula. Can you see they're removing the needle now, putting it in the shops spin, then you're gonna attach your extension set now. And this is also what will stop the blood if you touch the extension site, um, the blood won't be pulling out. Ok. And you're gonna take down. So I keep pausing it, take down the two wings to stabilize it and then you're gonna flush the cannula. Now, do let me know if there's any pain. Yeah. So when you flush the cannula, you just twist the end, make sure this is unhooked because I, there's a lot of things to remember. So somebody's like, why is it not working? Why is it not working? You are actually in the vein? You've just got to unhook this. Ok. So make sure um, it's open and once again, signposts say to the patient, I'm going to be putting some Saline um through the cannula to make sure it's in the right place. Let me know if it's painful. Another thing to look for also is, um, if there's bubbling around the cannula site. Ok. And you'll know that it's in the right place if you don't feel resistance when you put the saline in, so Saline should go in quite smoothly. OK? If there is some resistance, it's most likely you're not in the right place. Also tell the patient though it's gonna be cold, they're not shocked. OK? And you're just gonna put the rest of the dressing on and then you're gonna label it with the date of in session. Ok? And then you take your gloves off. Mm OK. And the important. Do not forget for cannulation. Main different one is the flushing. Make sure you're flushing twice at the start for the extension set. And then at the end to make sure the cannula is in place once again to k make sure you take it off, make sure the Bevil is facing upright. I think we can, you know, it's a lot more obvious, make sure you got a flashback, the two flashbacks. And then once again, if you don't, maybe you need to withdraw a little bit fiddle around. Sometimes I give up a bit too early and then I see one of the um phlebotomists taking their time and then they finally get it. So just be patient. OK? And then once again, make sure you locate that sharp, sharp spin and put it near you again. And once again, this is a summary of cannulation just for your vision and kind of you can use it as a mark scheme before I move on to communication. Does anyone have any questions about cannulation? Any worries, any concerns? I'll just give a little bit of a pause again. Once again, you can ask at the end. So moving on to communication. So communication is a big part of the marks for all the Os stations. And of course, when you work in a hospital, it's essential. So communication is really important to explain the procedure. So you can gain consent and ensure that the patient is comfortable and understands what is going on. So there's no shocks there. I know in the paces. Um the patient has their own mark scheme and they'll be um kind of examining you as well, giving that feedback. This isn't the case for the OS you, but they can definitely influence the marking. So this is when going to boards practicing, speaking to patients really helps and you can really tell who's been on placement, speaking to patients and who's just been missing placements. So please make sure you are going at least a bit and practice speaking to patients. Now for the clinical skill stations, there's three parts for communication you got before during and after the procedure, the structure that I run through can be adapted for each of the clinical skill stations. I recommend writing our checklist, what you need to do before and after and then just change it for each but for the other lectures use this structure and then just adapt it with them. So once again, I'll go into um in depth communication for being puncture cannulation, but you can adapt the spiel for all of them. Ok? And I recommend you do no, before the procedure. As soon as you walk through that door. First thing you're gonna do is wash your hands. OK? First thing you gotta do, I'd even recommend making like a loud rubbing noise when you're washing your hands, cos the examiner will be tired. So they might not remember alerts them and it also reminds yourself. So you don't come out of the exam, panicking like, oh my God, I didn't wash my hands at one of the stations. You'll know you did cos you make that sound. So now you've entered the room, it's time for introductions. So you're gonna introduce yourself to the examiner. Give your C ID when you get the, get, when you get the OK, you're gonna introduce yourself to the patient. Now you've all done your CPA. So I'm sure you know how to introduce, introduce yourself, just see your name and your role. So for example, good evening, my name is Kumar. I'm 1/5 year medical student. Then you're gonna find out the patient information, ok? So you're gonna find out their name. You wanna be polite and get those extra sweet marks, how they like to be dressed date of birth and also age. I was really nervous in my ask you. So I there was no way I was gonna work out the date of birth, the age from my date of birth. So I just also asked and how old does that make you? And also if you're in hospital or not the GP setting, you need to check the hospital band and make it really extra, make sure you're really looking at it. Ok? Like I said, the driving test, really look at um the band. I do. People could swap bands, you could get confused it's just to protect yourself. OK. Once you're done with the introductions, you're gonna build a pore. So you wanna avoid any medical jargon and use neutral words. So for example, you'd be like, have you taken, have you had your bloods taken before they might say no. Would you like me to explain it? Yep. So this will involve me inserting a small needle into one of your veins in your arm to collect a blood sample. How does that sound? No, but yeah. OK, good. Um Oh, sorry, I just ran the wrong one that was explaining the procedure and the consent. So like I just said, and there's a, a small needle into your arm to collect a blood sample and then you'll be like, are you OK with that? And then you've got your, you explain your procedure and you've got your consent going back to the building report. You just got um kind of form a relationship with the patient. So you're just like, OK, so um what's brought you in today? They could be like, oh, you know, I'm really tired. I've just been feeling so tired every day and then you could go oh thank you for sharing that. Um Sorry, I'm I'm blanking. Thank you for sharing that. Um I really hope we can find out what happens, what's happening to you. That must be really hard. Then you've got that tick, you build the report with the patient. They feel they've been seen um and you get their sweet marks. Ok. You can also even ask how you're feeling today as well. Now you've done those three things, introduction, you will report, you've explained procedure and consent. You're gonna go into the five questions that you need to ask. Vaseline. First thing you need to ask, um is about allergies. Now, does anyone know what allergy? You need to definitely check there's a few questions in this bit. So please answer what allergy is really important. Could you repeat that? I think you cut out. So, just repeat that question. Yeah. Um, what allergy do you need to check on or what's the most important allergy to check about latex? Yeah, latex. Exactly. If they have a latex allergy, just use the latex free gloves. Ok, great. Then you're next, you're gonna ask about medications. Now, the two medications you're gonna ask about are anticoagulants and blood thinners. Another question for you. Why do you need to ask about these two medications? Two different reasons? If you only know one of them, that's fine. Ok. So with anticoagulants, if a patient is on anticoagulants, they're more likely to bleed, um, more likely to bruise. So this is just to warn them that after the venipuncture, if they do bruise, don't worry, this is normal for them. Ok. So just reassuring the patient then with blood thinners, like in the name, it will thin the blood. So patients will likely to bleed. So you just gotta warn them that they might bleed more than normal people or not normal people. Just, um, they're normal and don't worry about this. This is what happens when you're on blood thinners. Um, so they'll try to apply a bit more pressure for longer. Ok. Next is surgery? So you're gonna ask if you had any surgeries to the arm or in general? Another question, what's one really important thing you need to check if the patient has or not to do a surgery? Hope you can still hear me. Um, anyone know, I wanna guess here. So it's a fistula. Um, and this is what it looks like here. So it's helped with, um, a dialysis so they can only really do it here in the anterior cubital fossa. So if you see this, you've gotta to avoid it. Ok? Go to the arm, go to the, go to the hand, go to the foot. Ok? As a very delicate system, you don't wanna disrupt it. If they have it on one arm, I'd still avoid you on the other arm. It's just in case they need to change this one over to the other one. Ok? To make sure you ask by a fistula specifically. Next is about, um, being comfortable. So I thought a good way to remember it is, um, the four ps. So check if they're in pain. Are you in any pain? They might say yes. So, um, I'll ask one of the nurses to give you some painkillers preference. Which arm they like it on pus. How are you with needles? If they are, if they have a phobia of needles, ask them what happens when you get your blood taken. So you're prepared, then also reassure them, say I'm gonna try and take your bloods as quickly and as pain free as possible. But please stop me at any point if you're uncomfortable and that's kind of similar to the power. So giving the patient a little bit of power. So just say, yep, if you have any questions, please stop me and if you feel uncomfortable, let me know, ok, just give them a bit of power so they can trust you a bit more and they're not as stressed, ok? And then the last one, now it's not really to do with before the procedure, but I put it in here. So you don't forget it. It's the expiry date. Like I said before, it's really important to check this as you don't know in the oy, which if they're gonna give you new equipment and they're gonna give you old equipment. And also in day to day, if you are taking blood from a patient, you don't wanna be using old equipment, ok? That's just dangerous. Once again, it protects yourself. So like I said, be really extra and look, look at the expiry dates and say, examine everything's in date, ok? Now, the only difference between this structure of cannulation and venipuncture is just explaining the procedure. So with cannulation, you could check if they've had a blood, if they've had um their bloods taken before. So you can compare it, you could say um cannulation is similar to having your bloods taken. But with the cannula, the cannula stays in place, but the needle is removed. Ok. And then if you wanted to explain it overall, you can just say a cannula is a small tube, um, that'll be inserted into the vein. It allows us to give you fluids or medications or to take multiple blood samples from without having to use multiple needles. Ok? Um, and that's just the two ways to do it. And then this is a summary of the before the procedure, there's a little checklist. So I'd recommend is you just adapt this for each of the other clinical skills that I spoken about today? Ok. So yeah, I got five questions that you need to ask and this is a big sweet one. Ok. Any questions about that? Ok. Moving on to during the procedure. So as I previously mentioned, you need to make sure you're signposting what you're doing and informing the patient some of these procedures, you know, like the needle ones, they can be quite scary and patients get tense. So it's really important to let them know what's going on and not just shock them. Ok. So I'll just give you a few examples. So I'm going to cut my equipment. Now, if you, for example, you walk out of the room or you walk somewhere, patient might panic and be like, where have they gone? Where have they gone? Was I meant to follow them and then they're ready in a stress state. It's just letting them know what you're doing. I'm going to put this down in your arm. It will feel tight. Let me know if it's too tight. Once again, make you, it shows that you care about the patient and you don't want them to be uncomfortable. Check the cannulas in front in the right place. I'll pass some salt water or saline through the tube. It may feel cold. It might be like, oh my God, why did you, why is it cold? Something gone wrong? Ok. It's once a year and it's all about making the patient feel comfortable. I'm going to wipe your armless alcohol, wipe it made for cold and then I'm ready you to insert the needle if you want to look right once again. Yeah, this is all about making the patient feel comfortable. Ok? And this is when you get the extra marks. This is when you, if you wanna get the top marks, it's really important to do this. Ok. Now, on to after the procedure. So um I'm just gonna give you a structure like I did before this procedure. Ok. So before the procedure, I think the number of questions could vary, ve function, cannulation. Yep, it's five. But for, for example, um suturing it could be seven, you might need to ask about a tetanus vaccine or has this been cleaned? For example, so that might vary. But after the procedure, you've got to do the five same things. Ok, for every clinical skill. So these are five steps not to forget afterwards, advice, results and safety netting trust guidelines. So in terms of advice for bean puncture, you need to ask about the dressing, ok? So if no one's on, if they're not on any of those medications, I mentioned they can keep the dressing on for 30 minutes to an hour and let them know that if they are on a blood thinner, you wanna make sure they keep it on for two hours, ok? And by a bit of pressure, so let them know that in terms of the results. Now it varies if you're in the GP or in the hospital. So normally if you're in the GP, you'll get your results back in a week. If you're in the hospital, you'll get it in a few hours. Now, it does vary from trust to trust people, tell you different things. So just to protect yourself to say according to our trust guidelines, it says this, it says that, ok, then in terms of safety netting, you just got to warn the patient about any signs of infection. So if you see any redness, any swelling, any pus in the area, any itchiness that's a sign of infection. Come back to A&E um come to go to A&E or from the ward. Let one of the healthcare professionals know. OK. And that's the first step. Next one is documentation. So I would just ask the examiner after you've done the advice examiner, would you like me to document anything? And they can say yes, they can say no, they can say write it on the blood bottle, write it on a piece of paper or just verbally say it. Ok? Now there's a range of things you can document. The most important things are the patient identity. So their name, date of birth, um hospital number, then also um your role, your name and then um you can also put any complications, what arm you use. Uh There's just a range of things you can ask, but main things is patient and patient identification and yours. Ok? And safety is just a point to remind yourself about where you're being safe. So you don't get caught out and this just reassures that you'll pass the station. Ok? It's possible before you taped down the arm, taped down the gauze. Have you checked if the patient's bleeding out? If you don't check, this patients could, could have an unknown, for example, unknown bleeding disorder and then they could just walk out and then just let them bleeding. Ok? So before you tape down, make sure you lift up the gauze and just check they're not bleeding. Ok? So that's one safety thing. Hyper your shots in the bin. That's a second safety thing. And then also have you taken the torn off? Am I seen patient um, students finish everything and then forget the tourniquet is still on there. Now, of course, with a real patient, they'll tell you cos it'll be really tight, but a model won't. So just make sure you've taken the tourniquet off. And another thing is have you wash your hands? Ok. Those are all the safety points. And if you've done that, don't worry, it's unlikely you're gonna fail. And the last two are bribing the patient and bribing the examiner. Once again, these are the like extra sweet things you can do. So I was just gonna say to the patient. Thank you so much for being cooperative today. I know this can be quite scary. You've done a great job. Um If you have any questions for me, um Let me know if not, you're free to go by the patient, then you get a bribe the examiner. Thank you, examiner for examining me today. Would you like me to put the equipment away and clean? Great. And those are just the extra nice things you can do. Ok? And once it, yeah, and then of course, yeah, like I said, already washed your hands. Now, this is just a summary slide of what I've just talked about. So it's slightly different with um cannulation for some of the things. So in terms of advice, you've got to talk about the fluid bag. So take the patient, if you do have a fluid bag attached, you can go to the bathroom, just make sure you ask a healthcare professional of help, same thing with safety netting. So, signs of affection and then in terms is that a result, you talk about changing the cannula. So just say um after four days, your cann needs to be um changed according to our trust guidelines. If um this hasn't been changed, please let one of the healthcare professionals know. OK. Once again, you're protecting yourself. Documentation is the same. Safety is basically the same, but you need to make sure the cannula has been flushed twice. OK? And then the tool here removed sharps in the bin and then you wash your hands and the same thing again, bribe the patient and bribe the examiner. OK? So this is just a summary of what I've talked about. Um So make sure you're doing regular osk practice, preparing communication, part practice on patients and nonmedical students, prior clinical skills on patients models or speaking through the station using your imagination Anterior cube with the fos for the suitable veins. Um how to perform venipuncture, the equipment step by step and what not to forget. Same for cannulation and then how to communicate before during and after the procedure. Now, if you can remember five questions you need to ask before five steps, you need to ask after you're pretty much on track for high mark. So it's like I said, if you can't practice the actual skill enough, focus on those bit and you'll do well already. Ok. Thank you so much for listening to my talk. I really hope it was useful. Um Could you please scan the QR code? This helps me know what you like and what you didn't like? Um And if you have any questions, I'll take some now. It could be about the ven puncture cannulation. It can be about clinical skills in general or even the ask in general. I'm here to help. So honestly ask, ask away, just gonna stop sharing. Now. Thank you so much. Uh Yeah. Any questions that you have just put in the chat or feel free to unmute and please um fill out the feedback form so that you can claim your certificate as well and also get access to the slides uh later on. OK. We'll just wait one or two minutes, any questions at all. Um Happy to uh guru is happy to answer. Also, let me know if it did make sense what I was saying. Um Or if you have any thing you're confused about, let me know even a thumbs up if you understood it just so I know. Uh Yeah. So once you guys have filled the feedback form, then you'll get access to the slides. Um I think it will be sent on the meal uh app. Yeah, I think that was a really good presentation uh, clearly, um, very well explained. Everything been a function can. And so thank you so much for giving your time. And again, any questions you have um the poll or you can message on me and we can direct the questions to you as well.