Clinical procedures and technical skills
Domain 4 - Clinical procedures and technical skills
This domain assesses preparation, asepsis, technique, and recognition of complications for common bedside and operative procedures.
Core rules
- Confirm indication, contraindications, coagulation status, and informed consent.
- Use the WHO surgical safety checklist or a procedure time-out: patient, site, side, allergies, antibiotic prophylaxis, and imaging.
- Follow sterile technique: hand hygiene, maximal barrier precautions, skin antisepsis, and a sterile field.
- Use ultrasound guidance where evidence supports it - central venous access, regional blocks, thoracentesis.
- Document the procedure, findings, specimens, and complications, and arrange post-procedure monitoring.
Worked example
A coagulopathic patient needs a central line. Correct order: assess indication and alternatives, correct platelets or coagulation if time allows, obtain informed consent, position the patient, use ultrasound to identify and cannulate the vein, confirm placement, and monitor for pneumothorax or bleeding. If the internal jugular vein is thrombosed, use the femoral or subclavian route with the same aseptic standards.
Traps
- Skipping the time-out or side marking.
- Ignoring anticoagulation or thrombocytopenia.
- Using ultrasound without knowing the anatomy and pitfalls.
- Failing to document consent and complications.