SANE-A cheat sheet

SANE-A certification is issued by the American Nurses Credentialing Center (ANCC) and covers adolescent and adult patients; SANE-P covers prepubertal children.

Scope of practice is set by the state Nurse Practice Act plus institutional policy and protocols; a SANE cannot independently order or prescribe outside that authority.

Informed consent for the forensic examination must be voluntary and revocable; patients may accept medical care and decline any or all evidence collection.

The SANE role combines medical-forensic history, physical assessment, injury identification, evidence collection, documentation, prophylaxis, referral, and testimony.

A fact witness testifies to direct observations; an expert witness may offer opinions grounded in specialized education, training, and experience.

Chain of custody must be documented at every transfer, including date, time, releasing and receiving party, item description, and purpose of transfer.

HIPAA permits disclosure of protected health information for reporting abuse, neglect, or violent injury as required or permitted by law.

Mandatory reporting obligations are defined by state statute and override patient requests for confidentiality when the statutory trigger is met.

Certification renewal requires continued clinical practice hours and continuing education; a lapsed credential affects eligibility to practice as a certified SANE.

Structures requiring systematic inspection: mons pubis, labia majora and minora, clitoris, urethral meatus, hymen, fossa navicularis, posterior fourchette, perineum, and anus.

Tanner stages 1 through 5 describe breast and pubic hair development; estrogenized hymenal tissue is thick, redundant, and moist, whereas prepubertal tissue is thin and delicate.

Hymenal morphology varies normally: annular, crescentic, redundant, septate, cribriform, and microperforate configurations are all described variants.

The posterior fourchette, fossa navicularis, and labia minora are the most frequently injured genital sites following penile penetration.

Examination positions include lithotomy (supine, legs abducted), lateral recumbent, and prone knee-chest, which improves visualization of the anus and posterior vagina.

Magnification with a colposcope and bright, angled lighting improves detection of mucosal tears not visible on gross inspection.

The anal examination inspects perianal skin, anal folds, and sphincter tone and requires explicit separate consent.

Baseline vital signs, pain score, and orthostatic measurements guide triage for hypovolemia and hemodynamic instability before the forensic examination proceeds.

Oral assessment includes lips, frenulum, buccal mucosa, palate, and posterior pharynx for petechiae, tears, or bruising.

DNA-bearing body swabs are generally collected up to about 120 hours post-assault; clothing, bedding, and other items may be collected beyond that window.

Each swab is air-dried, placed in a paper envelope, sealed with tamper-evident tape, and labeled with patient identifiers, collector name, site, date, and time.

Plastic bags are avoided for biological evidence because trapped moisture promotes bacterial growth and DNA degradation.

A known reference sample (buccal swab or blood) from the patient is required to distinguish patient DNA from foreign DNA.

Toxicology specimens (blood and urine) are refrigerated if not delivered promptly; urine has a longer detection window for most substances.

Clothing is collected in paper bags; wet or heavily stained items are air-dried before packaging.

Every transfer of evidence is logged so the chain of custody remains unbroken from collection through laboratory analysis and return.

Evidence the patient declines cannot be collected; the refusal is documented and care continues.

Kits are stored per jurisdictional rules (often refrigerated or controlled room temperature) and held for the statutory retention period.

Non-fatal strangulation leaves no visible external marks in roughly half of cases; absence of visible injury does not exclude strangulation.

Documented signs include facial and conjunctival petechiae, subconjunctival hemorrhage, ligature marks, neck swelling, voice change, cough, dysphagia, and odynophagia.

Loss of consciousness, incontinence, visual changes, and respiratory symptoms are high-risk indicators requiring emergency evaluation.

Airway edema may worsen over 24 to 72 hours; discharge instructions must list return precautions for breathing difficulty, voice change, or neck swelling.

Stabilization of life-threatening injury takes priority over evidence collection; collection resumes once the patient is medically stable.

Trauma-informed sequence: explain before each step, obtain permission, allow a support person, offer breaks, minimize repeat retelling, and let the patient set the order.

Injuries are documented with type, size in centimeters, color, shape, anatomic location, and a body diagram.

Photographs are taken with consent, with and without a scale, and recorded in a log noting time, photographer, and body location.

Many states classify strangulation as a felony independent of visible injury, and standardized strangulation documentation forms are recommended.

HIV nPEP: initiate within 72 hours of exposure, ideally within 2 hours; continue for 28 days; preferred adult regimen is tenofovir DF/emtricitabine plus dolutegravir.

STI prophylaxis: ceftriaxone 500 mg IM once (1 g if weight 150 kg or greater), doxycycline 100 mg PO twice daily for 7 days, metronidazole 2 g PO once.

Pregnancy alternative: azithromycin 1 g PO once replaces doxycycline; metronidazole timing is adjusted in some first-trimester protocols.

Hepatitis B: unvaccinated patients receive hepatitis B immune globulin plus the first vaccine dose, with the series completed per schedule.

Emergency contraception: copper IUD up to 5 days (most effective), ulipristal acetate 30 mg up to 120 hours, levonorgestrel 1.5 mg up to 72 hours with reduced efficacy to 120 hours.

Baseline testing includes pregnancy, HIV, syphilis, hepatitis B and C, and nucleic acid amplification tests for gonorrhea and chlamydia.

Repeat HIV testing is recommended at approximately 6 weeks, 3 months, and 6 months after exposure; syphilis serology is repeated at later intervals.

HPV vaccination is offered according to age-based recommendations during the follow-up visit.

Rape trauma syndrome: an acute phase of disorganization (fear, shock, somatic complaints) followed by a long-term reorganization phase (phobias, anxiety, depression, altered relationships).

Tonic immobility, an involuntary freeze response during assault, is a documented survival reaction and is never evidence of consent.

Memory during highly stressful events is fragmented; inconsistent recall of peripheral detail is expected and does not indicate fabrication.

Use trained interpreters rather than family members or children; an accompanying person may be the assailant.

Screen for suicidal ideation, depression, PTSD symptoms, and substance use, and provide crisis resources with a warm handoff.

Populations facing added barriers include male survivors, LGBTQ+ patients, people with disabilities, incarcerated persons, immigrants, and trafficking victims.

Cultural factors shape disclosure, eye contact, and willingness to undress; ask about examiner gender preference and use of a chaperone.

Absence of visible distress, flat affect, or calm cooperation is a common trauma response and does not suggest the assault did not occur.

A fact witness testifies only to personal observations; an expert witness may give opinion testimony based on specialized knowledge after qualification by the court.

Subpoenas for records must be validated through hospital legal counsel or risk management before any protected health information is released.

Rape shield statutes generally bar evidence of the complainant's prior sexual conduct or reputation except in narrow statutorily defined circumstances.

Consent is the ethical and legal foundation of the examination; a patient may withdraw consent at any time and documentation must reflect the scope consented to.

Mandatory reporting requirements for child abuse, elder abuse, and specified injuries are statutory and override confidentiality.

A break in chain of custody can render evidence inadmissible; documentation must show continuous accountability for each item.

Testimony rules: answer only the question asked, avoid speculation, use plain language, and state uncertainty rather than guessing.

Adolescent consent rules differ by state; emancipation status and minor-consent statutes determine who may authorize examination and treatment.

Documentation must be objective, timed, and measurable: record size in centimeters, shape, color, and anatomic location rather than conclusory labels.

Patient statements are recorded as direct quotations attributed to the patient and kept distinct from examiner observations.

Body diagrams and a photography log (time, photographer, location, scale) support later authentication of images in court.

The IAFN Standards of Practice and CDC treatment guidelines are the principal evidence-based references for forensic nursing care.

Quality indicators include time from report to examination, kit completion rate, documentation completeness, chain-of-custody accuracy, and follow-up completion.

Case review and peer review identify documentation gaps that drive protocol revision and staff education.

Evidence retention periods are set by state statute and institutional policy and must be confirmed before any kit destruction.

Appraisal of new research for practice change includes assessment of study design, sample size, and applicability to the local patient population.