NVQ evidence

Sarah was a 23 year-old lady who was admitted with photophobia and headaches. One of the investigations that she required was to have a lumbar puncture. This was to be carried out by a doctor. My assessor watched me undertake the procedure of assisting the doctor with the investigation.

I knew Sarah as I had met her at the start of the shift, having introduced myself to her and explained my role to her.

I was with Sarah when the doctor explained the procedure and asked her if there any questions. She was quite nervous when she had the procedure explained to her. A I asked her if she did not mind me a assisting the doctor with the procedure. She said she didn't mind. My assessor, who is female, was going to be in attendance so the issue of two males attending to a female was not an issue. Also informed consent had been offered. The doctor needed to go and answer his bleep this gave me time to ask her if there was anything which she didn't understand and also what was making her nervous. She said that she was finding was going to hurt. I explain to her that she would be having some of local anaesthetic apply it prior to the procedure. Ensuring that she was OK with the information I gave her, I explain that had to go and prepared a trolley for a doctor, after having asked if she required to use toilet facilities.

I followed the following procedure:-

I applied gloves and apron post or washing and drying my hands
I then located at a suitable dressings trolley hands and commenced washing it. This involved the use of a disposable paper towels and Universal detergent as well as hot-water. I began to wash the top of the trolley, working my way down using a new paper towel for each area, commencing washing furthest away from the working towards me. I ensured that each surface totally dry before proceeding to the next area. I ensured that or poor areas of the trolley were cleaned, including undersurface.
I checked with a doctor to see what equipment was required, located it and placed it on the lower rung of the dressing trolley.
I drew the curtains around Sarah's bed and took up the trolley, touching only the legs, to her bedside, ensuring that nothing touched the trolley itself such has been curtains.
I removed my gloves and apron and washed and dried my hands.

The Doctor then asked Sarah it to lie on her left hand side with her knees tucked up as far as she was able to towards her chin. I in short that she was as comfortable as she could be assisting her to adjust her pillows. She remained quite tense so I ensured that I remained calm and to did not cause extra stressed to the situation.

I washed and dried my hands and applied another pair of gloves and apron. The doctor then washed and dried his hands and applied sterile gloves. I opened the required sterile packaging of the lumbar puncture kit ensuring that I only touched the corners of the sterile field. I opened out other required pieces of equipment such as various needles. The doctor arranged the sterile part of the pack as he had sterile gloves on and I did not. He required some iodine solution to the poured into a gallipot. Prior to pouring the solution into the gallipot, I showed him the label so that he could see that it was what he wanted it to the as well as it was in date. He also required a syringe full of lignocaine, the local anaesthetic. I showed him the vile so that he could see that it was what he wanted to be and that it was in date. Ensuring that all of the liquid was in the lower part or that the vial, I broke the seal and held the vile so that he was able to draw the liquid into his syringe without losing sterility. He then carried out the procedure. There were times in the procedure when said experience pain. Unfortunately, this was a natural part procedure as the local anaesthetic could only cover a certain depth of their area or where the needle was to be inserted. As I was required to stay clean, I was I able to touch Sarah at this time so all I could do was was a to reassure her verbally as best I could. When required to in the course the procedure, held a specimen pot underneath the needle access point to obtain a specimen of that cerebral spinal fluid. I had in short that I had not touched the inside of the plot as it was sterile. I did this three times. I wrote numbers on the pots so that they could be distinguished later. On this occasion, the Doctor sent off the specimens.

As there were sharp objects in the sterile field, the Doctor clear the way these. I cleared away all other waste, re-cleans a trolley in a manner as described earlier in this piece (after having removed man but an apron and disposing of them in a yellow bag and washing and drying my hands and the apply new a apron and gloves)


Post procedure, I checked Sarah's Blood Pressure, pulse, temperature, respirations and Oxygen Saturation. These were within normal limits. It was necessary for Sarah to remain lying down flat for a period of four hours. During this time I made sure that she was comfortable, and that she had not got any outstanding needs that she needed to be addressed. I also checked the dressing on her back to see if it was in place and for excess strike throuh.


Elements Covered
X12
1
.1 .2 .3 .4 .5 .6 .7 .8 .10

Ranges
1a 1b


2
.1 .2 .3 .4 .5 .7 .8 .11 .12

Ranges
1a 1b

3
.1 .2 .3 .6 .7

Ranges
1a 1b


X19
1
.2 .3 .5 .6 .7 .8 .9 .11 .12

Ranges
1e 1f 2a 2b

2
.1 .2 .3 .4 .5 .6 .8 .10

Range
1a


3
.1 .2 .3 .4 .5 .6 .7 .12 .13

Range
2d