OSCE Hub

Mark Scheme:

1. Introduces self and confirms identity
2. Explains procedure and obtains consent
3. Gathers equipment (needle, barrel, tubes, tourniquet, swabs, gloves, sharps bin)
4. Washes hands (Aseptic Non-Touch Technique)
5. Positions arm and applies tourniquet
6. Palpates suitable vein
7. Cleans site with skin prep (30 seconds) and allows to dry
8. Re-washes hands and dons gloves
9. Anchors vein and inserts needle (bevel up, 15-30 degrees)
10. Connects blood bottles in correct 'Order of Draw'
11. Releases tourniquet before removing needle
12. Withdraws needle and applies immediate pressure
13. Discards needle into sharps bin immediately (no re-capping)
14. Labels bottles at the bedside (do not pre-label)
15. Checks site and applies dressing
16. Discards waste and thanks patient

Key Points:

Order of Draw: Blood culture, Light blue (Coag), Red/Gold (Serum), Green (Heparin), Purple (EDTA), Grey (Glucose)
Always let the alcohol dry to prevent haemolysis and stinging
Invert tubes gently; do not shake
Never re-cap a needle
Apply pressure for at least 1-2 minutes to prevent haematoma

Common Errors:

Forgetting to release the tourniquet
Placing the sharps bin too far away
Re-palpating the vein after cleaning without cleaning the finger
Shaking the blood tubes vigorously
Pre-labelling the tubes before the procedure

Mark Scheme:

1. Introduction, identity check, and consent
2. Explains need for cannula and risks (bruising, infection)
3. Collects equipment (cannula, flush, dressing, bungs, tray)
4. Washes hands and applies gloves
5. Applies tourniquet and identifies vein
6. Cleans site thoroughly
7. Primes the connector/bung with saline
8. Anchors vein and inserts cannula until 'flashback' 1 seen
9. Lowers angle and advances needle slightly to ensure cannula is in lumen
10. Advances cannula over the needle (flashback 2 seen)
11. Applies pressure proximal to cannula, removes needle, and discards in sharps bin
12. Attaches bung/connector and flushes with saline (checks for swelling/pain)
13. Secures with dressing and labels with date
14. Cleans up and thanks patient

Key Points:

Flashback 1 (needle) and Flashback 2 (cannula) are critical steps
Flush the cannula to ensure patency and check for extravasation
Standard adult size: 20G (Pink) or 22G (Blue). Trauma/Blood: 14G/16G (Orange/Grey)
Use a 'non-touch' technique for the key parts
Always document the procedure in the clinical notes

Common Errors:

Advancing the needle too far and piercing the back wall of the vein
Not priming the extension set (bungs) with saline first
Re-capping the needle
Insufficient skin cleaning time
Forgetting to document the date of insertion