MedExamHelperClinical skills procedure handbook
How to use this handbook
This handbook is a procedural reference, not a substitute for supervised training. Every procedure below assumes you have been signed off locally for the step in question. Local guidelines, local equipment, and local infection-control policies override anything written here. The handbook gives the shape; the workplace gives the detail.
Each section follows the same pattern: what the examiner scores, the steps that are easy to forget under pressure, and the safety callout.
Venepuncture
What the examiner scores. Hand hygiene before the procedure, patient identification confirmed, tourniquet time within the local limit, samples labelled at the bedside, sharps disposed of immediately. The procedure itself is rarely what fails; the surrounding steps are.
Steps that are easy to forget under pressure. Introducing yourself and confirming the patient's full name and date of birth. Asking about fainting episodes before the needle goes in. Releasing the tourniquet before withdrawing the needle. Inverting the bottles the correct number of times — not shaking, not under-mixing. Labelling every bottle at the bedside, before you leave the room.
Safety callout. Never recap a needle. Dispose of the sharps at the point of use. If you sustain a needlestick injury, follow your local occupational-health pathway the same shift; do not wait for the next working day.
Arterial blood gas
What the examiner scores. Modified Allen's test performed and documented before radial sampling, heparinised syringe prepared correctly, sample analysed within the timeframe your local lab expects, firm pressure applied to the site for the full duration your trust specifies. The radial site is preferred over the brachial; the femoral site is reserved for emergencies and is rarely tested.
Steps that are easy to forget under pressure. Aspirating the sample without air bubbles; an air-contaminated sample will be rejected by the analyser, and you will have to repeat the procedure. Tapping the syringe to mix the heparin with the blood rather than shaking it. Labelling the sample with the inspired oxygen concentration at the moment of sampling; the analyser needs the FiO2 to interpret the result. No air bubble; no shaking; FiO2 on the label.
Safety callout. The most common reading error is confusing the partial pressure of oxygen with the oxygen saturation on the printout. They are reported in the same row of numbers and mean different things. If you are asked to interpret the result, say which is which before you give a value.
Peripheral IV cannulation
What the examiner scores. Hand hygiene, gloves worn before the skin is touched, tourniquet applied without occluding arterial flow, chosen vein released before insertion, cannula secured and dated, flush administered to confirm patency, sharps disposed of immediately. The examiner also scores whether you escalated appropriately when the first attempt failed.
Steps that are easy to forget under pressure. Asking about latex allergy before touching the tourniquet or the dressing. Choosing the correct gauge for the intended use. Documenting the date, time, and site on the dressing itself, not just in the notes. Flushing with saline to confirm patency before connecting any infusion.
Safety callout. A failed first attempt is not a failure. Two failed attempts at the same site is a trigger to escalate, to a senior colleague or to a vascular access team, depending on the urgency. Document the escalation. The patient who has been stuck four times by a junior who did not ask for help is the patient the system is meant to prevent.
Urinary catheterisation
What the examiner scores. Aseptic non-touch technique throughout, anatomy confirmed before the catheter is advanced, the catheter advanced to the hilt before the balloon is inflated, the balloon inflated with the correct volume of sterile water, the catheter connected to a closed drainage system, and the entire procedure explained to the patient in language they understood before any step began.
Steps that are easy to forget under pressure. Consent. The catheter is an intimate procedure; consent is not implied by the patient being on the ward round list. Checking for latex allergy. Lubricating the catheter with sterile lubricant, not with anything else. Confirming urine flow before inflating the balloon. Inflating the balloon with the full volume specified by the manufacturer; under-inflation leads to balloon-cuff failure and catheter dislodgement.
Safety callout. Male and female anatomy differ in the obvious ways, and the catheter length differs accordingly. Forcing a catheter against resistance is a sign of false passage; stop, deflate, reposition, and consider whether the catheter is the right size or shape. Patient dignity matters before, during, and after the procedure.
Suturing and wound closure
What the examiner scores. Wound assessment before closure, choice of suture material appropriate to the site and tissue, aseptic technique, needle handling without touching the suture with your fingers, knots tied square and locked, and a clean wound edge at the end. The examiner also scores the closure plan: when to remove sutures, when to review, and what to tell the patient about infection signs.
Steps that are easy to forget under pressure. Infiltrating local anaesthetic before cleaning the wound, not after. Cleaning from the inside of the wound out, not the other way around. Choosing the right needle for the right tissue; a cutting needle behaves differently in skin from a round-bodied needle in bowel. Loading the needle in the needle holder at the right angle; a poorly loaded needle will bend or break.
Safety callout. Tetanus status. Antibiotic prophylaxis only when indicated by local guidelines, not by reflex. A wound that does not look right — extensive tissue loss, contamination, neurovascular compromise — is a wound that needs senior review before closure, not a wound that needs closing first and reviewing later.
Basic and advanced life support
What the examiner scores. Recognition of the collapsed patient, calling for help at the right moment, starting chest compressions within the local timeframe, correct hand position, correct depth and rate, switching rescuers at the recommended interval, and using the defibrillator safely. The algorithm is a reference; face-to-face training is the assessment.
Steps that are easy to forget under pressure. Asking loudly for help before starting compressions. Exposing the chest before applying the pads. Continuing compressions while the defibrillator charges. Standing clear during analysis and shock delivery. Counting compressions aloud or to a metronome; depth and rate drift within seconds without feedback.
Safety callout. This handbook is not the place to learn BLS or ALS. Use a face-to-face course run by a recognised resuscitation council. The course is annual for a reason; the algorithm changes, the equipment changes, and the muscle memory decays faster than you think. Practise on a manikin; do not practise on a real patient.
Safety and escalation
The handbook ends with the safety callouts because they are the ones that fail under pressure. A procedure done cleanly and a procedure done with a needlestick injury are not the same procedure.
Sharps. Never recap. Dispose at the point of use. If a sharp goes through your glove, follow the local occupational-health pathway the same shift.
Consent. Every procedure has a consenting step. The consent may be implied in an emergency; it is not implied in a routine venepuncture on an inpatient. Document the consent.
Escalation. Two failed attempts at the same procedure is the trigger to ask for help. The senior you escalate to will not mark you down for asking. The patient will remember if you did not.
Documentation. Write the procedure, the time, the site, the equipment used, and the complications in the notes before you leave the bedside. The note is the only record the next clinician will read.
Where this pillar sits
This page is the hub for the procedure cluster. The other pillars complete the picture: complete OSCE station library for the OSCE-side practice of these procedures, how to pass the viva for the viva questions that follow a procedure, and exam format guides by country for the formats where these procedures appear.