Nursing Procedure and Advanced First aid practical

course

Prepared By: Hawre S.Aziz

ER Nurse
Certified Medical Trainer
First aid and Fundamental Of Nursing Lecturer
2025
six rights of medication administration
Routes of drug administration
Injectable route
Intra muscular injection
Subcutaneous injection (SC)
Intradermal (ID)
Intradermal injections (ID) are injections administered into
the dermis,.These types of injections are used for
sensitivity tests , The dosage of an ID injection is usually
under 0.1 ml. The angle of administration for an ID
injection is 5 to 15 degrees .
Before administer any injection ,you should check :
 Composition
 Expire date
 Route of administration
Don’t forget the 3 Ds before venepuncture
 Depth
Direction
 Diameter
Types of IV Access
 Peripheral IV Catheter (Cannulation ).
 Central Line (Central Venous Catheter)
 IV cannulation
• Intravenous (IV) cannulation is a technique in which a
cannula is placed inside a vein to provide venous access.
Parts of cannula
Indications
 Fluid and electrolyte administration
 Medication administration
 Blood and blood product administration
 To administer total parenteral administration
 Blood sampling
Contraindications
 Infection or inflammation in the site of cannula insertion
 Irritant drugs like chemotherapy ( need CV line)
Cannula types
• Orange: 14 gauge cannula. It is used in operation theatres or
in emergency situations such as rapid transfusion of blood,
blood products or intravenous fluids.
• Grey: 16 gauge cannula. It is also used in operation theatres
or in emergency situations such as rapid transfusion of
blood, blood products or intravenous fluids.
• Green: 18 gauge cannula. It is used for patients who require
blood transfusions, total parenteral nutrition and for
delivering large amounts of intravenous fluids.
• Pink: 20 gauge cannula. It is used for patients who require
blood transfusions, total parenteral nutrition and for
delivering large amounts of intravenous fluids.
• Blue: 22 gauge cannula. It is used in patients when the
cannula is to be inserted in small veins. It may also be used
in children for delivering medications and fluid
• Yellow : 24 gauge can be used in children for delivering
medications and fluid
Intravenous Cannula size, colour and flow rate
General Principles of peripheral IV cannulation
1. Avoid joints, choose least mobile sites.
2. Avoid tortuous veins.
3. Avoid cubital fossa.
4. Avoid nearby arteries or nerves and tendons.
5. Choose prominent or convex sites.
6.Save large veins for future or possible emergency
Situations .
Materials required for IV cannulation
 Dressing tray
 Gloves (non-sterile)
 Apron (non-sterile)
 Gauze pieces or cleaning wipes
 Intravenous cannula
 A tourniquet
 Bandages to keep the cannula in place
 Rubbing alcohol
 Antiseptic solution
 Normal saline
 Sterile syringe
 A waste bin for sharp instruments
Process of IV cannulation
 Confirm patients identity
 Explanation
 Prepare equipment
 Identify the vein
 Ensure that the tourniquet is used properly ( on upper arm
 Insert the needle at 30 degree
 Remove the needle
 Safe disposal
 Flush and secure cannula
 Aftercare advice
 Documentation
Insertion site
 Dorsal venous arch ( metacarpal veins )
 Forearm
Complications of IV cannulation
 Local and systemic infection.
 Phlebitis and Thrombophlebitis.
 Thromboembolism or even gangrene
 Pain.
 Haemorrhage.
 Haematoma.
 Extravasation.
 artery injury .
 Nerve injury
 Needle stick injuries
Phlebotomy (Venepuncture ,Blood draw )
• Phlebotomy is when someone uses a needle to take
blood from a vein, usually in your arm, it's an important
tool for diagnosing many medical conditions ,A person
who performs a phlebotomy is called a phlebotomist,
although most doctors, nurses, and other technicians…
Blood sampling systems
Multiple evacuation system
Blood collection tubes
Tips to find a vein
 Gently palpate the patient’s arm to find a vein.
 Use a tourniquet.
 Use a flashlight to illuminate the veins.
 Ask the patient questions about their blood draw
history. Has it been this difficult for other
phlebotomists to draw their blood?
 Ask another phlebotomist for help.
 Take a short break and try again in 10-15 minutes.
Site selection of vein
usually in the arm, Median cubital vein is first choice
because it is large and less pain , others are : cephalic
vein and basilic vein .
Types of wound
control of external bleeding
1.Direct pressure
2.Indirect pressure
3.Raising the limb for a level higher than form the heart level
Suturing (sewing )
• The surgical suture is used to hold body tissues together after injury or
surgery.
Purposes of suturing

ü stop bleeding
ü reduce pain and infection
ü repair the cutaneous wound
ü minimize scarring
ü maximize wound healing
Equipment
ü Tray
ü Suture material
ü Needle holder
ü Stich Scissors
ü Antiseptics
ü Anesthetics
ü Artery forceps
ü Blade surgery
ü scalpel handles
classifications of suture material
1.According to absorbability :
ü Absorbable
ü Non absorbable
2.According to the raw material (structure):
ü Monofilament
ü Multifilament
3.According to the shape:
ü Curved
ü Circle
ü Straight
4.Accordin to the tip of the needle
ü Round
ü Cutting
ü Reverse cutting
 common examples of suture materials
• Absorbable :
ü Catgut
ü Polyglactin (vicryl)
ü Dexon ( polyglycolic acid {PGA} )

• Non absorbable:
ü Silk
ü Nylon
ü Cotton
ü Stainless steel
ü Prolene (polypropylene )
 Critical wound healing period
• Skin 5-7 days
• Mucosa 5-7days
• Subcutaneous 7-14 days
• Peritoneum 7-14 days
• Fascia 7-14 days
Suturing techniques
• Simple interrupted
Suturing techniques
• Simple continues
 Suturing techniques
• Subcuticular
Removing sutures
Ideal Qualities of a First Person On The Scene
 Safety first
 Communication
 Empathy.
 Fitness.
 Initiative.
 Positivity.
 Selfless.
 Keeping secret
 Updatable
Golden hour
Basic life support (BLS)
• Basic Life Support is a type of care that first-responders
provide to anyone who is experiencing cardiac arrest,
respiratory distress or an obstructed airway.
Advanced cardiac life support (ACLS)
• Advanced cardiac life support (ACLS) is a group of
procedures and techniques that treat immediately life-
threatening conditions, including cardiac arrest, shock,
stroke, and trauma
ACLS person rights
 Basic treatment of cuts and injuries
 Given emergency medications
 Advanced airway management
 Advanced cardiac monitoring
 Advanced CPR
 Using Defibrillator
 Invasive procedures
Cardiopulmonary resuscitation (CPR)
• Is a life saving technique that is performed when someone's
heart and breathing is stopped .
• American heart Association recommended to do CPR hard
and Fast
Ages in first aid
 Neonate : new-born to 1 month
 Infant : 1 month to1 year
 Baby : 1 year to 3 years
 Child : 4 years to 12 years
 Adult : above 12 years
Compression ratio
 For Adults : 30 compression by two Breathing
 For child and infants : 30:2 for one rescuer , 15:2 for two
rescuer
 For neonates : 3:1
Rescue breathing
 Ambubag (BVM)
 Mouth to Mouth
 Mouth to nose
crash cart
Emergency drugs in resuscitation
1. Adrenaline (Epinephrine ) during cardiac arrest : heart muscle
contraction & tighten the blood vessels .
 Routes : IV/IO
 dose : 1 mg IV then push 20 ml saline ( for adult) and 0.3-0.5 mg for
pediatric
 Note : adrenaline can be given every 3-5 minutes
2. Atropine for bradycardia(pulse 40 B/M ) : block the action of vagus
nerve
 route : IM/IV
 dose : 0.6-1 mg , repeated every 3-5 minutes , maximum : 3 mg
3. Cordarone (Amiodarone) for arrhythmia (ventricular arrhythmia ) :
antiarrhythmic medication class lll
 routes : IV
Dose : 150 mg in 10 minute , can be repeated after 10 minutes
Defibrillation
• Is the administration of electric shocks to the heart in order
to reset normal heart rhythm in persons who are
experiencing severe arrhythmia (like VT , VF ) .
• A heart which is in asystole (flat line) cannot be restarted by
a defibrillator, but would be treated only by
cardiopulmonary resuscitation (CPR)
Types of defibrillator

 Manual defibrillator

 AED ( Automated External Defibrillator )

 ICD (implantable cardioverter

defibrillator)
1. VT with pulse :
• stable : medication
• unstable : cardioversion
2. Pulseless VT :
• Defibrillator
Reversible causes of cardiac arrest
Signs of death
 Pupil dilation
 His/her eyes has no reacted to light
 No gag reflex
 Cyanosis
 No pulse
 No breathing
 Asystole ( flat line ECG)
summary
 D.O.A = dead on arrival
 EMT shouldn’t begin CPR if ( the case appeared rigor mortis
, DNR order )
 Ribs may be broken esp. In infants and old ages , broken ribs
no matter , doctors are able to repair broken ribs but they
can not repair death.
 CPR in first 3 minute is key of survival
 Permanent Brain damage occur after 10 minutes
 Always remember writing death note as legal affairs