Procedure stations

Explain your role, confirm identity and assess comfort. Clarify the problem, intended benefit and urgency. Check contraindications, relevant examination, observations, investigations and imaging. Ask about previous procedures, relevant illness, allergies and medicines, including anticoagulants or antiplatelets where relevant.

Decide what you can safely undertake, what supervision is needed and whether another approach would be better. If a procedure is time-critical, make the immediate safety priorities explicit.

Find out what the patient understands and what concerns them. Explain what you propose, what it may feel like, the relevant benefits and risks, and reasonable alternatives. Invite questions and check understanding. Confirm consent or the appropriate lawful basis before proceeding, using the relevant national framework and local policy when a person cannot decide for themselves.

“What would you like to know before we decide?” “Please tell me if you need a pause.”

Use GMC decision-making and consent guidance. Protect privacy, use communication support when needed and offer a chaperone where appropriate.

Agree how pain and anxiety will be managed. Review medicines already given. When sedation is needed, assess the patient and airway, plan the required staff, monitoring, rescue equipment and recovery arrangements, and conduct a safety brief. Use the RCEM procedural sedation guidance and your current local protocol.

Check each medicine’s concentration, dose, route and contraindications. Include previous and planned local anaesthetic in the total dose. Arrange ongoing monitoring and a person responsible for recovery before starting.

Confirm the patient, procedure and site or side. For applicable invasive procedures, independently agree the site with a second practitioner, one of whom should be ST4 or above, in line with RCEM’s invasive-procedure guidance. Use the local safety check.

• Position the patient safely and preserve dignity.
• Clean hands, select PPE and prepare the required aseptic field.
• Check the procedure equipment, monitoring and any rescue equipment work.
• Brief assistants on the plan, roles, anticipated problems and when to call for help.

Use the manufacturer’s instructions for the equipment in front of you. A familiar-looking device may operate differently.

Carry out the procedure using the appropriate technique while maintaining asepsis and communicating with the patient and team. In simulation, demonstrate what the task permits and explain steps that cannot be physically performed.

Recognise an unexpected finding, loss of sterility, worsening discomfort or physiological change. Pause or stop when appropriate, reassess and seek help early. Avoid repeating an unsuccessful attempt without reconsidering the plan.

Use the checks appropriate to this procedure to confirm success and detect complications. Reassess the patient. Secure devices, account for needles, guidewires and other items, and arrange any required samples, tests or imaging. State who will review the result and act on it.

• Restore comfort; provide dressings, analgesia and ongoing treatment as indicated.
• Agree monitoring or recovery, the responsible team and any review or device-removal plan.
• Explain expected symptoms, warning signs and how to obtain help; give appropriate written advice.
• Document the indication, consent, site, technique, medicines, findings, complications and next steps.

Ask for any remaining questions. If care transfers, confirm who has accepted responsibility and what still needs to be done.

Practise choosing the appropriate access, explaining the indication and maintaining asepsis. Include confirmation of position or function, securement, sample labelling and the monitoring or removal plan. Central and arterial access require procedure-specific competence and checks.

• RCEM — preparation and safety checks for invasive procedures

Practical teaching and procedure links

• Venepuncture
• IV cannulation
• IO access 
• Central access 
• ABG
• Arterial line

For pleural fluid procedures, use ultrasound to select a safe site immediately before the procedure with the patient in the intended position. For lumbar puncture, assess contraindications and the clinical indication; in suspected meningitis, urgent treatment must not be delayed for an unsafe or deferred LP.

After uncomplicated pleural aspiration in an asymptomatic patient, a routine chest radiograph is not always required. Chest drain insertion has a different post-procedure imaging plan. Use the BTS statement for the relevant procedure.

• BTS — pleural procedures clinical statement (2023)
• NICE NG240 — lumbar puncture in suspected bacterial meningitis
• Merck Manual — knee arthrocentesis

Practical teaching and procedure links

• Lumbar puncture/interpretation
• Paracentesis
• Ascitic drain/interpretation
• Joint aspiration: knee example/interpretation
• Pleural aspiration
• Seldinger chest drain

Know which treatment the rhythm and clinical state require. Rehearse defibrillator safety, synchronisation for cardioversion and assessment of electrical and mechanical capture during pacing. Plan analgesia/sedation where appropriate and reassess the patient after treatment.

• RCUK — adult ALS (2025)
• RCUK — bradyarrhythmia algorithm (2025 PDF)
• RCUK — tachyarrhythmia algorithm (March 2026 PDF)

Practical teaching and procedure links

• ECG
• Transcutaneous pacing
• Synchronised DC cardioversion
• Defibrillation 
• Pericardiocentesis

For procedural sedation, prepare appropriately trained staff, a safety brief, rescue equipment and monitored recovery. RCEM recommends ECG, oxygen saturation, blood pressure and continuous capnography monitoring. Sedation and analgesia need separate consideration.

Confirm tracheal tube placement using sustained waveform capnography and ongoing clinical assessment. Rehearse the failed-airway plan and escalation. For a neck-airway emergency, distinguish tracheostomy from total laryngectomy: a person with a total laryngectomy breathes through the neck stoma.

• RCEM — procedural sedation guideline (2022)
• Difficult Airway Society — adult difficult intubation guidance (2025)
• National Tracheostomy Safety Project — emergency guidance
• BTS/ICS — acute hypercapnic respiratory failure and NIV

Practical teaching and procedure links

• Procedural sedation: Adult; Paediatric;
• RCEM sedation guideline and drug guidance
• Airway adjunct: OPA; NPA
• BVM ventilation
• Supraglottic airway insertion
• Endotracheal intubation/Rapid sequence induction
• Oxylog 3000 plus setup
• Neck-airway emergencies: tracheostomy algorithm; laryngectomy algorithm  
• Front of neck access
• Non-invasive ventilation: BiPAP (BTS/ICS guidance); CPAP

The Oxylog page is device-specific teaching. Use the manufacturer’s instructions and local training for the ventilator available to you.

Call the appropriate obstetric, midwifery, neonatal and anaesthetic help early. Use the current obstetric emergency pathway and prepare for newborn care alongside maternal care. For intimate examination, explain each step, obtain consent, offer a chaperone and preserve dignity.

• RCOG — shoulder dystocia guidance
• RCOG — umbilical cord prolapse guidance
• NICE NG235 — intrapartum care and postpartum haemorrhage
• NICE NG133 — hypertension in pregnancy and eclampsia
• RCUK — newborn life support (2025)
• RCUK — maternal cardiac arrest and resuscitative hysterotomy (2025)

Practical teaching and procedure links

• Resuscitaire
• Emergency delivery
• Shoulder dystocia (RCOG guidance)
• Cord prolapse
• Antepartum haemorrhage
• Postpartum haemorrhage
• Eclampsia (NICE guidance)
• Resuscitative hysterotomy
• Speculum examination

Clarify the indication, consent and need for a chaperone. For catheterisation, review previous urological problems or surgery, assess difficulties and follow the local escalation pathway. Avoid repeated traumatic attempts. Include drainage, securement, documentation and the ongoing catheter plan.

Practical teaching and procedure links

• Urethral catheterisation
• Suprapubic catheter
• Paraphimosis reduction
• Penile block 
• Urinalysis

Choose immobilisation and intervention for the injury and patient. Reassess neurovascular status before and after reduction, splinting or plaster application. Explain swelling precautions, pressure symptoms, weight-bearing advice and follow-up.

Airway, haemorrhage and trauma procedures require the relevant team, equipment and current trauma protocol. Collar application is part of a selective spinal-injury assessment; the video below demonstrates a technique rather than deciding who needs immobilisation.

• NICE NG41 — spinal injury assessment and immobilisation
• NICE NG39 — major trauma
• RCUK — traumatic peri-arrest and cardiac arrest (2025)

Practical teaching and procedure links

Trauma

• Neck collar
• Lateral canthotomy 
• Splints: Kendrick traction splint, Thomas, SAM
• Combat tourniquet
• Trauma chest drain
• Thoracotomy and traumatic arrest: RCUK guidance
• Escharotomy

Fracture/dislocation

• Distal radius (Colles) fracture
• Elbow dislocation
• Pulled elbow
• Shoulder dislocation
• Hip dislocation
• Patellar dislocation

Other

• Suturing techniques
• Slings: 
• Broad/high arm
• Polysling
• Dressings:
  • Buddy strapping
  • Finger dressing
  • Adaptic digit
• POP application:
  • Upper limb
  • Lower limb
• Walking boot
• Use of crutches

The Kendrick link is Defence Medical Command guidance for deployed care; use your own device instructions and local indications.

Before a block, confirm the indication, correct side, baseline neurological findings, contraindications and the total local anaesthetic dose. Use the local block safety check, appropriate monitoring and an agreed rescue plan for local anaesthetic toxicity.

• RCEM — fascia iliaca block guideline (October 2025)
• RCEM — Bier’s block guidance (revised November 2017)
• Association of Anaesthetists — local anaesthetic toxicity guidance

The Bier’s block document is an older RCEM resource; follow your department’s current IV regional anaesthesia policy and competency requirements.

Practical teaching and procedure links

• Facial blocks
• Bier’s block
• Haematoma block
• Wrist blocks: landmark / ultrasound
• Digital nerve blocks
• Fascia iliaca block: RCEM 2025 guidance, including landmark and ultrasound approaches
• Ultrasound-guided femoral nerve block
• Ankle blocks: landmark/ultrasound

NG tube placement: confirm and document position using the approved aspirate-pH or X-ray pathway before putting anything through the tube. NHS England identifies pH 1–5.5 or appropriately interpreted X-ray as acceptable initial checks; auscultation after injecting air is not a safe confirmation method.

• NHS England — enduring nasogastric-tube safety standards

For nasal packing, use the instructions for the exact product and arrange an appropriate review/removal plan. For ultrasound, use a defined clinical question, document findings and limitations, and work within your training.

Practical teaching and procedure links

• Handwashing
• Personal protective equipment
• NG tube placement
• Rapid Rhino nasal packing
• Peak expiratory flow rate
• POCUS