Invasive Procedures

Procedures are not a major emphasis of the Medicine Clerkship, but performing them is a service to your patients and your team. Procedures are performed under the supervision of a physician, usually an intern or resident. Procedures fall into three groups:

A. Procedures that require direct supervision: the supervising physician must be physically present during the procedure.
  • Arterial blood gas
  • Central venous catheter
  • Thoracentesis
  • Paracentesis
  • Lumbar puncture
  • Nasogastric lavage
  • Bladder catheter insertion
  • Dressing wounds
  • Basic wound laceration
B. Procedures that require general supervision: the supervising physician must be aware that you are doing the procedure, but need not be physically present. When you first perform these procedures, you should do so under direct supervision. When you can perform them competently, you may perform them under general supervision.
  • Venipuncture
  • Intravenous catheter (peripheral vein)
  • Skin testing (for example, PPD)
C. Procedures that students should not perform: all others
In particular, clerkship students should not administer parenteral medications

For all procedures, the student should:
  • Understand the indications, contraindications, and possible complications of the procedure.
  • Observe it being performed.
  • Ask your resident if he or she would supervise you in performing the procedure. Gather all the materials and perform the procedure under direct supervision.
  • Obtain appropriate consent. Written consent is required for some procedures and must be obtained by a licensed physician.
  • As you become more accomplished in phlebotomy and IV catheter placement, you may perform these under indirect supervision. All other procedures should be performed under direct supervision.

The New England Journal of Medicine has created excellent on-line video demonstrations of certain procedures. The links are:
 
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