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Domain 5 : Practical procedures
Practical procedures underpin all forms of organ system support. All these competencies will include, where relevant, attention to:


By the end of specialist training, the trainee...

5.1 Administers oxygen using a variety of administration devices
5.2 Performs fibreoptic laryngoscopy under supervision
5.3 Performs emergency airway management
5.4 Performs difficult and failed airway management according to local protocols
5.5 Performs endotracheal suction
5.6 Performs fibreoptic bronchoscopy and BAL in the intubated patient under supervision
5.7 Performs percutaneous tracheostomy under supervision
5.8 Performs thoracocentesis via a chest drain


By the end of specialist training, the trainee...

5.9 Performs peripheral venous catheterisation
5.10 Performs arterial catheterisation
5.11 Describes a method for surgical isolation of vein / artery
5.12 Describes ultrasound techniques for vascular localisation
5.13 Performs central venous catheterisation
5.14 Performs defibrillation and cardioversion
5.15 Performs cardiac pacing (transvenous or transthoracic)
5.16 Describes how to perform pericardiocentesis
5.17 Demonstrates a method for measuring cardiac output and derived haemodynamic variables

Central Nervous System:

By the end of specialist training, the trainee...

5.18 Performs lumbar puncture (intradural / 'spinal') under supervision
5.19 Manages the administration of analgesia via an epidural catheter


By the end of specialist training, the trainee...

5.20 Performs nasogastric tube placement
5.21 Performs abdominal paracentesis
5.22 Describes Sengstaken tube (or equivalent) placement
5.23 Describes indications for, and safe conduct of gastroscopy

Renal / Genitourinary system:

By the end of specialist training, the trainee...

5.24 Performs urinary catheterisation

Features of competent performance

  • Consider indications, contraindications & complications of the procedure
  • Prior planning & preparation of patient (including consent), staff and equipment
  • Prioritisation of tasks (patients and procedures)
  • Consider comfort of the patient
  • Awareness of relevant applied anatomy and physiology
  • Correct placement / insertion technique - alternative modes and methods
  • Attention to safety: safe use of equipment, infection control, confirmation of correct placement, prevention / management of complications 
  • Maintenance and safe use of devices - troubleshooting
  • Consider duration of placement, discontinuation and removal
  • Appropriate referral / consultation
  • Recognition of limitations (self and others)
All competencies
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Note that the "Resources" that are included in this page, have not been updated in the recent years. An updated collection of useful resources will be available soon as part of the ESICM Academy (for more details, see www.esicm.org).

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