Knowledge

Generic
Patient selection - indications, contraindications and potential complications of the procedure / intervention
Universal precautions and preventative infection control techniques (hand washing, gloves, protective clothing, sharps disposal etc.)
Principles of aseptic technique and aseptic handling of invasive medical devices
Methods and routes of insertion - associated indications and complications
Appropriate use of drugs to facilitate the procedure
Detection of potential physiological alterations during the procedure
Indications for specific monitoring to ensure patient safety during an intervention / procedure
Complications of the technique, how to prevent/recognise them and initiate appropriate treatment
Methods of sterilisation and cleaning or disposal of equipment
Management and use of the device once in situ necessary to minimise the risks of complications
Indications and technique for removal

Respiratory System
Signs, symptoms and causes of acute airway insufficiency and indications for intervention
Methods of maintaining a clear airway
Indications, selection and insertion of oral (guedel) airways, nasopharyngeal airways and laryngeal mask airways (LMA)
Tracheal intubation: selection of tube type, diameter & length; indications and techniques; methods to confirm correct placement of a tracheal tube
Monitoring during sedation/induction of anaesthesia for endotracheal intubation
Airway management in special circumstances, (head injury, full stomach, upper airway obstruction, shock, cervical spine injury)
Causes of regurgitation and vomiting; prevention and management of pulmonary aspiration
Cricoid pressure: indications and safe provision
Management of difficult intubation and failed intubation (local algorithm or protocol)
Indications for and principles of fibreoptic intubation; use of fibreoptic intubation with airway adjuncts
Indications and methods of securing an emergency surgical airway
Indications and techniques for needle and surgical crycothyroidotomy
Indications and contraindications to tracheostomy (percutaneous and surgical) and minitracheostomy
Techniques for percutaneous and surgical tracheotomy
Management of and complications associated with tracheostomy tubes
Principles of endotracheal suctioning
Consequences of the procedure during ventilation
Indications, contraindications and complications of oxygen therapy
Environmental hazards associated with storage and use of oxygen; strategies to promote safety
Use of pipeline gas and suction systems
Storage and use of oxygen, nitric oxide (NO), compressed air and helium, including use of gas cylinders
Principles of pressure regulators, flowmeters, vaporizers and breathing systems
Indications for and operation of fixed and variable performance oxygen therapy equipment, humidification and nebulising devices
Indications for different modes of ventilation and operation of at least one positive pressure ventilator, one non-invasive ventilator, and a constant positive airway pressure (CPAP) device
Indications and complications of hyperbaric oxygenation
Methods of bronchoscopy via an endotracheal tube
Methods of bronchoscopic broncho-alveolar lavage (BAL) in an intubated patient
Safety and maintenance of flexible fibreoptic endoscopes
Detection and management of haemo/pneumothorax (simple and tension)
Insertion and management of chest drains and air exclusion devices
Patient groups at risk who may require chest drain placement under ultrasound or CT guidance

Cardiovascular System
Surface anatomy: structures in the antecubital fossa; large veins and anterior triangle of the neck; large veins of the leg and femoral triangle; arteries of the arms and legs
Methods for securing vascular access rapidly
Principles, routes and techniques of peripheral and central venous cannulation
Principles and techniques for surgical isolation of a vein or artery
Methods for insertion of a tunnelled central venous catheter (e.g. for parenteral nutrition)
Indications, contraindications, and complications of peripheral intravenous infusion / injection and central venous infusion / injection
Principles of arterial catheterisation
Allens test - application & limitations
Recognition and management of inadvertent intra-arterial injection of harmful substances
Principles of haemodynamic monitoring - invasive & non invasive methods, indications & limitations, physiological parameters and waveform interpretation
Invasive & non-invasive systems available for measuring cardiac output and derived haemodynamic variables, the principles involved and the type and site of placement of the monitoring device
Interpretation of, relationships between, sources of error and limitations of measured and derived cardiovascular variables including pressure, flow, volume and gas transport
Indications, limitations and complications of techniques of measurement of cardiac output (e.g. pulmonary artery catheters, oesophageal Doppler, PiCCO, LiDCO) and action to prevent them
Principles of ECG monitoring (heart rate, rhythm, conduction, ST segment change & QT interval) - indications, limitations and techniques. Advantages and disadvantages of different lead configurations
Principles and techniques of cardiac pacing
Detection and acute management of cardiac tamponade
Anatomical landmarks and technique for percutaneous pericardial aspiration

Central Nervous System
Physiological effects of pain and anxiety
Recognition and methods of assessment of pain
Indications, contraindications, methods and complications of epidural catheterisation
Indications, contraindications and complications of epidural infusion / injection; principles of safe epidural drug administration
Contraindications, methods and complications of epidural catheter removal
Indications for lumbar puncture and CSF sampling; laboratory analysis of CSF samples

Gastrointestinal System
Principles of nasogastric cannulation in the intubated and non-intubated patient
Principles and techniques for insertion of gastro-oesophageal balloon tamponade tube (e.g. Sengstaken-Blakemore)
Principles of peritoneal lavage
Indications, contraindications, complications and technique of abdominal paracentesis
Alternative routes for enteral feeding: indications, contraindications and complications of post-pyloric and percutaneous feeding tube placement

Renal / Genitourinary System
Urinary catheterisation techniques: transurethral and suprapubic
Urinary catheterisation in pelvic trauma: indications, contraindications and techniques

Skills & Behaviours

Generic
Prioritise tasks and procedures
Select appropriate equipment or device & use resources efficiently
Prepare equipment, patient and staff prior to undertaking the procedure
Obtain informed consent/assent from the patient where appropriate
Use drugs as indicated to facilitate the procedure
Choose an appropriate route / method of insertion and position the patient accordingly
Identify relevant anatomical landmarks
Use protective clothing (gloves / mask / gown / drapes) as indicated
Perform the procedure in a manner which minimises the risks of complications
Undertake appropriate investigation to confirm correct placement of device or exclude complications
Sterilise, clean or dispose of equipment appropriately
Recognise and manage emergencies; seek assistance appropriately
Lead, delegate and supervise others appropriately according to experience and role

Respiratory System
Manage anaesthesia and control the airway during initial tracheostomy tube insertion in the intensive care unit (ICU)
Accurately assess the airway for potential difficulties with airway management
Choose a safe environment to undertake airway management (or optimise environment as circumstances allow)
Optimise the patient's position for airway management
Maintain a clear airway using oral / nasal airways
Support ventilation using bag and mask
Insert and check correct placement of laryngeal mask airway
Select appropriate tracheal tube type, size and length
Perform intubation and verify correct placement of tube
Manage and minimise cardiovascular and respiratory changes during and after intubation
Apply an end-tidal CO2 detector post-intubation and interpret a capnograph trace
Demonstrate rapid sequence induction of anaesthesia / cricoid pressure
Change an orotracheal tube
Perform extubation
Prepare equipment for difficult or failed intubation
Demonstrate failed intubation drill (according to local algorithm or protocol)
Demonstrate minitracheotomy or needle crico-thyoidotomy
Change a tracheostomy tube electively
Identify patients requiring tracheostomy; discuss indications and contraindications for percutaneous tracheostomy
Perform endotracheal suction (via oral / nasal / tracheostomy tube)
Check pipelines; check and change portable cylinders
Undertake bronchoscopy to assess tube position
Undertake bronchoscopy to perform bronchoalveolar lavage
Demonstrate aseptic insertion of an intrapleural chest drain and connection to a one-way seal device
Demonstrate emergency relief of tension pneumothorax

Cardiovascular System
Insert peripheral cannulae via different routes
Establish peripheral venous access appropriate for resuscitation in major haemorrhage
Insert central venous catheters by different routes
Describe a method for tunnelled intravenous catheterisation
Minimise blood loss related to clinical investigations and procedures
Insert arterial catheters by different routes
Distinguish between arterial and venous blood samples
Prepare equipment for intravascular pressure monitoring
Insert a temporary pacing wire
Demonstrate emergency percutaneous pericardial aspiration
Establish & review pacing box settings
Use manual external defibrillators
Use automated external defibrillators (AED)

Central Nervous System
Select an appropriate epidural infusion regimen and titrate safely
Select & determine adequacy and route of administration of analgesia
Manage an established epidural infusion
Administer bolus analgesia via an epidural catheter
Minimise complications associated with opioid and non-opioid analgesics

Gastrointestinal System
Insert a nasogastric tube in an intubated and non-intubated patient
Insert an abdominal drain

Renal / Genitourinary System
Perform aseptic urinary catheterisation: male and female

Attitudes

Generic
Recognises personal limitations, seeks and accepts assistance or supervision (knows how, when and who to ask)
Considers patient comfort during procedures / investigations
Desire to minimise patient distress
Accepts personal responsibility for the prevention of cross infection and self infection
Supports other staff in the correct use of devices
Promotes respect for patient privacy, dignity and confidentiality


Basic Sciences also underpin the competencies within this domain. These are presented in full in the Basic Sciences Syllabus.