🏥 OSCE Checklist — Venous Cutdown (Greater Saphenous Vein)
✅ Correct: 2
⚠️ Partial: 1
❌ Not Done: 0
🤝 Domain A: Introduction & Communication (1-6)
| # | Checklist Item | Score |
|---|---|---|
| 1 | Introduces self — states name and designation clearly to the patient | |
| 2 | Explains procedure — small surgical cut to access vein for emergency access | |
| 3 | Explains indication — shock, collapsed veins, or emergency fluid resuscitation | |
| 4 | Explains risks — mentions infection, nerve injury, bleeding, and hematoma | |
| 5 | Obtains informed consent — ensures understanding and agreement | |
| 6 | Reassures patient — addresses questions and concerns before starting |
🧠 Domain B: Knowledge (7-13)
| # | Checklist Item | Score |
|---|---|---|
| 7 | States indications — shock, burned/scarred, failed peripheral IV, drug users | |
| 8 | States contraindications — active infection, coagulopathy, iliac vein avulsion | |
| 9 | Identifies sites — Greater Saphenous (MC), Basilic, Cephalic | |
| 10 | Identifies GSV landmark — 1cm anterior & 1cm superior to medial malleolus | |
| 11 | Names nerve at risk — Saphenous nerve (parallel to GSV) | |
| 12 | Lists equipment — scalpel, hemostats, silk, cannula, antiseptic, lidocaine, fluid | |
| 13 | States catheter removal time — within 12–24 hours to avoid complications |
🖐️ Domain C: Psychomotor / Procedural Steps (14-33)
| # | Checklist Item | Score |
|---|---|---|
| 14 | Prepare IV line — removes air from tubings and hangs it on IV stand | |
| 15 | Wears PPE correctly — sterile gown, mask, eye protection, sterile gloves | |
| 16 | Positions patient correctly — supine with leg slightly rotated externally | |
| 17 | Antiseptic prep — applies povidone-iodine in circular outward motion | |
| 18 | Sterile draping — ensures medial malleolus remains visible as landmark | |
| 19 | Administers local anesthesia — 1% lidocaine (subcutaneous infiltration) | |
| 20 | Makes correct skin incision — 3cm transverse at identified landmark | |
| 21 | Blunt dissection — identifies GSV through subcutaneous tissue | |
| 22 | Isolates GSV — avoids saphenous nerve; gentle tissue handling | |
| 23 | Places two silk suture ties — proximal and distal around the vein | |
| 24 | Lifts vein using slings for counter-traction before venotomy | |
| 25 | Performs venotomy — No.15 blade, approx 40% of vein diameter | |
| 26 | Inserts cannula — carefully into venotomy and advances proximally | |
| 27 | Confirms placement — checks blood return or flushes with saline | |
| 28 | Secures cannula — proximal tie around hub; distal vein ligated | |
| 29 | Connects IV fluids — attaches tubing from prepared line | |
| 30 | Verifies flow — ensures IV drip is running properly | |
| 31 | Wound closure — skin sutures and secures tubing to skin | |
| 32 | Applies sterile dressing over the wound site | |
| 33 | Disposes sharps and waste safely and appropriately |
💬 Domain D: Attitude & Professionalism (34-39)
| # | Checklist Item | Score |
|---|---|---|
| 34 | Maintains sterile field — no breaks in aseptic technique | |
| 35 | Handles tissues gently — avoids rough or careless manipulation | |
| 36 | Works systematically and calmly under pressure | |
| 37 | Communicates with patient/team throughout the procedure | |
| 38 | Responds to complications correctly — (e.g., if artery hit) | |
| 39 | Aftercare explanation — complications and removal time |
📊 OSCE PERFORMANCE SUMMARY
| Domain | Score | Max | % | Status |
|---|
Common Mistakes Made by Students
- ❌ Wrong landmark — Not placing incision correctly (must be 1 cm anterior + 1 cm superior to medial malleolus)
- ❌ Too deep initial incision — Cutting directly into the vein instead of performing blunt dissection
- ❌ Forgetting two suture ties — Placing only one silk suture or placing both on the same side (proximal OR distal)
- ❌ Venotomy too large — Making an incision >50% of the vein diameter, causing the vein to tear
- ❌ Forgetting to tie the distal suture before venotomy — leads to backflow/bleeding
- ❌ Breaking sterile field — Touching unsterile surfaces, poor glove technique, improper draping
- ❌ Ignoring the saphenous nerve — Not mentioning or protecting it during dissection
- ❌ Not confirming cannula placement — Skipping blood return/saline flush step
- ❌ Skipping consent or giving a rushed, incomplete explanation
- ❌ Not securing the cannula — Forgetting to tie the proximal suture around the hub
- ❌ Forgetting wound closure — Leaving the incision open after cannula placement
- ❌ Not mentioning catheter removal time (12–24 hours) during post-procedure counselling
- ❌ Poor communication — Speaking to the manikin/model like an object, not a patient
What the Examiner Particularly Wants to See
Examiners in OSCE specifically look for these high-yield points:
- Correct anatomy knowledge — Exact GSV landmark (1 cm anterior + 1 cm superior to medial malleolus) and awareness of the saphenous nerve
- The TWO suture technique — Proximal and distal silk ties placed correctly before venotomy; this is a classic examiner focus point
- Venotomy precision — 40% transverse diameter, not more; shows surgical judgment
- Sterile technique — Any break in asepsis is an automatic concern; examiners watch gloves, draping, and instrument handling closely
- Confirmation of cannula placement — Blood return or saline flush; many students skip this
- Emergency mindset — Can the student verbalize what to do if percutaneous access fails, in a calm and systematic manner?
- Complication awareness — Especially saphenous nerve injury, air embolism, and thrombophlebitis
- Communication quality — Does the student actually speak to the patient as a human being, or just perform steps mechanically?
- Indication to remove catheter — Mentioning 12–24 hour removal shows depth of clinical knowledge
- Holistic flow — A smooth, uninterrupted sequence from preparation → procedure → closure → aftercare without needing to be prompted