With the beginning of the academic year, senior residents find themselves in a teaching role for procedures. Seniors, make sure you discuss these things with your intern to set yourselves up for success! For any procedure, from a central line to a paracentesis, find out:

1. Vitals are always vital! What are the most recent set of vitals? If the procedure is a central line for pressors, that should most likely be the first priority.

2. Was this procedure attempted or completed before? If so, was there any difficulty? For example did the patient have to be taken to IR for a central line due to difficulties with the bedside procedure? This could guide next steps and inform if this should be done again.

3. What is this indication this time? For example, is the paracentesis diagnostic and therapeutic? Helps with time management as well.

4. Did you get consent from the correct individual (patient, guardian, etc.)? Is it uploaded into the chart?

5. Did you look at the site with ultrasound and set up the room? We must be aware of patient and provider comfort and safety. Be mindful of tension on IV lines, consider turning off tube feeds, be sure oxygen and telemetry if applicable will always be connected, etc.

6. Is the patient allergic to anything being used in the procedure? Such as Lidocaine? If so, alternatives must be sought and discussed as soon as possible.

7. Have coags, hemoglobin, platelets been checked and are they appropriate for the procedure (goal INR <2, hemoglobin >7, platelets >50k)?

8. As for intra-procedure guidance, does the team have a runner for supplies? Someone to help/comfort the patient? A set of unsterile gloved hands if need be? Is the ultrasound plugged in so it doesn’t go off during the procedure?

Now go do some safe and successful procedures! #MedTwitter what further guidance do you have for supervising procedures?