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Table 3 Final INEXTUS instrument

From: Validation of an instrument for the evaluation of exchange transfusion (INEXTUS) via an OSCE

Station 1. Clinical history and risk approach of the patient with neonatal jaundice Yes No
 1. The student identifies background of pregnancy and childbirth
  a. Inquires about obstetric care and birth spacing   
  b. Asks about history of the evolution of previous pregnancies (emphasis on abortions, deaths or stillbirths)   
  c. Asks about pathological history during pregnancy (UTI, infections, preeclampsia, tropical exanthematous diseases)   
  d. Inquires about the number of prenatal check-ups and when they started   
  e. Determines the gestational and chronological age of the patient   
 2. Review prenatal exams (Complete blood count, serology, blood typing and indirect Coombs, thyroid stimulating hormone, ultrasound. Others according to particular case)   
 3. The student identifies history and risk factors for severe neonatal jaundice   
  a. Jaundice in the first 24 h   
  b. Group incompatibility—verifies maternal and neonatal blood typing   
  c. Coombs positive   
  d. Gestational age from 35 to 37 weeks   
  e. Family history of haemolytic disease   
  f. Clinical factors: cephalohaematoma and exclusive breastfeeding   
  g. History of maternal blood ingestion   
Percentage of skills met at Station 1: _____%   
Station 2. Comprehensive evaluation of the patient with jaundice Yes No
 1. Evaluates skin and mucosal colouration describing percentage of extent of involvement   
 2. Evaluates signs and symptoms of acute hyperbilirubinemic encephalopathy
  a. Hypotonia   
  b. Lethargy   
  c. Poor suction   
 3. Evaluates signs and symptoms compatible with haemolysis
  a. Evaluates vital signs of the new-born   
  b. Evaluates state of consciousness   
  c. Performs abdominal palpation to rule out hepatomegaly   
Percentage of skills met at Station 2: _____%   
Station 3: Definition of clinical behaviour Yes No
 1. The student determines the use of paraclinical tests and requests:
  a. Complete Blood Count. (CBC)   
  b. Total and direct bilirubin levels   
  c. Direct Coombs test of the new-born   
  d. Reticulocytes   
  e. Peripheral blood smear   
 2. The student performs the comprehensive interpretation of the data and classifies the patient
  a. Classifies the type of hyperbilirubinemia according to the results as severe   
  b. Orders immediate intensive phototherapy   
 3. Indicates that exchange transfusion is required according to the use of the nomogram   
 4. The student explains the behaviour to the parents and resolves their concerns   
 5. Sign informed consent   
Percentage of skills met at Station 3: _____%   
Station 4. Preparation of the equipment for the procedure Yes No
 1. The student verifies that he or she has the appropriate personnel to perform the procedure (head nurse and nursing assistant)   
 2. Properly selects the catheter
  i. Preterm: 2.5f; Near-term: 5f; At term: 5-7f   
 3. Requests, prepares and verifies equipment for catheter passage (Gloves, gauze, sterile gown and drapes, mask, cap, cloths, sterile gauze, scalpel blades, 3 and 4 zero floss, syringes loaded with heparinized serum, chlorhexidine solution, surgical team) 1 2
 4. Request, prepare and verify equipment for exchange transfusion   
  i. 5,10 and 20 ml Syringes   
  ii. Three-way stopcocks   
  iii. Bag to dispose of blood and metal support to hang it   
  iv. Pipes to connect the systems   
 5. The student requests the blood from the laboratory and verifies it when it is delivered
  i. Properly requests blood according to group and Rh compatibility   
  ii. Request fresh blood less than 5 days old   
 6.The student determines the type of fluid to be used and the volume of replacement
  i. The student performs the adequate calculation of the replacement volume considering the diagnosis of the patient (5 cc in premature infants, 10 cc at term)   
Percentage of skills met at Station 4: _____%   
Station 5. Performance of exchange transfusion Yes No
 1. The student verifies the conditions of the patient and monitors vital signs
  i. Check blood pressure   
  ii. Heart rate   
  iii. Respiratory rate   
  iv. Oxygen saturation   
 2. The student performs the umbilical catheter passage appropriately
  i. Verify the distance at which the catheter will be inserted   
  ii. Follow the rules of asepsis and antisepsis for performing the procedure   
  iii. Adequately and successfully introduces the catheter to the previously determined site   
  iv. Check its permeability   
  v. Fix the catheter   
  vi. The student requests images to verify the position of the catheter (Request an abdominal x -ray)   
 3. The student performs the exchange transfusion sequentially and in an orderly manner
  i. Properly connect the exchange transfusion system   
  ii. Complies with the order of introducing the aliquot—blood extraction in the stipulated time and volume   
  iii. Instructs the help staff to record in detail the meticulous aliquot process   
 4. The student orders post-exchange transfusion monitoring to detect the appearance of early complications   
 5. The student requests diagnostic testing at the end of the procedure and 6 h after it (blood count, bilirubins and serum electrolytes)   
Percentage of skills met at Station 5: _____%   
Station 6. Information to parents Yes No
 1. The student reports the results of the procedure to the parents   
Percentage of skills met at Station 6: _____%