Clinic Practice III OSCE

nitrous oxide before setup step 1

• collect patient payment BEFORE obtaining nitrous oxide cylinders from the dispensary

  • the dispensary will require proof of payment before releasing cylinders

nitrous oxide before setup step 2

• gather equipment and supplies

  • nitrous oxide and oxygen cylinders

  • tubing (black/gray hose and white vacuum hose)

  • reservoir bag (balloon)

  • filter (blue)

  • appropriate size nose piece (small medium or large)

nitrous oxide before setup step 3

• inspect and disinfect equipment

  • wipe down cylinders and equipment

  • when opening sterilized tubing packages, ensure all items have been reoved from the package

nitrous oxide before setup set up step 4 (final)

• obtain and record baseline vital signs immediately BEFORE administrations

nitrous equipment set up step 1

• connect vacuum system

1. locate the white vacuum hose

2. insert the appropriate end into the high-volume evacuation (HVE) port

3. connect the opposite end of the vacuum hose to the scavenging tubing attaches to the nose piece assembly

4. turn on the HVE and verify it is functioning properly by listening for a hissing sound

5. HVE MUST remain on for the entire appointment

nitrous equipment set up step 2

• connect the main nitrous hose

1. locate the black/gray hose

2. attach one end to the nitrous oxide delivery unit

3. attach the opposite end to the filter tip assembly

nitrous equipment set up step 3

• attach the filter tip and reservoir bag

• connect the filter tip to the delivery unit near the reservoir bag

nitrous equipment set up step 4

• attach and size the nose piece

1. select the appropriate nose piece size for the patient

2. connect the nose piece to the tubing assembly

3. check for any gas leaks

4. place the nose piece securely over nose

turning nitrous on

1. open the cylinder valve according to manufacturer instructions

2. push the control knob inward and turn it to the left to start gas flow (oxygen at 100% first, 6-8 L then nitrous)

3. confirm the gauge activate

4. observe the reservoir bag

   1. should inflate and deflate with breathing, confirms proper airflow and patient respiration

during nitrous administration

1. never leave patient unattended, a certified instructor must be with the patient at all times

2. continuously monitor the patient

3. observe for signs of discomfort or adverse reactions throughout treatment

discontinuing nitrous oxide

1. approximately 10-20 minutes before the end of the appointment, discontinue nitrous oxide

2. administer 100% oxygen for a minimum of 5 minutes before dismissing patient

3. continue monitoring the patient during oxygenation period

turning nitrous oxide off

1. reduce the nitrous oxide flow to zero

2. push the control knob inward, turn it to the right, then pull outward to shut off gas flow

3. close the cylinder valves

4. confirm all gauges return to zero

5. verify the system is completely shut down before disconnecting equipment

post-procedure cleanup nitrou

1. remove and discard the nose piece and filter tip

2. disinfect (wipe down)

   1. tubing

   2. delivery unit surfaces

   3. gauge surfaces

   4. reservoir bag exterior as appropriate

3. wipe down all equipment according to clinic infection control procedures

4. return cylinders and equipment to the designated storage area

before nitrous set up

1. collect patient payment before obtaining nitrous oxide cylinders from the dispensary

2. gather equipment and supplies

3. inspect and disinfect equipment

4. obtain and record baseline vital signs before administration

nitrous equipment set up

1. connect vacuum system

2. connect main nitrous hose

3. attach the filter tip and reservoir bag

4. attach and size the nose piece

5. turn nitrous oxide on

sharpening Gracey curette odd-numbered end

• hold instrument vertically in non-dominant hand and start with end of curette with toe facing you and the cutting edge facing away from the arm

• place the terminal shank a few minutes before 12, with the sharpening stone 3 minutes after twelve

• proceed with sharpening in a straight line heel→ toe. DO NOT rotate stone

• to round toe, rotate instrument toe to face the 3 o’clock position and place sharpening stone below instrument angled to 2 o clock

• rotate stone around toe

• place cylindrical stone and roll along face of stone

sharpening Gracey curette even numbered side

• hold instrument vertically in non-dominant hand and start with end of curette with toe facing away from you and the cutting edge facing away from the arm

• place the terminal shank a few minutes before 12, with the sharpening stone 3 minutes after twelve

• proceed with sharpening in a straight line heel→ toe. DO NOT rotate stone

• to round toe, rotate instrument toe to face the 3 o’clock position and place sharpening stone below instrument angled to 2 o clock

• rotate stone around toe

• place cylindrical stone and roll along face of stone

sharpening sickle scalers

• do not sharpen face of the blade

• stone will be moved from heel→ toe

• hold instrument in non-dominant hand with a firm palm grasp

• hold instrument vertically at 12 o’clock with the instrument tip facing you

• place stone at 3 minutes past 12 o’clock

• finish on a downward stroke

• to sharpen opposite end, rotate instrument to where the tip is facing away from you

explorer

• 11 / 12 diagnostic explorer (old dominion tip)

• EXD 11/127

probe

• Shepard’s hook explorer and probe Expro

• XP23/NC 127

universal curettes

• Barnhart 5/6 or Columbia 13/14

• Barnhart has a long, deep shank whereas Columbia has a shorter, more curved shank and blade (“C” shape)

Anterior sickle

• double ended-jackette (right angled, square sickle) and sickle scaler

• SH5/33XE2

Posterior sickle scaler

• 204SXE2

mini area-specific gracey

• SAS 1/2R9E2

mesial area-specific gracey curettes

• SG 11/12E2

• SG 15/16

distal area-specific gracey curettes

• SG 13/149E2

• SG 17/18

anterior nevi/ perio file

• SCNEVI1XE2

posterior nevi

• SCNEVI4XE2

furcation probe

• PQ2N7

sharpening universal curettes

• hold instrument vertically in non-dominant hand and start with end of curette with toe facing you and the cutting edge facing away from the arm

• place the terminal shank at 12, with the sharpening stone 3 minutes after 12

• proceed with sharpening in a straight line heel→ toe. DO NOT rotate stone

• to round toe, rotate instrument toe to face the 3 o’clock position and place sharpening stone below instrument angled to 2 o clock

• rotate stone around toe

• place cylindrical stone and roll along face of stone