Section H Examinations & Procedures

Nov 18, 2025
8 min read

Index

Introduction
Systematic Wound Assessment
Aseptic Wound Cleansing
Principles of Dressing Selection and Application
Recognising and Managing Wound Infection
Wound Closure: Steristrips, Skin Glue and Sutures
Safe Suture Removal
Knowing When to Refer
Using Local Anaesthesia in Minor Procedures
Core Clinical Observations and Bedside Monitoring
Interpreting Urinalysis and Pregnancy Tests
Conducting an Audiogram
Safe Specimen Collection and Handling
Key Clinical Reflections and Skills Gained

1. Introduction

Effective wound care and basic clinical assessment skills sit at the heart of safe frontline practice. From wound assessment and closure to bedside observations, urinalysis and specimen handling, each step has a direct impact on patient safety, healing, and clinical decision-making.

At Kraken Medical, we believe that structured, practical skills like these are what turn protocols into confident, competent practice. This article draws together core competencies around wound management and everyday clinical observations, translating them into a clear, stepwise approach suitable for clinicians working in demanding environments – whether at sea, in primary care, occupational health, or remote settings.

2. Systematic Wound Assessment

A structured approach to wound assessment ensures no key element is missed and allows progress to be tracked over time.

1. Size, depth and edges

Measure length, width and depth using a consistent method.
Examine wound edges for inflammation, maceration, separation or irregularity. Poorly approximated or undermined edges may signal delayed healing or infection.

2. Colour and tissue viability

Healthy granulation tissue is usually pink or red.
Dark, grey, green or black areas may indicate necrosis, poor perfusion or heavy infection in the wound bed or surrounding skin.

3. Exudate and discharge

Note volume, colour and consistency (e.g. serous, sanguineous, purulent).
Changes in exudate can mark a shift in healing phase or signal infection.

4. Signs of infection

Increased redness, warmth, swelling, pain or localised tenderness.
Pus, foul odour or systemic features such as fever or malaise.
Red streaking may indicate lymphangitis and spreading infection.

5. Healing progress over time

Is the wound becoming smaller and shallower?
Is there evidence of granulation and epithelialisation?Regular review and comparison with previous documentation are essential.

6. Communication and documentation

Discuss complex or concerning findings with colleagues and wound care specialists.
Record measurements, tissue type, exudate, surrounding skin condition and interventions.
Clear documentation enables continuity of care and early recognition of deterioration.

7. Patient education

Explain the wound findings in understandable language.
Teach signs of infection, the importance of dressing care, and when to seek review.

3. Aseptic Wound Cleansing

Maintaining aseptic technique is critical to preventing iatrogenic infection.

Hand hygiene: Perform thorough handwashing or use an alcohol-based rub before and after the procedure.
Preparation: Gather sterile supplies (cleansing solution, gauze, dressings, sterile gloves, drapes) and explain the procedure to the patient.
Sterile field: Use sterile drapes/towels to create a controlled work area.
Sterile gloves: Apply correctly while maintaining asepsis.
Cleansing technique:
- Use sterile solution (as per local protocol).
- Work from the cleanest area (centre of wound) outwards.
- Use a new swab for each stroke to avoid reintroducing contaminants.
Drying: Gently pat dry with sterile gauze – avoid rubbing fragile tissue.
Waste disposal: Discard used materials into appropriate clinical waste streams.
Documentation: Record the solution used, wound appearance and patient tolerance.

4. Principles of Dressing Selection and Application

The right dressing supports a moist, protected environment that promotes optimal healing.

Stepwise approach:

Preparation and consent
- Position the patient comfortably and ensure privacy.
- Obtain informed consent and explain sensations to expect.
Hand hygiene and PPE
- Perform hand hygiene and apply sterile gloves.
Remove old dressing
- Use aseptic technique, observing the previous dressing for odour, discharge and adherence – these findings inform your assessment.
Cleanse if needed
- Irrigate or gently cleanse as guided by protocol and wound type.
- Pat dry with sterile gauze.
Choose an appropriate dressing
- Consider wound size, depth, exudate level, location and healing stage.
- Options may include gauze, adhesive films, hydrocolloids, foams or advanced dressings.
Apply and secure
- Cover the entire wound with a margin beyond the edges.
- Avoid touching the sterile surface that will contact the wound.
- Secure with adhesive strips or tape without excessive pressure.
Patient education and documentation
- Advise on keeping the dressing clean/dry, when to return, and red-flag symptoms.
- Document dressing type, wound status and any concerns.

5. Recognising and Managing Wound Infection

Early recognition of infection prevents complications such as cellulitis, abscess formation and systemic sepsis.

Key signs and symptoms:

Increasing redness and swelling beyond the original wound margins
Local warmth and escalating pain or throbbing
Purulent or cloudy discharge and/or foul odour
Delayed or regressing healing
Fever or systemic malaise
Red streaks moving proximally (suggesting lymphatic spread)
Tissue colour changes to grey, green or dark shades

Action:

Reassess the wound thoroughly and consider taking a swab or culture if indicated by local policy.
Escalate to an appropriate clinician for antimicrobial decisions.
Adjust wound care (e.g. more frequent dressing changes, different dressing type) and monitor closely.
Document findings, interventions and escalation steps.

6. Wound Closure: Steristrips, Skin Glue and Sutures

Selecting the right closure method balances wound strength, infection risk and cosmetic outcome.

Steristrips (adhesive skin closure strips)

Ideal for small, superficial wounds with low tension and clean edges.
Bring wound edges together without puncturing the skin.
Often chosen where cosmetic outcome is important or sutures are unnecessary.

Skin glue (tissue adhesive)

Forms a protective film holding clean, low-tension wound edges together.
Useful for minor lacerations and small surgical incisions.
Non-invasive and quick to apply; naturally peels off as healing progresses.

Sutures

Provide strong mechanical support for deeper, larger or higher-tension wounds.
Available in absorbable and non-absorbable materials, chosen according to location and tissue type.
Commonly required in areas with movement (joints, limbs) or where layered closure is needed.

Key considerations:

Wound characteristics: size, depth, contamination, tension, location.
Cosmetic concerns: face and visible areas may favour glue or Steristrips where appropriate.
Patient factors: allergies, comorbidities, ability to comply with aftercare.
Follow-up: ensure clear plan for review and, where relevant, suture removal.

7. Safe Suture Removal

Suture removal should be painless, clean and preserve the integrity of the healed wound.

Procedure essentials:

Confirm that the expected healing time for that anatomical area has passed and assess for adequate closure.
Check for any signs of infection or dehiscence.
Prepare equipment: sterile removal scissors, forceps, gloves, good lighting.
Maintain aseptic technique with hand hygiene and sterile gloves.
Gently lift the suture knot with forceps and cut close to the skin on the side that has been exposed to the least contamination.
Withdraw the suture smoothly in the direction that minimises stress on the wound.
Observe the wound as each suture is removed; if separation occurs, seek senior review.
Provide aftercare advice – wound support (e.g. Steristrips if needed), hygiene, and when to return.
Document date, number of sutures removed, wound status and any issues.

8. Knowing When to Refer

Recognising the limits of your role is a hallmark of safe practice.

Situations that warrant referral include:

Large, deep or complex wounds, particularly those requiring surgical input
Suspected foreign bodies or deep tissue damage (muscle, tendon, bone, nerve)
Wounds near vital structures, major vessels, nerves or joints
Wounds in special sites (face, eyes, genitalia, major joints)
Non-healing or recurrent wounds despite appropriate care
Significant infection or systemic involvement
Patients with high-risk comorbidities such as diabetes, vascular disease or significant immunosuppression

Clear communication with the patient, their primary clinician and the receiving specialist ensures safe, coordinated care.

9. Using Local Anaesthesia in Minor Procedures

Local anaesthesia enables minor procedures to be performed comfortably and safely.

Benefits:

Effective local pain relief with minimal systemic impact
Rapid onset and shorter recovery compared with general anaesthesia
Allows procedures in outpatient or community settings

Risks and considerations:

Rare allergic reactions – always check allergy history
Potential nerve injury or prolonged altered sensation with incorrect technique
Systemic toxicity if excessive doses are used or injected intravascularly
Limited duration – anticipate procedure time and plan accordingly

Administration techniques:

Topical: creams or sprays for surface procedures (e.g. cannulation sites).
Infiltration: injection around the planned wound or incision.
Nerve or field blocks: injection near a nerve or around the operative field to anesthetise a larger area.

Good communication, explanation of expected sensations, and informed consent are essential, particularly for anxious patients.

10. Core Clinical Observations and Bedside Monitoring

Accurate observations are foundational to safe decision-making.

Visual acuity: Using tools such as a Snellen chart to detect refractive errors or acute deterioration in vision.
Temperature: Reliable measurement (oral, tympanic, rectal, or forehead) aids in identifying infection, inflammation or hypothermia.
Blood pressure, pulse, respirations:
- BP reflects cardiovascular status and perfusion.
- Pulse provides heart rate and rhythm information.
- Respiratory rate is an early indicator of deterioration and respiratory compromise.
Chest auscultation: Listening for crackles, wheezes, reduced air entry or other abnormal sounds helps identify respiratory pathology.
Peak flow: Monitoring airway obstruction in conditions such as asthma and COPD.
Blood glucose: Crucial for managing diabetes and recognising hypo- or hyperglycaemia.
Height and weight: Permit BMI calculation and trend monitoring, informing nutritional status and dosing decisions.

Competence lies not only in taking measurements but in interpreting deviations, recognising red flags and escalating when needed.

11. Interpreting Urinalysis and Pregnancy Tests

Urinalysis

A routine urinalysis can yield important information about hydration, renal function and metabolic status.

Key components:

Colour and clarity: Pale yellow and clear is generally normal; cloudiness or unusual colours may signal pathology or medication effects.
Specific gravity: Indicates concentration; low suggests overhydration, high may reflect dehydration or renal concentrating issues.
pH: Typically slightly acidic; abnormal values may accompany infection or metabolic disturbance.
Glucose and ketones: May indicate uncontrolled diabetes or metabolic stress.
Protein: Persistent proteinuria raises concern for renal disease or other systemic pathology.
Cells and casts: White cells, red cells or casts may point to infection, inflammation or intrinsic kidney disease.

Abnormal results should be interpreted in clinical context and may prompt referral to nephrology, endocrinology or further investigation.

Pregnancy testing

Positive result: Indicates presence of hCG and probable pregnancy – requires timely referral for confirmation and antenatal planning.
Negative result: Suggests no pregnancy, but if suspicion remains (e.g. missed periods, symptoms), repeat testing or further assessment is appropriate.

Sensitivity, privacy and clear communication are essential given the emotional impact of these results.

12. Conducting an Audiogram

Audiometry is an important tool in assessing hearing and detecting early impairment.

Core steps:

Prepare a quiet environment and check the audiometer.
Take a focused hearing history, including noise exposure and existing aids.
Explain the test clearly to ensure reliable responses.
Test each ear separately using headphones or inserts across a range of frequencies and intensities.
Record the lowest intensity at which tones are consistently heard (hearing thresholds).
Plot these on an audiogram and compare to normal ranges.
Identify patterns suggestive of conductive, sensorineural or mixed hearing loss.
Discuss results with the patient and arrange referral to audiology or ENT where indicated.
Document findings comprehensively.

13. Safe Specimen Collection and Handling

Accurate laboratory results depend on correct sampling, labelling and transport.

Urine:

Aim for a clean-catch midstream sample in a sterile container.
Provide clear instructions and label immediately with patient identifiers and date/time.

Stool:

Use a clean, dry container and collect from different parts of the stool.
Label accurately and send promptly to minimise degradation.

Sputum:

Encourage deep coughing to produce sputum rather than saliva.
Collect in a sterile container, label and transport quickly.

Blood:

Select an appropriate vein and use correct aseptic venepuncture technique.
Draw into the correct tubes (e.g. EDTA for FBC), label accurately, and gently mix where required.

Across all specimen types:

Follow infection control precautions (gloves, hand hygiene, safe sharps disposal).
Ensure correct packaging and transport conditions.
Document collection details, including any special instructions given to the patient.

14. Key Clinical Reflections and Skills Gained

Across these competencies, several themes emerge:

Structured approaches reduce error: Whether assessing a wound or interpreting a urinalysis, using a systematic framework supports safe, repeatable practice.
Documentation is clinical, not administrative: Good notes track progress, support escalation and protect patient safety.
Communication underpins everything: Explaining procedures, sharing findings with colleagues, and educating patients all contribute to better outcomes.
Knowing when to escalate is a core skill: Recognising complex wounds, non-healing, or abnormal results and referring appropriately demonstrates clinical maturity.
Infection prevention is everybody’s business: Aseptic technique, correct specimen handling and early detection of infection are fundamental, not optional extras.