Table 3

Military surgery procedural-based assessments: Vascular trauma—Arterial shunt for Common Femoral Artery injury; Sub-section (V) Procedural technique

V.Procedural technique: global (G) and task- specific items (T)
IT1(G)Follows an agreed, logical sequence or protocol for the procedure
IT2(G)Consistently handles tissue well with minimal damage
IT3(G)Controls bleeding promptly by an appropriate method, for example, minimum use of diathermy, tourniquet if necessary
IT4(G)Demonstrates a sound technique of knots and sutures/staples
IT5(G)Uses instruments appropriately and safely
IT6(G)Proceeds at appropriate pace with economy of movement
IT7(G)Anticipates and responds appropriately to variation, for example, anatomy, previous hip replacement
IT8(G)Deals calmly and effectively with unexpected events/complications
IT9(T)Uses assistant(s) to the best advantage at all times
IT10(T)Communicates clearly and consistently with the scrub team
IT11(T)Communicates clearly and consistently with the anaesthetist
IT12(T)Gains proximal control of the common femoral artery with the use of slings or carefully placed clamps
IT13(T)Gains distal control of artery with the use of slings or carefully placed clamps
IT14(T)Debridement of the devitalised tissue and define limits of wound
IT15(T)Assess inflow and outflow
IT16(T)Appropriate deployment of Fogarty catheter to clear thrombus where required
IT17(T)Administers heparinised saline proximally and distally to achieve local anticoagulation of the vessel
IT18(T)Selects appropriate shunt (eg, Javid/Argyle/Sundt or fashions own, eg, dual lumen haemodialysis catheter in CFA bifurcation injury)
IT19(T)Proximal end of shunt inserted in a retrograde manner
IT20(T)Distal end of shunt inserted in distal end of artery without kinking
IT21(T)Shunt secured with 2-0 silk ties around shunt and vessel
IT24(T)Removes clamps in collaboration with anaesthetist
IT25(T)Checks that recipient and donor limb pulses are palpable
IT26(T)Carries out check of graft function (eg, duplex)
IT27(T)Completes haemostasis and recognises need to correct any associated coagulopathy
IT28(T)Checks foot perfusion before completing operation