OSCE: Removal of Nail or Nail Fold Aka. Nail extraction

Nail extraction

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Patient Introduction and Consent

Task	Done Correctly	Done Incorrectly	Not Done
Introduce yourself and confirm the patient's name.	[ ]	[ ]	[ ]
Explain the procedure’s indications and objectives.	[ ]	[ ]	[ ]
Verify contraindications to the procedure.	[ ]	[ ]	[ ]
Inform the patient of potential complications.	[ ]	[ ]	[ ]
Obtain informed consent with signature.	[ ]	[ ]	[ ]

Indications

• Subungual hematoma.

• Partially or totally avulsed nail.

• Fungal infection (Onychomycosis).
  

Contraindications

• Absolute:

  • Bleeding diathesis.

• Relative:

  • Allergy to local anesthetic.
    

Complications

• Bleeding.

• Infection.

• Nail bed injury.

• Paronychial injury.

  
  

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Procedure Steps

Equipment Preparation

Task	Done Correctly	Done Incorrectly	Not Done
Collect and prepare sterile equipment.	[ ]	[ ]	[ ]

Required Equipment:

• Antiseptic solution and cotton swabs.

• Sterile drapes.

• 5-10 mL syringe with a fine-gauge needle.

• Lidocaine (1%) or bupivacaine (0.5%) without adrenaline.

• Metzenbaum or iris scissors.

• Forceps.

• Straight arterial clamp or hemostat clamp.

• Vaseline gauze or Bactigras.

• Absorbable suture material.

  
  

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Site Preparation

Task	Done Correctly	Done Incorrectly	Not Done
Clean the area with antiseptic solution.	[ ]	[ ]	[ ]

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Anesthesia: Digital Nerve Block

Task	Done Correctly	Done Incorrectly	Not Done
Perform a digital nerve block using proper technique.	[ ]	[ ]	[ ]

1. Injection at the Base of the Digit:

   • Insert the needle at a 45° angle on the lateral side of the digit, just proximal to the web space.

   • Inject 1-2 mL of lidocaine while withdrawing the needle slightly.

   • Redirect the needle to the palmar/plantar surface of the same side and inject 1-2 mL.

2. Repeat on the Opposite Side:

   • Move to the other side of the digit and repeat the same process.

3. Confirmation of Anesthesia:

   • Wait 5-10 minutes for the anesthetic to take effect.

   • Test the anesthesia by gently pinching the digit or using a blunt instrument.
     

Comment Section:

Nail Removal: Total/Partial Extraction

Task	Done Correctly	Done Incorrectly	Not Done
Inspect the nail bed for injuries.	[ ]	[ ]	[ ]
Use proper technique for nail extraction.	[ ]	[ ]	[ ]

1. Inspect the Nail Bed:

   • Check for lacerations or other injuries.

   • Suture any lacerations with absorbable material if necessary.

2. Perform Total/Partial Nail Extraction:

   • Use Metzenbaum or iris scissors to gently insert under the nail between the nail plate and the nail bed.

   • Carefully advance toward the nail base, separating the nail from the nail bed.

   • Use the hemostat or arterial clamp to grasp the nail and remove it completely.
     

Wound Closure and Dressing

Task	Done Correctly	Done Incorrectly	Not Done
Apply appropriate dressing to the wound.	[ ]	[ ]	[ ]

1. Cover the nail bed with Vaseline gauze or Bactigras.

2. Secure with a sterile dressing.
   

Post-Procedure Care

• Advise the patient to keep the dressing dry and intact.

• Schedule a follow-up visit for wound assessment.
  

Score Sheet

Task	Done Correctly	Done Incorrectly	Not Done
Patient introduction.	[ ]	[ ]	[ ]
Explanation of procedure.	[ ]	[ ]	[ ]
Contraindications assessed.	[ ]	[ ]	[ ]
Informed consent obtained.	[ ]	[ ]	[ ]
Digital nerve block.	[ ]	[ ]	[ ]
Nail removal performed.	[ ]	[ ]	[ ]
Dressing applied.	[ ]	[ ]	[ ]