Deployed Critical Care Local Safety Standards for Invasive Procedures (LocSSIPS)

Objectives

Local Safety Standards for Invasive Procedures (LocSSIPs) Checklists for use in the in the deployed setting.

Scope

This guideline provides LocSSIPs Checklists for Intubation, Chest drain insertion, CVC insertion, Percutaneous Tracheostomy insertion and Nasogastric tube insertion, for use in the deployed Critical Care (CC) setting.

Audience

Critical Care Nurses and Doctors.

Initial Assessment & Management

Safety Checklists for Invasive Procedures. Local Safety Standards for Invasive Procedures (LocSSIPs) have arisen from a framework document produced by NHS England’s Patient Safety Domain and the NatSSIPs group to promote safe practice locally. 

The aim of LocSSIPs is to:

Build on the positive aspects of the WHO Safer Surgery Checklist, acknowledging that checklists alone are not enough to ensure patient safety.

A team trained in this area with safe practice at the forefront of their thinking would reinforce best practice and improve patient safety.

Prolonged Casualty Care

In the prolonged casualty care setting and Large Scale Combat Operations (LSCO) there will still be a requirement for invasive procedures for patient care. It is important to continue to consider patient safety and the use of processes like LocSIPPs to ensure this could be even more important in this setting.

In a prolonged hold it is important to consider ongoing care requirements post invasive procedure. This means looking at the care requirements after that procedure and looking at the current staffing, their skill mix, patient numbers and ongoing combat operations and making a decision whether the procedure remains the right thing in that context or whether less invasive options are possible.

Invasive Procedure Safety Checklist: INTUBATION

BEFORE THE PROCEDURE
PREPARATION
Have all members of the team introduced themselves?	Yes	No
Is patient position optimised?	Yes	No
Are spinal precautions required?	Yes	No
Pre-oxygenate: 100% FiO2 for 3 mins	Yes	No
Are nasal cannula for apnoeic ventilation needed?	Yes	No
Is cricoid pressure considered and NGT aspirated?	Yes	No
Post intubation sedation ready?	Yes	No
EQUIPMENT & DRUGS
Is monitoring attached ? (ECG, SpO2, BP on regular cycling, EtCO2)	Yes	No
Is suction ready and working?	Yes	No
Is adequate venous access in place?	Yes	No
Are working laryngoscope/s and bougie ready?	Yes	No
Are endotracheal tube/s ready?	Yes	No
Are oropharyngeal airways and LMA’s available?	Yes	No
Is emergency trolley at the bedside?	Yes	No
Are induction drugs, paralytics and vasopressors appropriate and ready?	Yes	No
Any drug allergies known?	Yes	No
TEAM
Is senior help needed?	Yes	No
Is role allocation clear? (Intubator, drugs, assistant, cricoid, MILS)	Yes	No
Is difficult airway anticipated?	Yes	No

TIME OUT Verbal confirmation between team members before start of procedure

Were difficult airway plans discussed?	Yes	No
Is senior help needed?	Yes	No
Is role allocation clear? (intubator, drugs, assistant, cricoid, MILS)	Yes	No
Is difficult airway anticipated?	Yes	No
Any concerns about procedure?	Yes	No
If you had any concerns about the procedure, how were these mitigated?

SIGN OUT

Endotracheal position confirmed (EtCO2 trace)?	Yes	No
ETT length recorded and checked (B/L Air entry)?	Yes	No
ETT secured and cuff pressure checked?	Yes	No
Nasal O2 Removed?	Yes	No
Appropriate ventilator settings confirmed?	Yes	No
Analgesia and sedation started?	Yes	No
Chest X-Ray required?	Yes	No
Any adverse event? If so complete ASER.	Yes	No
Hand over to nursing staff?	Yes	No

Invasive Procedure Safety Checklist: CHEST DRAIN INSERTION

BEFORE THE PROCEDURE
Indication: Eg Pneumothorax, Haemothorax
Patients identity checked and correct?	Yes	No
Does the procedure need to be done ASAP?	Yes	No
Has consent been appropriately taken?	Yes	No
Is suitable equipment available? (Including USS)	Yes	No
Confirm site and side of clinical abnormality.	Yes	No
Correlate clinical signs with CXR.	Yes	No
Anticoagulant drugs and clotting checked?	Yes	No
Any drug allergies known?	Yes	No
Safe site of drain insertion identified? (See picture)	Yes	No
Are there any concerns for this procedure in this patient?	Yes	No

TIME OUT Verbal confirmation between team members before start of procedure

Is patient on appropriate ventilator setting and FiO2 100%?	Yes	No
Is patient adequately sedated, analgesed and/or paralaysed?	Yes	No
Is position optimal?	Yes	No
All team members identified and roles clear?	Yes	No
Any concerns about procedure?	Yes	No
If you had any concerns about the procedure, how were these mitigated?

SIGN OUT

Sutures, tubing and dressing secure?	Yes	No
Guidewire removed? (if seldinger)	Yes	No
Patient advised about care and not to raise drain above head?	Yes	No
Are Antibiotics indicated?	Yes	No
Is analgesia prescribed?	Yes	No
In effusion, confirm 500ml not drained in first hour and specify to be informed if more than 1500ml in first 24 hours.	Yes	No
Chest X-Ray requested?	Yes	No
Any adverse events? If so complete ASER.	Yes	No
Hand over to nursing staff?	Yes	No

Invasive Procedure Safety Checklist: CVC INSERTION

BEFORE THE PROCEDURE
Indication: Eg Difficult access, Central drug administration, TPN
Any known drug allergies?	Yes	No
Coagulation and bleeding risk checked?	Yes	No
Is all equipment available, including ultrasound?	Yes	No
Sterility of operator confirmed? (Hands scrubbed and appropriate PPE worn)	Yes	No
Confirm appropriate site chosen.	Yes	No
2% Chloraprep (2% Chlorhexadine Gluconate/70% isopropyl alcohol) applied and allowed to dry?	Yes	No
Large drape to cover patient in sterile manner used?	Yes	No
Are there any concerns for this procedure in this patient?	Yes	No

TIME OUT Verbal confirmation between team members before start of procedure

Is patient appropriately positioned?	Yes	No
All team members introduced and roles clear?	Yes	No
Is position optimal?	Yes	No
Any concerns about procedure?	Yes	No
If you had any concerns about the procedure, how were these mitigated?

SIGN OUT

Correct injection caps applied with sterile technique?	Yes	No
Sterile dressing applied?	Yes	No
Guidewire removed?	Yes	No
Chest xray required/ordered?	Yes	No
Any adverse events? If so, complete ASER	Yes	No
Transduse CVC - CVP waveform present? Record CVP here: If doubt - perform paired CVC and arterial gasses Arterial Sats: CVC sats:	Yes	No

Chest Xray Review
Appropriate position on CXR	Yes	No
Further actions required:

Invasive Procedure Safety Checklist: PERCUTANEOUS TRACHEOSTOMY

BEFORE THE PROCEDURE
Have all members of the team introduced themselves?			Yes	No
Patient identity checked and correct?			Yes	No
Consent completed?			Yes	No
Is suitable tracheostomy and equipment available? (emergency trolley/bronchoscope)			Yes	No
Is appropriate monitoring available? (including EtCO2)			Yes	No
Are there any Contraindications to performing the procedure? (High FiO2 >0.45, High PEEP >12, anatomical, vascular, coagulopathy)			Yes	No
Medicines and coagulation checked?			Yes	No
Any Known drug allergies?			Yes	No
Is feed stopped and NG aspirated?			Yes	No
Are spinal precautions required?			Yes	No
Are there any concerns about this procedure for the patient?			Yes	No
Level of difficulty anticipated prior to the start of the procedure
None anticipated	Possibly difficult	Difficulty anticipated

TIME OUT Verbal confirmation between team members before start of procedure
Is patient on adequate ventilator settings and 100% FiO2?	Yes	No
Is patient adequately sedated and paralysed?	Yes	No
Is position optimal?	Yes	No
Cuff tested as intact?
All team members identified, and roles assigned?	Yes	No
Any concerns about procedure?	Yes	No
If you had any concerns about the procedure, how were these mitigated?

SIGN OUT
Tracheostomy position confirmed with Bronchoscope?	Yes	No
Ventilator settings reviewed post procedure?	Yes	No
Sedation reviewed?	Yes	No
Any adverse event? If so, complete ASER	Yes	No
Post procedure hand over given to nursing staff?	Yes	No

Invasive Procedure Safety Checklist: NG TUBE INSERTION

BEFORE THE PROCEDURE
Patient identity checked as correct?	Yes	No
Appropriate consent completed?	Yes	No
Check NG equipment and tube size	Yes	No
NG measurement ( cms)	Yes	No
Are there any contraindications to performing the procedure? (Coagulopathy/base of skull#/ previous sphenoidal surgery)	Yes	No
Base of skull# consult Neurosurgery and consider oral gastric tube	Yes	No
Are there any concerns about this procedure for the patient?	Yes	No

TIME OUT Verbal confirmation between team members before start of procedure
Base of skull # ruled out if applicable?	Yes	No
Is position optimal?	Yes	No
All team members identified and roles assigned?	Yes	No
Any concerns about procedure?	Yes	No
Any adverse events? If so complete ASER	Yes	No
If you had any concerns about the procedure, how were these mitigated?

SIGN OUT
Any equipment issues?	Yes	No
X-ray requested?	Yes	No
Aspirate NG and Aspirate PH test completed	Yes	No
Length of NGT documented as: _____	Yes	No
Post procedure hand over given to nursing staff?	Yes	No
NGT placement confirmed, and X-ray reviewed by	Yes	No

Last reviewed: 24/01/2026

Next review date: 24/01/2027

References

Faculty of Intensive Care Medicine, LocSSIPS safety Checklist templates. Available at: LocSSIPs | The Faculty of Intensive Car Medicine

The app and website was publicly released on 2 Apr 2024