Nursing Instruments and Procedures: An Illustrated Step-by-Step Guide

Nursing Skills Textbook

Clinical Nursing Instrumentation and Essential Nursing Procedures

A detailed, textbook-style guide to common nursing and midwifery instruments, their parts, principles, applications, care, safety, and core nursing procedures.

Designed for nursing students, skills laboratories, revision and clinical orientation.

Clinical safety note: This chapter is educational. Non-invasive skills are presented step by step. Invasive procedures such as injections, IV cannulation, urinary catheterisation and nasogastric tube insertion require authorised clinical training, supervision, aseptic technique and local institutional protocols; therefore, they are described as professional workflows rather than self-practice instructions.

Contents

Chapter 1 — Clinical Instrumentation Chapter 2 — Nursing Procedures Stethoscope Sphygmomanometer Clinical Thermometer Pulse Oximeter Kidney Dish Artery Forceps Dressing Forceps Surgical Scissors Vaginal Speculum Reflex Hammer Syringe and Needle Peripheral IV Cannula Hand Hygiene Manual Blood Pressure Pulse Oximetry Temperature Measurement Respiratory Rate Bed Making Oral Care Urine Specimen Collection Supervised Invasive Skills

Chapter 1 — Clinical Instrumentation

Clinical instrumentation is the systematic study and safe use of devices, tools and equipment used to assess patients, support diagnosis, perform procedures, maintain asepsis, monitor physiological function and provide treatment. A nurse is expected not only to recognise an instrument, but also to understand its purpose, major parts, working principle, indications, limitations, cleaning method, storage requirements and safety precautions.

Diagnostic instrument

1. Stethoscope

Real stethoscope photograph. Wikimedia Commons, file “STETHOSCOPE.jpg”.

A stethoscope is an acoustic instrument used for auscultation. It transmits sound generated within the body to the examiner’s ears. In nursing practice it is used during cardiovascular, respiratory and abdominal assessment and, with a manual sphygmomanometer, during auscultatory blood pressure measurement.

Main partsEartips, binaural metal tubes, flexible tubing, stem and chest piece. The chest piece may contain a diaphragm, bell, or tunable diaphragm.

Common applicationsHeart sounds, breath sounds, bowel sounds, Korotkoff sounds during blood pressure assessment and selected vascular sounds.

PrincipleBody vibrations move the diaphragm/bell and are transmitted through the air column in the tubing to the earpieces.

CareClean eartips and chest piece between patients according to local infection-prevention policy. Avoid immersion of the whole device and avoid extreme heat.

Important nursing points

• Select appropriately sized eartips and insert them in the direction of the ear canals.
• Warm the chest piece before placing it on a patient when appropriate.
• Use direct skin contact where clinically appropriate because clothing may create artefacts.
• Compare findings systematically and document abnormal sounds according to institutional terminology.

Vital-sign instrument

2. Sphygmomanometer

Real sphygmomanometer photograph from Nigeria. Wikimedia Commons, file “The sphygmomanometer.jpg”.

A sphygmomanometer measures arterial blood pressure. Manual devices usually contain an inflatable cuff, bladder, tubing, inflation bulb, release valve and an aneroid or mercury pressure scale. Automatic devices combine cuff inflation with electronic oscillometric detection.

TypesMercury, aneroid and digital/automatic monitors.

Clinical useScreening, routine vital signs, monitoring hypertension, perioperative observation, acute-care surveillance and medication-response assessment.

Key accuracy factorCuff size. A cuff that is too small tends to overestimate pressure; one that is too large may underestimate it.

MaintenanceInspect cuff, tubing and valve; keep aneroid gauges calibrated according to institutional schedule.

Vital-sign instrument

3. Clinical Thermometer

Clinical thermometer photograph. Use an approved digital clinical thermometer in current practice.

A clinical thermometer measures body temperature. Modern nursing practice commonly uses digital oral/axillary thermometers, tympanic thermometers and non-contact or temporal devices. Choice depends on patient age, condition, infection-control requirements and clinical setting.

SitesOral, axillary, tympanic and temporal routes are common. Rectal measurement is reserved for selected settings and protocols.

SafetyUse the correct probe cover or decontamination method. Never interchange probes intended for different sites unless the manufacturer allows it.

Monitoring instrument

4. Pulse Oximeter

Real clinical photograph of a nurse demonstrating pulse oximetry. Wikimedia Commons.

A pulse oximeter provides a non-invasive estimate of peripheral oxygen saturation (SpO₂) and pulse rate using differential absorption of red and infrared light by oxygenated and deoxygenated haemoglobin.

UsesRespiratory assessment, postoperative monitoring, oxygen-therapy monitoring, emergency observation and deterioration screening.

Common sources of errorMotion, poor perfusion, cold extremities, nail products, strong ambient light, dyshemoglobinaemias and inappropriate probe placement.

General nursing instrument

5. Kidney Dish

Real stainless-steel kidney dish. Wikimedia Commons, file “Kidney Dish Instrument Medical.jpg”.

The kidney dish, also called an emesis basin, is a curved receptacle designed to sit close to the body. Depending on the procedure and infection-prevention policy, it may hold swabs, dressings, small instruments or waste, and may be used as a receiver during oral care or minor procedures.

Care

Reusable dishes must undergo cleaning and decontamination appropriate to their intended use. A dish used as a contaminated receiver must never be returned to a clean field without reprocessing.

Haemostatic instrument

6. Artery Forceps / Haemostat

Real Péan artery forceps. Wikimedia Commons, file “PeanArterialForceps.JPG”.

Artery forceps are locking surgical forceps used by trained clinicians to clamp vessels or grasp selected materials during procedures. Typical components include finger rings, shanks, a box lock, ratchet and serrated jaws.

Safety: These are professional surgical instruments. Their application to tissue or blood vessels requires procedural training and clinical supervision.

Dressing instrument

7. Dressing Forceps

Real modern forceps from the Wellcome Collection via Wikimedia Commons.

Dressing forceps are used to handle sterile dressings, swabs and selected materials without direct hand contact. They may be toothed or non-toothed depending on the purpose. In wound care, the handling end must remain within the sterile field when sterile technique is required.

Cutting instrument

8. Surgical and Dressing Scissors

Surgical scissors. Different designs are chosen for dressings, sutures, tissue or bandage work.

Scissors vary in length, curvature, tip shape and blade design. Nursing units commonly use bandage scissors and stitch scissors, while operating theatres use specialised tissue scissors. Instruments must be inspected for alignment, damage and cleanliness before use.

Midwifery / gynaecology instrument

9. Vaginal Speculum

Real vaginal speculum photograph. Wikimedia Commons, file “Vaginal speculum.JPG”.

A vaginal speculum is used by trained clinicians to visualise the vaginal walls and cervix during gynaecological examination and selected procedures. Common forms include Cusco’s self-retaining bivalve speculum and Sims’ speculum.

ApplicationsCervical inspection, collection of cervical specimens, selected screening procedures and examination of vaginal walls.

Nursing responsibilitiesConsent and privacy support, correct equipment preparation, chaperoning according to policy, appropriate positioning, specimen handling, infection prevention, reassurance and documentation.

Clinical note: Speculum insertion is an intimate clinical procedure and should be performed only by appropriately trained and authorised personnel with consent and privacy safeguards.

Neurological instrument

10. Reflex Hammer

Real reflex hammer. Wikimedia Commons, file “Reflexhammer.jpg”.

A reflex hammer is used during neurological examination to elicit deep tendon reflexes. Common designs include Taylor, Queen Square, Babinski, Buck and Trömner hammers. Reflex findings are interpreted together with muscle tone, power, sensation and other neurological findings.

Medication-delivery device

11. Syringe and Needle

Disposable syringe used in clinical care. Sharps require regulated handling and disposal.

A syringe consists of a barrel, plunger and tip. When a needle is attached, the needle consists of a hub, shaft and bevel. Syringes are used by trained healthcare professionals for medication preparation and administration, aspiration and selected procedures.

Sharps safety: Needles are inherently hazardous. They require supervised professional training, standard precautions, approved sharps containers and institutional medication-administration policy. This chapter does not provide self-injection technique.

Vascular access device

12. Peripheral Intravenous Cannula

Peripheral venous catheter/cannula used for clinical vascular access.

A peripheral IV cannula is a short catheter used for temporary venous access. Components vary by manufacturer but commonly include a catheter, needle introducer, hub and protective features. Selection depends on therapy, vein condition, patient factors and local policy.

Professional use only: Cannulation can cause bleeding, infiltration, extravasation, phlebitis, infection and needlestick injury. Insertion must be taught and assessed in a supervised clinical skills environment.

Chapter 2 — Essential Nursing Procedures

A nursing procedure is a planned sequence of actions carried out to assess, maintain or improve a patient’s health while protecting dignity, safety and infection prevention. Every procedure should begin with patient identification, explanation, consent where required, preparation of equipment, hand hygiene and risk assessment, and should end with comfort measures, reassessment, waste disposal and documentation.

Core procedure

1. Clinical Hand Hygiene

Real photograph of a nurse performing hand hygiene. Wikimedia Commons.

Purpose

Hand hygiene reduces transmission of microorganisms between patients, staff, equipment and the healthcare environment. It is one of the most important measures for preventing healthcare-associated infection.

Equipment

Running water, liquid soap, disposable towel and appropriate waste bin. Alcohol-based hand rub is used when indicated and when hands are not visibly soiled, in accordance with infection-prevention policy.

Step-by-step technique

1. Remove unnecessary hand and wrist items according to local policy; inspect hands for cuts or skin problems.
2. Wet the hands with clean running water and apply enough liquid soap to cover all hand surfaces.
3. Rub palm to palm, then clean the back of each hand with fingers interlaced.
4. Rub palm to palm with fingers interlaced and clean the backs of fingers against opposing palms.
5. Rotationally rub each thumb and then clean fingertips and nail areas against the opposite palm.
6. Include wrists where required by policy and continue rubbing for the recommended duration.
7. Rinse thoroughly under running water without touching the sink.
8. Dry with a disposable towel and use the towel to turn off a manual tap when appropriate.

Documentation

Routine hand hygiene is not usually charted as an isolated procedure; it is an expected component of standard precautions. Specific isolation or infection-control compliance may be recorded according to local policy.

Vital signs

2. Manual Blood Pressure Measurement

Real photograph of a nurse measuring blood pressure. Wikimedia Commons.

Purpose

To determine systolic and diastolic arterial pressure and monitor cardiovascular status.

Equipment

Appropriately sized cuff, calibrated sphygmomanometer, stethoscope, documentation chart and cleaning materials.

Step-by-step technique

1. Confirm patient identity, explain the procedure and provide a brief rest period when possible.
2. Position the patient comfortably with the arm supported at approximately heart level and the cuff area free of restrictive clothing.
3. Select an appropriate cuff size and apply it evenly to the upper arm using the artery marker when provided.
4. Locate the brachial pulse and position the stethoscope over the artery without pressing excessively.
5. Inflate the cuff according to accepted clinical technique and the patient’s expected pressure range.
6. Release cuff pressure gradually while listening for Korotkoff sounds and observing the gauge.
7. Record the systolic pressure at the first clear repetitive sound and the diastolic pressure at disappearance of sounds, unless local policy specifies otherwise.
8. Deflate completely, remove the cuff, ensure comfort and repeat only when clinically indicated after an appropriate interval.
9. Document the reading, arm, patient position and any relevant circumstances such as pain, exertion or abnormal rhythm.

Clinical interpretation: A single abnormal reading should be interpreted in context. Repeat measurement, symptoms, baseline values and local escalation thresholds matter.

Monitoring

3. Pulse Oximetry

Real clinical pulse-oximetry demonstration. Wikimedia Commons.

Step-by-step technique

1. Explain the procedure and assess the chosen site for warmth, circulation, movement and factors that may interfere with the reading.
2. Ensure the probe is clean and appropriate for the patient and site.
3. Apply the probe so the light emitter and detector oppose each other as designed by the manufacturer.
4. Allow the displayed pulse signal and saturation value to stabilise.
5. Compare the displayed pulse with the patient’s actual pulse when accuracy is uncertain.
6. Interpret the number together with respiratory rate, work of breathing, consciousness, perfusion and oxygen therapy.
7. Document SpO₂, pulse, oxygen-delivery method if any, and relevant clinical observations.

Remember: Pulse oximetry is an estimate and can be misleading in poor perfusion, motion, some pigment/nail conditions and abnormal haemoglobin states.

Vital signs

4. Digital Temperature Measurement

Clinical thermometer used for body-temperature assessment.

Step-by-step technique

1. Identify the patient, explain the procedure and choose the measurement site based on age, condition and policy.
2. Perform hand hygiene and prepare the thermometer with the appropriate clean probe or disposable cover.
3. Position the probe correctly for the selected non-invasive site following the device instructions.
4. Wait for the device to signal completion and read the value.
5. Remove the probe, discard any single-use cover and decontaminate the device as recommended.
6. Document temperature, route/site and clinically relevant symptoms such as chills, sweating or antipyretic therapy.

Vital signs

5. Respiratory Rate Assessment

Real nurse–patient clinical photograph from Nigeria. Wikimedia Commons.

Step-by-step technique

1. Ensure the patient is at rest whenever the clinical situation allows.
2. Observe chest or abdominal movement without drawing unnecessary attention to the counting process.
3. Count complete respiratory cycles for an interval sufficient to obtain an accurate rate; use a longer observation when the rhythm is irregular.
4. Assess rhythm, depth, work of breathing, use of accessory muscles, ability to speak and any abnormal respiratory sounds.
5. Document the rate and relevant qualitative findings, and escalate significant abnormalities according to local protocol.

Comfort and infection prevention

6. Unoccupied Bed Making

Hospital bed prepared for patient care.

Purpose

To provide a clean, dry, wrinkle-minimised and safe bed that promotes comfort, skin protection, efficient care and infection prevention.

Step-by-step technique

1. Perform hand hygiene and gather clean linen before approaching the bed.
2. Raise the bed to a safe working height and apply brakes.
3. Remove used linen without shaking it; keep contaminated linen away from uniform and clean surfaces.
4. Place the bottom sheet evenly and secure it according to the bed design.
5. Add protective or draw sheets if required, keeping surfaces smooth and wrinkle-minimised.
6. Apply the top sheet, blanket and bedspread according to local ward practice, allowing sufficient room for feet.
7. Replace the pillowcase without allowing the pillow to touch contaminated surfaces.
8. Lower the bed to a safe position, leave the environment tidy and perform hand hygiene.

Fundamental nursing care

7. Oral Care for a Conscious Patient

Nursing oral-care image from Wikimedia Commons.

Purpose

To maintain oral cleanliness and comfort, reduce plaque and odour, protect mucosa, support appetite and identify lesions, dryness, bleeding or infection.

Step-by-step technique

1. Explain the procedure, ensure privacy and position the patient upright whenever possible.
2. Perform hand hygiene, put on appropriate gloves and protect clothing/linen with a towel if needed.
3. Inspect lips, gums, tongue, teeth, dentures and mucosa before cleaning.
4. Assist with toothbrushing using a soft toothbrush and appropriate toothpaste; clean all accessible surfaces gently.
5. Encourage rinsing and spitting when safe, or use careful suction-assisted oral care only in trained clinical settings where indicated.
6. Clean dentures separately if present and return them according to the patient’s preference and clinical condition.
7. Apply prescribed or approved lip moisturiser when appropriate and reassess comfort.
8. Dispose of waste, clean reusable equipment, remove gloves, perform hand hygiene and document abnormalities.

Specimen collection

8. Clean-Catch Midstream Urine Specimen

Urine specimen container used for laboratory testing.

Purpose

To obtain a urine sample with reduced contamination for urinalysis, microscopy or culture as requested.

Step-by-step technique

1. Verify the request, identify the patient and explain how to collect a midstream specimen without touching the inside of the sterile container or lid.
2. Provide privacy, hand-hygiene facilities and the labelled specimen container.
3. Instruct the patient to perform appropriate perineal cleansing when this is required by the laboratory protocol.
4. Ask the patient to begin voiding into the toilet, then collect the midstream portion into the container without interrupting the stream more than necessary.
5. Secure the lid, clean the outside if contaminated and place the container in the correct biohazard transport bag.
6. Send promptly to the laboratory according to local handling and refrigeration requirements.
7. Document collection and any factors that may affect interpretation.

Supervised clinical skills

9. Invasive Nursing Procedures — Professional Workflow Overview

The following procedures are important nursing competencies, but safe performance depends on supervised skills training, local policy, patient-specific assessment, aseptic technique, complication recognition and legal scope of practice.

Injection administration

Purpose: delivery of prescribed medication by an approved parenteral route.

Professional workflow: verify prescription and medication rights → assess contraindications/allergies → prepare medication using aseptic technique → identify and consent the patient → administer by the prescribed route using institution-approved technique → dispose of sharps immediately → monitor effect and adverse reactions → document.

Peripheral IV cannulation

Purpose: establish temporary venous access.

Professional workflow: verify indication → assess veins and patient factors → prepare sterile/aseptic equipment → perform trained insertion technique → secure and label device → confirm patency and assess site → monitor for infiltration, phlebitis, infection and extravasation → document.

Urinary catheterisation

Purpose: urinary drainage or selected diagnostic/therapeutic indications.

Professional workflow: confirm indication → explain and obtain consent → protect privacy → prepare sterile field → perform trained aseptic insertion → establish closed drainage → secure appropriately → monitor urine and complications → review daily need → document.

Nasogastric tube insertion

Purpose: enteral feeding, medication delivery or gastric decompression in selected patients.

Professional workflow: confirm indication and contraindications → explain procedure → prepare equipment → perform supervised insertion technique → verify position using the institution’s approved method before use → secure tube → monitor tolerance and complications → document.

Wound dressing

Purpose: protect a wound, manage exudate and support healing.

Professional workflow: assess wound and prescription → provide analgesia if ordered → prepare clean/sterile field as indicated → remove old dressing safely → reassess wound → cleanse and redress according to the wound plan → dispose of contaminated materials → document size, exudate, tissue, surrounding skin and pain.

Airway suctioning

Purpose: remove secretions when a patient cannot clear them effectively.

Professional workflow: assess need and oxygenation → prepare correct suction system and PPE → use trained sterile/clean technique appropriate to airway type → minimise duration and patient distress → reassess oxygenation and respiratory status → document response and secretion characteristics.

Important: Exact insertion angles, depths, device selection and hands-on manoeuvres for invasive procedures should be learned in an accredited skills laboratory and performed under qualified supervision.

Universal Nursing Procedure Framework

Before the procedureCheck order/indication, identify patient using approved identifiers, assess risks and allergies, explain the procedure, obtain consent where required, provide privacy, assemble equipment and perform hand hygiene.

During the procedureMaintain dignity, use standard precautions and aseptic technique where indicated, observe the patient continuously, use safe body mechanics and stop/escalate if deterioration occurs.

After the procedureRestore comfort and safety, reassess the patient, dispose of waste correctly, decontaminate equipment, perform hand hygiene and ensure call bell/accessories are within reach.

DocumentationRecord date/time, assessment findings, procedure performed, relevant equipment/device details, patient response, complications, specimens, education provided and escalation/follow-up.

Image note: The chapter deliberately uses real clinical/instrument photographs rather than AI-generated pictures wherever practical. Wikimedia Commons images remain subject to the licence stated on each original file page; keep the figure credits when republishing.