3.3 General Patient Care Procedures

General patient care is the largest tested sub-area within Clinical Patient Care, accounting for 28 items on the CCMA exam. This section covers the clinical procedures medical assistants perform daily.

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Patient Positioning

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Sterile Technique (Surgical Asepsis)

Principles of sterile technique:

Opening a Sterile Pack:

1. Place the pack on a clean, dry surface at waist level
2. Open the first flap away from you (far side)
3. Open the side flaps (left, then right — or right, then left)
4. Open the last flap toward you (near side)
5. Do not reach over the sterile field at any point

Sterile Gloving Technique:

1. Open the glove package on a clean surface
2. Pick up the first glove by the folded cuff (inner surface) with your non-dominant hand
3. Slide your dominant hand in, touching only the inside of the glove
4. Slide your gloved fingers under the cuff of the second glove (touching only the outer surface)
5. Pull the second glove onto your non-dominant hand
6. Adjust fingers without touching non-sterile surfaces

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Wound Care

Types of Wounds:

Wound Healing Phases:

1. Inflammatory phase (0-3 days) — Bleeding stops; redness, swelling, warmth (normal)
2. Proliferative phase (3-21 days) — New tissue (granulation) forms; wound contracts
3. Remodeling/maturation phase (21 days-2 years) — Scar tissue strengthens

Signs of Wound Infection:

• Increased redness, warmth, and swelling around the wound
• Purulent (pus-like) drainage; foul odor
• Fever
• Increased pain at the wound site
• Red streaks extending from the wound (possible lymphangitis)

Injection Techniques

Intramuscular (IM) Injections:

Subcutaneous (SubQ) Injections:

Intradermal (ID) Injections:

Z-Track Technique:

• Used for medications that stain or irritate tissue (e.g., iron dextran)
• Pull the skin laterally 1-1.5 inches before injecting
• Inject the medication at 90° into the muscle
• Wait 10 seconds before withdrawing the needle
• Release the skin — creates a zigzag path that prevents leakage

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Assisting with Minor Office Surgery

Medical Assistant Responsibilities:

1. Set up the sterile field and surgical instruments
2. Prepare the patient: position, drape, explain the procedure
3. Prepare the surgical site: clean with antiseptic (chlorhexidine or povidone-iodine)
4. Assist with local anesthesia administration
5. Hand instruments to the provider (using sterile transfer)
6. Retract tissue, blot with sterile gauze, cut sutures as directed
7. Apply dressings post-procedure
8. Label and handle specimens per protocol
9. Clean up: dispose of sharps in sharps container, biohazardous waste in red bags
10. Document the procedure

Common Minor Office Procedures:

• Laceration repair (suturing)
• Incision and drainage (I&D)
• Skin biopsy (punch, shave, excisional)
• Lesion removal (cryotherapy, electrocautery)
• Suture/staple removal
• Wound irrigation and debridement
• Mole removal

Suture/Staple Removal:

• Verify provider order before removing sutures/staples
• Use suture removal kit (suture scissors, thumb forceps)
• Clean the suture line with antiseptic before removal
• Cut suture close to the skin on one side; pull toward the incision line
• Use staple remover to squeeze under each staple and lift
• Apply wound closure strips (Steri-Strips) as directed
• Document the procedure, wound appearance, and number of sutures/staples removed