UCI HEALTH · DEPARTMENT OF NEUROLOGY · APP EDUCATION · 2026-04-30 · CHADWYCKE R. SMITH, MSN, NP, AGACNP-BC

Class II Procedural

Competency Series.

A privileging library for Advanced Practice Providers.

PROCEDURES — JUMP TO

GOVERNANCE · REFERENCES · STANDING RULES

01 VASCULAR ACCESS · RISK · HIGH

Central Venous Line Placement

IJ · SC · femoral · CXR confirmation

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02 VASCULAR ACCESS · RISK · MED-HIGH

Central Venous Line Removal

Trendelenburg · Valsalva · post-removal monitoring

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03 NEUROLOGIC · RISK · HIGH

Lumbar Drain Placement and Removal

Tuohy needle · CSF drainage · spinal anatomy

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04 VASCULAR ACCESS · RISK · HIGH

Arterial Line — Femoral

Femoral triangle · transduction · fluid responsiveness

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05 VASCULAR ACCESS · RISK · MED

Arterial Line — Radial

Puncture · collateral flow · transducer setup

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06 NEUROLOGIC · RISK · MED

Occipital Nerve Block

Greater / lesser occipital · headache management

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07 NEUROLOGIC · RISK · MED

Sphenopalatine Ganglion Block

SPG anatomy · transnasal · cluster headache

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08 WOUND CARE & SKIN · RISK · LOW-MED

Suturing

Wound closure · suture selection · stitch types

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09 WOUND CARE & SKIN · RISK · LOW

Suture and Staple Removal

Skin clip · timing · steri-strip transition

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10 TUBES & CATHETERS · RISK · LOW

Urinary Catheter Insertion

Foley · sterile technique · M/F anatomy

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11 TUBES & CATHETERS · RISK · LOW

Nasogastric and Orogastric Tube Insertion

Selection · technique · placement verification

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12 VASCULAR ACCESS · RISK · LOW

Peripheral IV Placement

Vein selection · ultrasound-guided access

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13 WOUND CARE & SKIN · RISK · LOW-MED

Punch Biopsy

Skin biopsy · α-synucleinopathy · specimen handling

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14 NEUROLOGIC · RISK · MED-HIGH

Lumbar Puncture

Diagnostic LP · CSF collection · post-LP care

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15 WOUND CARE & SKIN · RISK · LOW-MED

Laceration Repair

Wound assessment · debridement · primary closure

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GOVERNANCE

REFERENCES

STANDING RULES

RECENT UPDATES · 2026-05-12

36c (2026-05-10) — V2.5 HTML-first deck authoring pipeline. 15 procedure decks built from HTML source-of-truth.

36d–36e (2026-05-10/11) — Iterative deck refinement: literature freshness sweep (9+ AI-fabricated citations caught and replaced).

36f (2026-05-11) — html_to_pptx.py pipeline shipped (Playwright + python-pptx); section-isolation render path.

36g (2026-05-11) — 15 PPTX re-rendered with refreshed citations.

36h (2026-05-11) — Dailey & Schroeder textbook illustrations on proc 01.

36i (2026-05-11) — Cover-slide simplification.

36j (2026-05-12) — 59 new clinical imaging assets integrated across 12 procedures (Radiopaedia + Wikimedia + PMC peer-reviewed cases) via 15-agent sourcing swarm.

36k (2026-05-12) — Hybrid native-image PPTX export: images become individually-selectable PPTX shapes (SMEs can swap or resize in PowerPoint). Proc 01 layout fully repaired.

36l (2026-05-12) — Fully native PPTX shapes: every title, bullet, eyebrow, page number, and caption is now an individually-editable PowerPoint shape. Bundle size dropped from ~280 MB to 104.7 MB. Proc 13 bloat closed (65 MB → 11.7 MB).

V2 forward workspace established 2026-05-09. All Class II program updates after this date are tracked in V2 (github.com/hispeedtransmission/uci-app-level-2-upgrades-2026-05, private). V1 is frozen at its post-SPARC checkpoint pending archive.

SPARC Phases 4 and 5 ratified. Hero count corrected and made durable via sum-expression over the procedure manifest. Master Answer Key and Master Post-Test artifacts isolated to instructor-only subfolders per TJC MS.07.01.01, preserving FPPE proctored-volume integrity. Privilege Hand Off folder shipped to APP leadership (135 files, 588 MB).

V2 intake pipeline made read-only by contract. Comments and tracked changes from UCI Neurology faculty and APP leadership are preserved as first-class signals rather than regenerated. 13-name UCI Neurology autotrust roster locked; institutional admin edits auto-commit and emit a process-insight report.

PowerPoint cross-version compatibility hardened. Underlying OOXML metadata reconstructed across the affected procedure decks; ‘needs repair’ prompts resolved at the toolchain level rather than per-file.

RECENT UPDATES · 2026-05-02

Design system v1.2 applied across all 15 decks. Body type is IBM Plex Mono at 22pt, the WCAG 2.1 AA floor for normal text. Bullets are structural with hanging indent, so wrapped lines stay aligned with the body column. Layout uses a 12-column grid with a 2:3 default split. Each deck opens with a key-fact slide that frames the procedure’s hero number: 66% CLABSI reduction with the bundle, ≥40,000 platelets pre-LP, 5–10 mL/hr lumbar-drain rate, and so on.

Each deck has been independently reviewed against the Fluid Responsiveness deck-review prompt. Per-deck reviews and the cross-deck roll-up are in 02_Governance/Reviews/. The current pass closes the structural-revision flags from prior audits.

Every clinical claim carries an AMA-format reference list with inline numeric citations [N]; DOIs and PMIDs included where available. Imagery is sourced from public-domain, CC-BY, CDC PHIL, NIH Open-i, or Wikimedia, with inline credit. Slides awaiting UCI clinical photography are placeholder-marked rather than backfilled with stock images.

COLOPHON

Set in Instrument Serif (display), IBM Plex Sans (body), and IBM Plex Mono (eyebrow / monospace) — the typographic system from the Fluid Responsiveness reference deck.

Palette: ink #0B0F14 · bone #F4EFE6 · crimson #C23B2A · oxygen-blue #7FB8D6 · amber #D99A3F.

UCI APP CLASS II · DEPARTMENT OF NEUROLOGY · APRIL 2026 · CHADWYCKE SMITH, MSN, APRN, AGACNP-BC · approving authority: Claire Henchcliffe, MD, DPhil — Chair, Department of Neurology

Session synopsis — 2026-05-11 (Pattern-A + SME pass)

Five-commit sequence taking the 15-deck corpus from 51 hard+soft overflows to 0 hard / 1 soft, plus 14 SME-flagged clinical and visual concerns closed. Drive publish preserved all 15 fileIDs.

Citations (proc 02) — 5 slides swapped O’Grady NP 2011 (CDC insertion guidelines) for removal-specific sources: Ely EW Am J Med 2018 PMID 28860036 for air-embolism prevention; Shah Z Cureus 2022 PMID 35733506 for femoral retroperitoneal/intraperitoneal hematoma. All PMIDs PubMed-verified.

Image swaps — proc 14 slide 15 replaced asset with baked-in template tokens (<IMAGE 1> / <IMAGE 2>) with Blausen 0617 Lumbar Puncture illustration (Wikimedia, CC BY 3.0, 1500×750). Proc 01 slide 22 replaced implanted Venous Access Port (wrong asset) with Wikimpan adult-male post-procedure CVL CXR (Public Domain, 2837×2864); title + body relocated to left-column layout.

Restructures — proc 15 slide 20 Pain card: full LAST rescue protocol (STOP, call, 100% O₂, 20% lipid emulsion 1.5 mL/kg bolus + 0.25 mL/kg/min infusion, max 12 mL/kg, ASRA 2020) moved to citation footer; Pain card trimmed to single-line cue. Proc 10 slide 20 CAUTI: TextBox 8 cy extended into unused image-below real estate; CAUTI bundle bullet tightened to 273 chars while preserving all 7 bundle elements and both PMIDs (Patel 2022, Lo 2014).

Layout / typography — geometric clamp resized 46 overflowing shapes; swarm of 7 parallel agents applied 107 minimum-impact font shrinks (22pt → 20/18/16pt as needed); proc 01 slides 12/22/23 text-shape geometry rebuilt off image bounds; proc 02 slide 18 sub-bullet drift permanently silenced via <a:buNone/>.

Audit-tool foundation — _pipelines/audit_pattern_a.py now detects five defect classes (hard/soft overflow, bullet-glyph drift, text-overflow-from-box, image-z-order overlap). Position+size citation detection catches mixed-case corporate authors. Test suite refactored to invariant-style.

Residuals — 11 text_ov + 3 img_ov + 1 soft remain as borderline cases swarm agents visually confirmed acceptable. Documented in _pipelines/v2_pattern_a_swarm_summary_2026-05-11.md for any future SME review.