Name
IV SkillsASSESSMENTYesNOMethod of evaluation
1. Assesses for potential IV site.YND
2. Reviews medical order for IV. Follows six rights.YND/V
3. Patients prior experience with IV therapy.YNV
4. Assessed new IV site.YND/V
COMMUNICATION
5. Explains to client that IV needs to be placed.YNV
6. Documents attempt, client response, gauge size, location and
assessment of site. YND
CRITICAL THINKING
7. Recognizes signs and symptoms of IV infiltration.YNV
8. Able to explain interventions for infiltration and/or
phlebitis.YNV
TECHNICAL SKILLS
9. Performs hand hygiene.YND
10. Applies clean gloves.YND
11. Organize equipment on bedside stand or over the bed
table.YND
12. Open sterile packages, keeping sterile the parts that will
be connected to the IV system.YND
13. Prepare NS lock for infusion.YND
14. Identify site for IV placement and place tourniquet 4-6
above insertion site.YND
15. Select well dilated vein. Foster vein dilation
techniques.YND/V
16. Clean insertion site using antiseptic solution.YND
17. Apply gloves.YND
18. Anchor vein by placing thumb over vein and stretching skin
against the direction of insertion.YND
19. Insert catheter with bevel up 15-30 degree angle.YND
20. Look for blood flashback and advance very slightly.YND
21. Advance catheter into vein until hub rests at venipuncture
site. Remove stylet and lock into safety mechanism.YND
22. Release tourniquet.YND
23. Secure with transparent dressing.YND
24. Apply gentle pressure above insertion site. YND
25. Connect tubing to the catheter. Tape securely.YND
26. Flush with 3 mL sterile saline.YND
27. Write date, time, and initials on dressing.YND
28. Dispose of used needles in sharps container.YND
29. Remove gloves and wash hands.YND
30. Write date, time, and initials on dressing.YND
31. Prepare IV tubing and solution.YND
32. Prime infusion tubing.YND
33. Connect end of infusion tubing set to cannula.YND
34. Set up pump and select correct volume per hour.YND
35. Begin infusion by slowly opening clamp of tubing.YND
36. Prepares for IV Push (IVP) medication per orderYND
37. Checks for compatibility with IV fluidsYND/V
38. Administers through port closest to patient after scrubbing
the hubYND
39. IV infusion rate to same rate as medication YND
40. Resets IV infusion rateYND
41. Turns pump off and roller clamp to off.YND
42. Discontinues fluids, scrubs the hub and performs normal
saline flush and lock YND
43. Prepares for IVP medicationYND
44. Flushes with normal saline after scrubbing the hubYND
45. Administers IVP at correct rate/minYND
46. Flushes with Normal Saline at same rate as medication and
locks mechanism for saline lockYND
47. Removes IV site dressing.YND
48. Applies pressure over VP site using clean sterile
gauze.YND
49. Verbalizes need to assess catheter for intactnessYND/V
N = does not demonstrate competencyY = demonstrates
competencyMethod of evaluation for competency: Verbalizes =
VDemonstrates= D
Faculty Signature _________________________________ Pass
Fail
