Competency Skill Checklist: Intravenous Therapy

Name: Rebecca Butler

Instructions: Insert date of each attempt in the block provided. In the block by each criterion,
place a check mark under the appropriate column. When checklist is completed, save this
document as part of your professional profile. (CNO)

Intravenous Therapy Indicators

Met
st

Insert date of each attempt here

1. Assess patient and medical history for pertinent information
1.1 Obtains information from the patients medical record.
1.2 Examines patients upper extremity for veins suitable for catheter
insertion.
2. Plan nursing care for patient receiving peripheral intravenous
therapy
2.1 Chooses intravenous catheter according to hospital policy,
procedure, and practice guideline.
2.2 Chooses flow control device according to hospital policy, procedure,
and practice guidelines.
2.3 Assembles equipment and supplies for the procedure according to
hospital policy, procedure, and practice guideline.
2.4 Chooses personal protective equipment for standard precautions.
2.5 Formulates patient and family education.
3. Initiation of I.V.
3.1 Sets up the I.V. system.
3.2 Uses infection control measures.
3.3 Performs venipuncture.
3.4 Assess patient safety before leaving the room.
3.5 Documents nursing care.
3.6 Removes catheter when clinically indicated.
4. Evaluate the effectiveness of the nursing care rendered
4.1 Monitors venipuncture site.
4.2 Monitors the infusion system.
4.3 Observes patient for complications.

1
Oct 7

2nd
Oct 16

3rd
Nov 8

Adapted from Niagara Health Centre IV Initiation for R.N.

Comments: These represent successful IV therapy initiations that I did independently.