INTRAVENOUS THERAPY

Name: ___________________ Year & Section ___________ RLE: __________ Date____________

DIRECTIONS: Rate the Skill performance based on the performance level below.
3-Accomplished
Performed action as expected and knows the scientific rationale when asked
2-Needs Improvement
Missed a few expected actions but remembers actions and rationale when coached and
asked respectively
1-Beginning
Missed most required actions and remembers poorly when coached

Criteria 3 2 1
ASSESSMENT
1. Review physician’s order for type and amount of IV fluid and rate of fluid
administration. The nurse should follow the rights for medication administration.
2. Assess for factors/conditions that will respond to or be affected by IV fluid
administration.
- Peripheral edema
- Greater than 2% increase or decrease in body weight
- Dry skin and mucous membranes
- Distended neck veins
- Blood Pressure changes
- Irregular pulse rhythm; increase pulse rate
- Auscultation of crackles or rhonchi in lungs
- Inelastic skin turgor
- Anorexia, nausea, and vomiting
- Thirst
- Decreased urine output
- Behavioral changes
3. Assess client’s previous or perceived experience with IV therapy and arm
placement preference.
4. Obtain information from drug reference books or pharmacist about
composition of IV fluids, purposes of administration, potential incompatibilities,
and side effects to monitor for.
5. Determine if client is to undergo any planned surgeries or is to receive blood
infusion later.
6. Assess for the following risk factors: child or older adult; presence of heart
failure or renal failure, skin lesions, infection, low platelet count or receiving
anticoagulants.
7. Assess laboratory data and client’s history of allergies.
PLANNING
8. Prepare client and family by explaining the procedure, its purpose, and what
is to expect of client. Also explain the sensation the client is to expect.
9. Assist client to a position of comfort.
10. Perform hand hygiene.
11. Organize equipment on clean, clutter-free bedside stand or overbed table.
IMPLEMENTATION
12. Change client’s gown to the more easily removed gown with snaps at the
shoulder, if available.
13. Open sterile packages using sterile aseptic technique.
14. Prepare IV infusion tubing and solution.
15. Check IV solution, using five rights of drug administration. Make sure
prescribed additives has been added. Check solution for color, clarity, and
expiration date. Check bag for leaks, which is best if done before reaching the
bedside.
16. Open infusion set, maintaining sterility of both ends of tubing. Many sets
allow for priming of tubing without removal of end cap.
17. Place roller clamp about 2 to 5 cm (1 to 2 inches) below drip chamber and
move roller clamp to “off” position.
18. Remove protective sheath over IV tubing port on plastic IV solution bag.

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 19. Insert infusion set into fluid bag or bottle: Remove protector cap from tubing
insertion spike, not touching spike, and insert spike into opening of IV bag.
Cleanse rubber stopper on bottled solution with antiseptic and insert spike into
black rubber stopper of IV bottle.
20. Prime infusion tubing by filling with IV solution:
21. Compress drip chamber and release, allowing it to fill one-third to one-half
22. Remove protector cap on end of tubing and slowly release roller clamp to
allow fluid to travel from drip chamber through tubing to needle adapter. Return
roller clamp of “off” position after tubing is primed.
23. Be certain tubing is clear of air and air bubbles. To remove small air
bubbles, firmly tap IV tubing where air ensure that all air bubbles are removed. If
multiple port tubing is used, turn ports upside down and tap to fill and remove
air.
24. Replace cap protector on end of infusion tubing.

Total Score: /72

Comments:
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Clinical Instructor: _________________________