PROCEDURE CHECKLIST

Chapter 38, Skill 38-03: Converting an IV Infusion to a prn Lock

Check () Yes or No

PROCEDURE STEPS YES NO COMMENTS

If Patient Has IV Tubing Connected Directly to
the Cannula Hub:
1. Gather needed equipment and supplies: sterile
gloves, prn lock device, normal saline (NS)
flush, needle or blunt-tipped adapter, alcohol
wipes, and tape. Inspects packages for intactness
and expiration dates.
2. If the prn lock device does not allow use of
Luer-Lok device, apply a needle or blunt-tipped
adapter to the NS flush syringe and maintains
sterility.
3. Cleans the injection port of the new prn lock
device with alcohol wipe.
4. Connects the sterile Luer-Lok tip of the
syringe to the injection port, or inserts the needle
or blunt-tipped adapter into the injection port of
the prn lock while maintaining sterility.
5. Primes the new prn lock and leaves the
syringe with the remaining NS attached to the
prn device.
6. Follows the “Initial Implementation Steps.”
7. Assesses the patient’s IV site for signs of
infiltration or phlebitis. Prepares tape.
8. Stops the IV solution by turning off the pump
or closing thumb clamp on gravity flow.
9. Dons sterile gloves.
10. Loosens tape from site without disturbing
TOD and places sterile 2 × 2 under the cannula
hub.
11. Disconnects the IV tubing end from the
cannula hub, maintaining sterility.
12. Removes the end cap from the connecting
end of the new prn lock device without
contaminating and inserts it into the sterile hub
of the IV cannula, connecting securely.
13. Secures with tape. Aspirates with the NS
flush syringe to establish blood return.
14. Closes the sliding clamp on the prn lock
device and injects the remaining NS flush

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solution over 1 minute.
15. Removes gloves and washes hands.
16. Follows the “Ending Steps
17. Documents the conversion from IV infusion
to prn lock.
If Patient Has a prn Lock Device Connecting
the Cannula Hub to the Tubing:
1. Gathers needed equipment and supplies:
sterile gloves, NS flush, needle or blunt-tipped
adapter if needed, and alcohol wipes. Inspects
packages for intactness and expiration dates.
2. Follows the “Initial Implementation Steps.”
3. Assesses the patient’s IV site for signs of
infiltration or phlebitis. Prepares tape.
4. Dons sterile gloves.
5. Stops the IV solution by turning off the pump
or closing thumb clamp on gravity flow.
6. Disconnects the IV tubing from the injection
port of the prn lock and cleans the injection port
with an alcohol wipe.
7. Connects the NS flush syringe to the prn lock
port, or inserts a needle or blunt-tipped adapter
into the port of the prn lock.
8. Aspirates to establish blood return and flushes
the prn lock and cannula with NS flush slowly
over at least 1 minute.
9. Closes the slide clamp on the prn lock and
disconnects the NS syringe.
10. Removes gloves and wash hands.
11. Follows the “Ending Steps.”
12. Documents the conversion from IV infusion
to prn lock.

Recommendation: Pass _____ Needs more practice _____

Student: Date:

Instructor: Date:

Copyright © 2015, F. A. Davis Company