ST.

ALEXIUS COLLEGE
Gen. San. Drive, City of Koronadal, South Cotabato, Philippines 09506, Tel.: (083) 228-2019, Fax: (083) 228-4015, Email: st.alexiuscollege@yahoo.com

SKILLS CHECKLIST FOR IV INSERTION

NAME: ____________________________________________ DATE:_________ SCORE: _________

Performed

IV Insertion Correctly Incorrectly Not Remarks

Done Done Done

1. Verify the written prescription for IV therapy, check

prepared IVF and other things needed.
a. IV Fluid
b. IV Cannula
c. Alcohol Swab
d. Plaster (Hypoallergenic)
e. IV Administration Set
f. Kidney Basin
g. Dry Cotton Balls
h. Gloves
i. Alcohol
2. Explain procedure to reassure the patient & significant
others and observed the 10 R’s.
3. Do hand hygiene before & after the procedure.
4. Choose site for IV.
5. Apply tourniquet 5 to 12 cm. (2-6 in.) above injection site
depending on condition of patient.
6. Check for radial pulse below tourniquet.
7. Prepare site with effective topical antiseptic according to
hospital policy or cotton balls with alcohol in circular
motion and allow 30 seconds to dry. (No touch
technique). Wear gloves
8. Using the appropriate IV cannula, pierce skin with needle
positioned on a 15-30 degree angle.
9. Upon flashback visualization decrease the angle,
advance the catheter and stylet (1/4 inch) into the vein,
check if tip of catheter can be rotated freely inside the
vein.
10. Position the IV catheter parallel to the skin.
11. Hold stylet stationary and slowly advance the catheter
until the hub is 1 mm to the puncture site.
12. Release the tourniquet, remove the stylet and cannula
while applying digital pressure over the catheter with one
finger about 1-2 inch from the tip of the inserted catheter.
13. Put dry cotton balls on the IV insertion site. Apply
pressure. Put adhesive tape.
14. Do after care.
1st Attempt 2nd Attempt 3rd Attempt

____________________________________________
NAME AND SIGNATURE OF THE PRECEPTOR