Manila Central University

COLLEGE OF NURSING
NCM 118: INSERTING AN IV CANNULA

NAME: ____________________________ DATE:_____________________ SCORE:____________=___________%

Direction: Please rate the student’s performance using the scale below.
4 – EXEMPLARY (provides complete and accurate evidence in demonstrating knowledge, skills and attitude
necessary to facilitate client examination, assessment and intervention)
3 – PROFICIENT (provides clear evidence in demonstrating knowledge, skills and attitude necessary to facilitate
client examination, assessment and intervention)
2 – DEVELOPING (provides limited evidence in demonstrating knowledge, skills and attitude necessary to facilitate
client examination, assessment and intervention)
1 – BEGINNING (provides little or no evidence in demonstrating knowledge, skills and attitude necessary to
facilitate client examination, assessment and intervention)
PROCEDURE 4 3 2 1 Remarks
I. INSERTING IV CANNULA UTILIZING DUMMY ARM
Note: Prepare complete IV tray with IV infusions, dummy arm and
other safety devices.
1. Verify the written prescription of the doctor for IV therapy.
2. Check the dummy arm, prepare IVF and other things needed.
3. Explain the procedure to reassure the patient and significant
others and observe the twelve (12) rights in administering
medication.
4. Do hand washing/hand hygiene before and after the procedure.
5. Wear gloves only during venipuncture.
6. Choose appropriate site, location, size and condition of the vein.
7. Apply tourniquet 5 to 12 cm. (2-6 inches) above injection site.
8. Check for radial pulse below tourniquet.
9. Prepare site with effective topical antiseptic according to
hospital/institutional policy. (No touch technique)
10. Use the appropriate IV cannula utilizing the correct technique.
11. Insert catheter progressively until backflow is visualized.
12. Position the IV catheter parallel to the skin.
13. Hold stylet stationary and slowly advance the catheter until the
hub is 1mm to the puncture site.
14. Connect the infusion tubing of the prepared IVF aseptically.
15. Remove the tourniquet.
16. Open the clamp and regulate the flow rate.
17. Secure and apply the appropriate taping technique.
18. Tape a small loop of IV tubing for additional anchoring. Apply
splint, if needed.
19. Calibrate the IVF bottle and regulate the flow of infusion.
20. Label on the IV tape near the IV site to indicate the date of
insertion, type and gauge of IV catheter and countersign.
21. Label with plaster on the IV tubing to indicate the date when to
change the IV tubing.
22. Observe the patient and report any untoward effect.
23. Discard sharps and waste according to Health Care Waste
Management (DOH/DENR).
24. Document in the patient’s chart and endorse to the incoming shift
TOTAL
REMARKS:
___________________________________________________________________________________________________
______________________________ Date: __________________________
Student’s Printed Name & Signature
_______________________________
Instructor’s Printed Name & Signature Date: __________________________