Trinity University of Asia

St. Luke’s College of Nursing

PERFORMANCE CHECKLIST SKILL: REGULATING INTRAVENOUS FLOW RATES

Name of Student:_______________________________________________Date__________________

Level/ Section__________________________________________________Score:_________________

PROCEDURE DONE NOT REMARKS

DONE
ASSESSMENT
1. Reviewed accuracy and completeness of health
care provider order, followed Rights of Drug
Administration.
2. Performed hand hygiene, identified patient
using two identifiers.
3. Applied clean gloves, inspected and palpated skin
around IV site, asked patient how IV site feels,
assessed VAD for patency and signs of IV-related
complications, disposed of gloves, performed
hand hygiene.
4. Assessed IV system for patency.
5. Identified patient risk for fluid and electrolyte
imbalance.
6. Assessed patient’s knowledge of how positioning
of IV affects flow rate.
PLANNING
1. Gathered material to calculate flow rate.
2. Checked order for length of infusion, calculated
hourly rate if necessary.
3. Checked agency policy regarding Keep Vein Open
(KVO) flow rate if needed.
4. Used hourly rate to program EID or to calculate
minute flow rate.
5. Knew calibration of infusion set.
6. Selected appropriate formula to calculate minute
flow drops based on drop factor of infusion set.
IMPLEMENTATION

1.Using gravity flow:

a.Ensured IV container is at an appropriate height (36
inches above IV site).
b. Opened roller clamp on tubing until there are drops in
drip chamber, counted drip rate for 1 minute, adjusted
roller clamp if needed.
2.Using an Electronic Infusion Devices(EID)
a.Closed roller clamp on primed IV tubing
 b. Inserted tubing into chamber of EID control
mechanism.
c. Secured part of IV tubing through “air in line” alarm
system, closed door, turned on power, selected drop
rate, closed door and pressed start. If infusing, accessed
EID library and set rate and dose limits
d. Opened infusion tubing drip regulator completely
while EID was in use.
e. Monitored infusion rate and IV site for complications.
f. Assessed IV system from container to Vascular Access
Device(VAD) insertion site when alarm signals
3. Attached label to IV solution container with date and
time container changed.
4. Taught patient purpose of EID, purpose of alarms, to
avoid raising hand or arm that affects flow rate and to
avoid touching clamp.
5. Removed and disposed of used supplies, performed
hand hygiene.
EVALUATION
1. Observed patient every 1 to 2 hours, noted
volume of IV rate infused and rate of infusion.
2. Evaluated patient’s response to therapy.
3. Evaluated patient at established intervals for
signs of IV -related complications.
4. Asked patient to explain what causes pump to
alarm and what to do when it does.
RECORDING AND REPORTING
1. Record IV solution, rate of infusion, and integrity
and patency of system in appropriate log.
2. Record use of EID or control device and device ID
number.
3. Recorded patient response and unexpected
outcomes.
4. Recorded patient’s level of understanding and
ability to follow instructions.
5. Reported rate and volume left in infusion to next
nurse assigned to care for patient.

Evaluator’s Name and Signature: ______________________________

Date: __________