COLLEGE OF NURSING

Nursing Care Management _103

Procedural Checklist in
INTRAVENOUS FLUID PREPARATION

Name: Year/Sec: Rating:

Objectives:
1. Serve as guide in providing and quality nursing care to patients, relative to IV fluid preparation.
2. Promote the application of principles underlying the administration of IV fluid preparation.
3. Understands infection control principles in performing intravenous preparation to patients thoroughly.

Specific Objectives:
1. The students shall be guided on how to provide safe and quality nursing care regarding IV fluid preparation.
2. The students shall be able to define terms associated with IV fluid preparation.
3. Their knowledge, attitude and skills regarding IV fluid preparation are enhanced.

Item Weight Descriptors Verbal Interpretation

1.0 Excellent Performed the procedure with great ease and confidence, observing work
ethics (prudent, accepts criticisms and suggestions), able to rationalize
scientifically and shows diligence in documenting observations at all times
.
.75 Very Performed the procedure with less confidence, observing work ethics
Satisfactory (prudent, accepts criticisms and suggestions), able to rationalize
scientifically and shows minimal diligence in documenting observations.
.50 Satisfactory Performed the procedure but requires close supervision and shows
potential for improvement.
.25 Needs Failed to perform the procedure, unable to function well and needs
Improvement repeated specific/ detailed guidance or direction.

CRITERIA:
I. Skills –10 points 1.0 .75 .50 .25 Remarks
1.Verify written prescription in administration of
intravenous infusion
2.Explain the procedure to reassure the patient and
/or significant others.
3.Do hand hygiene before priming the tubing.
Prepare necessary materials for procedure(
IVsolution,administration set, IVpole)Place IV label on
IVF bottle duly signed by nurse who prepares it.
4.Check the integrity and sterility of the IV solution, IV
administration set. Open and prepare the infusion set.
5. Slide the roller clamp along the tubing until it is just
below the drip chamber to facilitate access then close
the roller clamp.
6.Remove the protective cover from the entry site of
the bottle aseptically. Remove the cap from the spike
and insert spike connector on the insertion site of the
IV solution aseptically.
7. Remove the cap from the spike and insert spike
connector on the insertion site of the IV solution
aseptically.
8.Hang the IV bottle on the IV pole and partially fill the
drip chamber with the solution.
9.Squeeze the chamber gently until it is half full of
solution.Open the air vent.
10. Release the roller clamp and let the fluid run
thorugh the tubing until all bubbles are removed.

COMMENTS:Strengths/Weaknesses:

CONFORME: EVALUATED BY:

__________________________________ __________________________________
Signature over Printed Name Signature over Printed Name
Student Clinical Instructor