CAPIZ DOCTORS’ HOSPITAL

Brgy. Lawa-an, Roxas City

Tel. #: 6510651
“PHILHEALTH ACCREDITED”

Name:
Signature: Date:

IV THERAPY SKILLS CHECKLIST

IV INSERTION

NOT
PROCEDURE DONE REMARKS
DONE
Check physician’s order and gather equipment and supplies. Introduce
1
self, explain what procedure is to be done and why.
Perform hand hygiene, following infection control measures, and verify
2
client’s identity. Assess for allergies (Latex, Tape, Antiseptics)
Provide comfort and safety for client and self, including raising bed to
3
appropriate height for procedure
Prepare client: Assist the client to a comfortable position, either sitting
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or lying. Expose the limb to be use but provide for client privacy.
Select venipuncture site:
A. Use client’s non-dominant arm. Identify possible venipuncture
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sites by looking for veins that are relatively straight.
B. Place towel or bed protector under extremity to protect linens.
Dilate the vein
A. Place extremity in a dependent position.
B. Apply tourniquet firmly 5 to 12 cm (2 to 6 in.) above venipuncture
site.
C. Explain that tourniquet may feel tight.
6 D. If vein did not sufficiently dilate, massage or stroke vein distal to
site and in direction of venous flow toward heart. Encourage client
to open and close hand.
E. Lightly tap vein with fingertips.
F. If preceding steps failed to distend vein, remove tourniquet and
wrap the extremity in a warm, moist towel for 10 to 15 minutes.
Minimize insertion pain as much as possible using ice, transdermal
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analgesic creams or intradermal injection if available.
Wear clean gloves and clean venipuncture site.
A. Clean skin at site of entry with a topical antiseptic swab.
B. Use a circular motion for a minimum of 30 seconds to scrub the
8 insertion site and surrounding area
C. Permit solution to dry on skin.
D. Prepare equipment aseptic technique (set aside catheter,
tegaderm, flush the extension set tubing)
9 Insert the catheter, and initiate the infusion.
A. Remove catheter assembly from sterile packaging.
B. Use nondominant hand to pull skin taut below entry site.
C. Hold the over-the-needle catheter at a 15- to 30-degree angle
with needle bevel up, inserted catheter through skin and into vein.
D. Once blood appears in the lumen of the needle, lower the angle
of the catheter until almost parallel with the skin, and advance the
needle and catheter approximately 0.5 to 1 cm (about 1/4 in)
further. Hold needle assembly steady, advance the catheter until
the hub is at the venipuncture site.
E. If hematoma occurred, release tourniquet, removed needle, and
apply pressure.
F. Release the tourniquet.
 G. Put pressure on vein proximal to catheter to eliminate or reduce
blood oozing out of catheter. Stabilize hub with thumb and index
finger of non-dominant hand.
H. Carefully remove stylet, engage needle-safety device, and
connect distal end of extension set tubing to the hub. Flush
catheter with sterile normal saline. Maintain sterility. Place stylet
directly into sharps container.
I. While maintaining sterility connect distal end of the extension set
to the IV tubing. Initiate infusion as prescribed.
Dress and label venipuncture site and tubing according to agency
policy. Apply Tegaderm dressing to secure the site if available.
A. Anchor needle firmly in place with the use of plaster or
10 transparent dressing.
B. Apply an IV site protector, if available or splint.
C. Loop any tubing and secured it with tape.
D. Discard tourniquet. Remove and discard gloves
Discard all used disposable items in appropriate receptacles. Clean any
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blood spills according to the Hospital Infection Control policy.
Return bed to lowest height. Remove gloves and perform hand
12
hygiene.
Document procedure.
1. Date and Time
13 2. Name and Signature of Nurse
3. Site Location
4. Type/Size of catheter

Over-all Remarks:

LEA P. ALAYON, PhD., RN

Printed Name and Signature of Evaluator Chief Nursing Officer
Date: ____________________