ILOILO DOCTORS’ COLLEGE

COLLEGE OF NURSING
West Avenue, Molo, Iloilo City

ASSISTING IN INSERTION OF INTRAVENOUS INFUSION

PERFORMANCE CHECKLIST

Student’s Name : ________________________________Score : _________________

Year & Sec: __________________________________Date Performed : ______________

PERFORMANCE CHECKLIST:
4 – Consistently demonstrates high level performance
3 – Satisfactorily achieves performance standards
2 – Performs task difficulty
1 – Unable to perform tasks as required

PROCEDURE 4 3 2 1
Introduce yourself and verify client’s identity
Explain the procedure to the client
Make sure the client’s clothing or gown can be removed over the IV apparatus if necessary
Gather equipment’s and bring to bedside. Perform hand hygiene
Open and prepare the infusion set
Remove tubings from the container and straighten it out
Slide the tubing clamp along the tubing until it is just below the drip chamber, then close the clamp.
Leave the ends of the tubing covered with the plastic caps until infusion is started
Spike the solution container
Remove the protective cover from the entry site of the bag
Remove the cap from the spike and insert the spike into the insertion site of the bag or bottle
Apply a medication label to the solution container, if medication was added
Hang the solution container on the pole. Adjust pole to suspend container about 1 meter (3ft) above the
clients head
Partially fill the drip chamber with solution by squeezing the chamber gently until it is half full of solution
Prime the tubing
Remove the protective cap and hold the tubing over a container, maintain sterility of the end of the tubing and
cap.
Release the clamp and let the fluid run through the tubing until all bubbles are removed. Tap the tubing with
your fingers to help the bubbles move
Re – clamp the tubing and replace the tubing cap maintaining sterile technique.
Select the venipuncture site
Use client’s non dominant arm, unless contraindicated
Place towel or bed protector under the extremity to protect the linens
Clean the venipuncture site with the topical antiseptic swab (alcohol) using a circular motion, moving from the
center outward for several inches. Permit the solution to dry on the skin.
NOTE: Catheter insertion is done by the physician or IV Therapist
Remove the protective cap from the distal end of the tubing, hold it ready to attach to the catheter maintaining
sterility of the end.
Once the needle was removed, engage the needle safety device and attach the end of the infusion tubing to
the catheter hub.
Initiate the infusion slowly by opening the tubing clamp

Tape the catheter by the “U” method

Use 3 strips of adhesive tape, each about 7.5cm (3 inches) long
Place the strip, sticky – side up under the catheter’s hub
Fold each end over so that the sticky side are against the skin
Place a second strip, sticky side down over the catheter hub
Place a third strip, sticky side down, over the tubing hub
Dress and label the venipuncture site and tubing according to agency policy
Apply a sterile transparent occlusive dressing
Discard tourniquet, remove the soiled gloves and dispose appropriately
Loop the tubing and secure it with tape
Label the dressing with the date and time of insertion type and gauge of needle or catheter used and your
initial
Apply a padded arm board to splint the joint as needed.
Adjust the infusion rate of flow according to the order
Label the tubing with the date and time of attachment and your initial
Document relevant data.
Date and time of venipuncture
The time of the start of infusion
The flow rate of the infusion
The amount and type of solution used and any additives
The type and gauge of needle or catheter
The venipuncture site
The client’s response
TOTAL

Students’ Signature:_________________

Instructors ‘Signature:________________