SKILLS CHECKLIST – VENIPUNCTURE FOR PIV INSERTION

Please print off a copy of this checklist for yourself, and bring it with you to your “live insertion” pre-arranged experience for your
evaluator. Submit the completed checklist to your educator.

Nurse: ______________________ Department: _______ Manager: _____________________

Key: C = Competent NC = Not competent
Criteria Demo # C/NC (√) Comments/Evaluator Initials

1. Maintains routine practices and 1

universal precautions throughout
procedure 2

2. Explains procedure to patient 1

 Completes assessment to
determine appropriate venous
access device type (PIV vs. 2
CVAD)
 Considers IV therapy to be
infused
 Considers the patient: 3
o Age, Co-morbidities
o Contraindications (ex.
allergies, CVA, 2
mastectomy, AV Fistula,
impaired circulation, 3
wounds, pain, etc.)
3. Selects appropriate venipuncture site. 1
Considers:
 Dominant/non-dominant arm, 2
vein length/width, valves,
joints/nerves, avoids areas of 3
flexion (ex. wrist/ACF)
 Assesses patient to determine
cathlon size needed: (Dilates
veins appropriately. ex. tourniquet,
fist clenching, dependent position,
warm compress)
4. Gathers Supplies 1
Antiseptic wipe, tourniquet, appropriate
sized cathlon, tape, gauze, primed 2
extension set, dressing, clean gloves, NS
flush 3

5. Prepares site: 1
 Cleanses site with 2%CHG/70%
alcohol in back and forth motion
covering an area slightly larger
than size of the dressing. Does 2
not retouch site after cleansing
 Applies tourniquet 15 cm (~ 6”)
above venipuncture site (radial 3
pulse should still be palpable)

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 Criteria Demo # C/NC (√) Comments/Evaluator Initials

6. Prepares Catheter 1
 Removes needle in straight
outward motion 2
 Ensures push tab is facing up and
catheter is seated back in notch 3

7. Stabilizes vein and performs 1

venipuncture
 Holds skin taught
 Inserts bevel up at approx. 10-30⁰ 2
angle depending on vein depth
 Observes for flashback 3
 Lowers angle after flashback
observed to almost parallel to
skin
 Advances needle (approx. 0.5cm)
slightly to ensure within vein
8. Maintains skin traction while 1
advancing plastic catheter only (one
hand or two hand technique) 2

9. Releases tourniquet, stabilizes the 1

catheter hub and presses button to retract
needle (while avoiding pulling needle out 2
of catheter hub). Discard needle into
sharps container. 3

10. Connects primed extension set and 1

flushes appropriately
2

11. Secures catheter with appropriate 1

IV Dressing and labels appropriately
with date, time and initials 2
 Avoids use of tape close to/on
insertion site 3
 Ensures insertion site visible

Date Demo # Evaluator’s Signature/Designation Print Evaluator’s Name /Initial

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