\iv checklist PROCEDURE II BLOOD TRANSFUSION STEPS CD IC REMARKS Verify doctor s written prescription and make a treatment card

according to hospital policy. Observe ten (10) Rs when preparing and administering any blood or blood components. Explain the procedure/rationale for giving blood transfusion to reassure patient and significant others and secure consent. Get patient histories regarding previous transfusion. Explain the importance of the benefits on Voluntary Blood Donation (RA 7719 National Blood Service Act of 1994). Request prescribed blood/blood components from blood back include blood typing and X-matching and blood result of transmissible Disease. Using a clean lined tray, get compatible blood from hospital blood bank. Wrap blood bag with clean towel and keep it at room temperature. Have a doctor and a nurse assess patient s condition. Countercheck the compatible blood to be transfused against the X-matching sheet noting ABO grouping and RH, serial no. of each blood unit, and expiry date with the blood bag label and other laboratory exams as required before transfusion (|Hgb and Hct) Get the baseline vital signs BP, RR sndTempearature before transfusion. Refer to MD accordingly. Give pre-med 30 minutes before transfusion as prescribed. Do hand hygiene before and after procedure. Prepare equipment needed BT (IV injection tray, compatible BT set, IV catheter/needle G 19/19, plaster, tourniquet, blood, blood components to be transfused, Plain NSS 500 cc, IV set, needle gauge 18 (only if needed), IV hook, gloves, sterile 2x2 gauze or transparent dressing, etc. If main IVF is with dextrose 5% initiate an IV line with appropriate IV catheter with plain NSS on another site, anchor catheter properly and regulate IV drops. Open compatible blood set aseptically and close roller clamp. Spike blood bag carefully; fill the drip chamber at least half full; prime tubing and remove air bubbles (if any). Use needle g. 18 or 19 for side drip (for adults) or g. 22 for pedia (if blood is given through the Y injection port, the gauge of needle is disregarded.) Disinfect the Y-injection port of IV tubing (plain NSS) and insert the needle from BT administration set and secure with adhesive tape.

PROCEDURE II: BLOOD TRANSFUSION: Cont d STEPS CD IC REMARKS Close roller clamp of IV fluid of Plain NSS and regulate to KVO while transfusion is going on. Transfuse the blood via the injection port and regulate at 10-15 gtts/min. initially for 15 minutes and then at the prescribed rate (usually based on the patient s condition). Monitor the patient within the first 5-10 minutes of transfusion and refer immediately to the MD for any adverse reaction. Observe/ Assess patient on an on-going basis for any untoward signs and symptoms such as flushed skin, chills, elevated temperature, itchiness, urticaria and dyspnea. If any these symptoms occur stop the transfusion, open IV line with plain NSS and regulate accordingly, and report to the doctor immediately. Swirl the bag gently from time to time to mix the solid with the plasma Nb one BT st should be used for 1-2 units of blood. When blood is consumed, close the roller clamp of BT, and disconnect from IV lines then regulate the IVF of plain NSS as prescribed. Continue to observe and monitor patient post transfusion, for delayed reaction could still occur. Re-check Hgb and Hct, bleeding time, serial platelet count within specified hours as prescribed and/or per institution s policy. Discard blood bag and BT set and sharps according to Health Care Waste Management (DOH/ DENR). Fill out adverse reaction sheet as per institutional policy. Remind the doctor about the administration of Calcium Gluconate if patient has several units of blood transfusion (3-5 more units of blood).

Signed by: NURSE PRECEPTOR II: _________________________ PARTICIPANT _________________________ DATE ____________ SCORE: ________________________________________ INSTRUCTIONS: Please check on the space provided whether the participant is able to perform the procedure correctly or whether it is incorrectly done. CD Correctly Done ID Incorrectly Done

PROCEDURE III: ADMINISTERING IV DRUGS IV MEDICATION PUSH THROUGH THE IV PORT IV MEDICATION PUSH THROUGH THE HEPARIN LOCK DEVICE PROCEDURE III: ADMINISTERING OF IV DRUGS: Cont d STEPS CD IC REMARKS III.B. IV MEDICATION PUSH THROUGH THE IV PORT Verify medication card aginst the written doctor s prescription. Observe the 10 Rs when preparing and administering medication. Explain procedure to reassure patient and significant others (the name of medicine and action/interaction of medication) before administration. Do hand hygiene before and after procedure (use gloves especially for chemotherapeutic and other vesicant drugs) Check patency and other reaction signs of swelling, redness, phlebitis, etc if any of these are evident, do not give the drugs). Check for skin test result of drug for IV push, drug-drug, drug-IV fluid incompatibility, dosage (computation) Prepare the necessary materials for the procedure such as: right drug, right diluents, IV injection tray, syringes with needles, alcohol, etc. Disinfect injection port of the diluents, vial or ampule as may be appropriate. Aspirate right amount of diluents for the drug (if the drug needs to be diluted) Aspirate the right drug dose, disinfect the Yinjection port of the IV administration set/catheter IV port. Close the roller clamp of the IV tubing from the bottle and push IV drug aseptically and slowly according to the manufacturer s recommendation Using same syringe, aspirate 1-2 cc of IVF to flush the medicine given. Regulate rate of IV fluid infusion as prescribed (if needed) Reassure patient and observe for signs and symptoms of adverse drug reaction. Discard sharps and other waste according to Health Care Waste Management (DOH/DENR)

Signed by: NURSE PRECEPTOR III: ____________________

PROCEDURE III: ADMINISTERING OF IV DRUG: Cont d STEPS CD IC REMARKS III. D. IV medication PUSH through the HEPARIN-LOCK DEVICE Check medication card against the written doctor s prescription. Observe 10 Rs when preparing and administering medication Explain procedure to the patient (name of medicine and action) before administration. Gather equipment to include / but not limited to IV tray, Normal Saline diluents or Isotonic solution, 2.5 cc syringes (2-3 pcs) as needed. Do hand hygiene before and after te procedure (use gloves especially for chemo drugs) Prepare medication to be administered, eg. Antibiotic, and draw it up into a syringe. Fill a tuberculin syringe with Heparin solution. NB Heparin solution is usually prepared with 0.1 cc. Heparin plus 0.9 cc Normal Saline or isotonic solution as prescribed by the Doctor. Fill 2.5 cc syringe with isotonic solution or Normal Saline solution 1 cc each If using Heparin Lock device with 3 way stop cock with luer-lock, rotate the stop cock so that the line going to the patient is closed (this will prevent backflow of blood) Remove the cover of the injection port aseptically and keep the sterility of the cover. Check the patency, open the IV line and inject NSS or Isotonic Solution to flush the Heparin Solution as prescribed by the Doctor. Close the IV line and remove saline syringe and insert medication syringe into the port. Give IV push 5-10 minutes for IV potent drug. For 2-3 IV medications, give at least 30 minutes to 1 hour interval. After each drug administered via IV push, flush with 2-3 cc saline solution. Observe patient for any adverse reactions and do nursing intervention accordingly. Document Discard waste according to Health Care Waste Management (DOH/DENR) Note: Normal Saline can take the place of Heparin. Studies have shown the efficacy of NSS. Heparin solution can be used if normal saline or Isotonic solution is not available and as prescribed by the MD.

Signed by: NURSE PRECEPTOR III: _____________________

PROCEDURE V: ONE STEPS

ON

ONE IV INSERTION

CD IC REMARKS Do hand hygiene before and after the procedures. Follow procedure in IV insertion aseptically and accordingly Discard Waste Materials according to Health Care Waste Management (DOH/DENR) Suggested Score Score ___1st attempt 20 pts highest score ___ 2nd attempt 15 points ___ 2nd attempt less 2-3 pints With hematoma ___ 3rd attempt 10 points ___ 3rd attempt With hematoma less 2-3 points **look for another participant for insertion