UNIVERSITY OF NORTHEASTERN PHILIPPINES
San Roque, Iriga City
COLLEGE OF NURSING & MIDWIFERY
Name: _______________________________________ Date: ________________
Year and Section: _______________________________ Grade: _______________
PROCEDURE CHECKLIST:
IV THERAPY
Instruction: Below is the grading scale that will be used to rate your performance.
5 - Excellent - 95 – 100
4 - Very Satisfactory - 88 – 94
3 - Satisfactory - 82 – 87
2 - Fair - 76 – 81
1 - Needs Improvement - 70 – 75
EQUIPMENT:
• Tourniquet
• Cotton balls with alcohol
• Cotton balls dry
• Abbocath G22
• Micropore
• Gloves
5 4 3 2 1 REMARKS
PROCEDURE
1. Checked physician's order and gathered
supplies. Introduced self, explained what
procedure was to be performed and why.
2. Perform hand hygiene, following infection
control measures, and verified client's
identity. Assess for allergies-Latex, antiseptic,
and tape.
3. Prepare the client: Assisted the client to a
comfortable position. Provide comfort and
safety for client and self, including raising bed to
appropriate height for procedure. Exposed the
limb to be used while providing client privacy.
4. Dilate the vein with tourniquet as
Appropriate. Select venipuncture site and
released tourniquet
5. Apply clean gloves and cleaned
venipuncture site and surrounding area with an
antiseptic swab using a back-and-forth motion
for a minimum of 30 seconds
6. Allow solution to dry on skin
7. Prepare the equipment (set aside
catheter, Tegaderm, prime the extension
set tubing with saline flush)
8. Dilate the vein with the tourniquet,
Used nondominant hand to pull skin taut below
entry site.
UNIVERSITY OF NORTHEASTERN PHILIPPINES
San Roque, Iriga City
COLLEGE OF NURSING & MIDWIFERY
9. Held the over-the-needle catheter at a 15- to 30-
degree angle with needle bevel up; inserted
catheter through skin and into vein.
10 Once blood appeared in the lumen of the
needle, lowered the angle of the catheter until
almost parallel with the skin, and advanced the
needle and catheter approximately 0.5 to 1cm
(about 1/4 in) further. Held needle assembly
steady, advanced the catheter until the hub was
at the venipuncture site.
11. Release the tourniquet.
12. Put pressure on vein proximal to catheter to
eliminate or reduce blood oozing out of catheter.
13. Stabilize the hub with thumb and index finger.
14. Engaged needle-safety device, and connected
distal end of extension set tubing to the hub.
Flush the catheter with normal saline;
maintained sterility; Apply Tegaderm dressing to
secure the site.
15. Place stylet directly into sharps container.
16. Loop any tubing and secured in with tape.
Remove and discard soiled gloves. Perform
hand hygiene. Return bed to lowest position.
17. Label IV site with date, gauge, initials.
18. Document name, date, time of insertion, gauge
of catheter, location of site, number of attempts,
and patient response.
19. IV catheter removal: Secure site, gently
remove tape and transparent dressing. Cover
the catheter with gauze, pull catheter straight
out, then apply pressure to the site. Tape gauze
to secure. Inspect catheter tip to make sure it is
intact.
Date/Time: _________________________ Instructor: ____________________________
