DE LA SALLE LIPA

COLLEGE OF NURSING
Nursing Care Management 103
Procedural Checklist in
PREPARATION of INTRAVENOUS FLUID ADMINISTRATION

Name: ____________ Date: ______Year/Sec: ___ Rating:

General Objectives: Given actual or simulated situations/conditions, the students will be able to safely and
accurately perform and discuss the Steps in Intravenous Preparation.
Specific Objectives:
1. Describe the factors that affect the Intravenous fluid administration.
2. Identify ways on how to prevent the occurrence problems during intravenous fluid administration.
3. Explain the essential concepts regarding fluids and electrolytes.
4. Identify signs and symptoms of infection on the sites and the immediate nursing action.
5. Discuss Nursing Responsibilities so as to eliminate the Risk of health problems related IVF administration.
Item Weight Descriptors Verbal Interpretation
4 Excellent Performed the procedure with great ease and confidence, observing work
ethics (prudent, accepts criticisms and suggestions), able to rationalize
scientifically and shows diligence in documenting observations at all times .
3 Very Performed the procedure with less confidence, observing work ethics
Satisfactory (prudent, accepts criticisms and suggestions), able to rationalize
scientifically and shows minimal diligence in documenting observations.
2 Satisfactory Performed the procedure but requires close supervision and shows
potential for improvement.
1 Needs Failed to perform the procedure, unable to function well and needs
Improvement repeated specific/ detailed guidance or direction.
CRITERIA:
I. Skills – 40% 4.0 3.0 2.0 1.0 Remarks
1. Checked patient's chart (IVF, Flow rate/running time). Gathered all
supplies/materials needed then performed Hand Hygiene. Identified
the patient and explained the procedure.
2. Prepared IV solution and tubing: Read the package instruction
(Checked the IVF). Maintain aseptic technique when opening sterile
packages and IV solution, Open the IV tubing package then Close
the roller clamp of the tubing.
3. Opened the IV fluid bottle, uncap the spike of the tubing, and insert
into entry site on IVF bag or bottle as manufacturer directs, squeeze
drip chamber and allow it to fill at least half way.
4. Removed cap at the end of the tubing, release clamp, and allow the
fluid to flow through the tubing until all air bubbles disappeared,
Close clamp, recap, maintaining sterility of the setup.
Changing Intravenous Solution
5. Carefully removed protective cover from new solution container.
6. Closed clamp on tubing, lift container off IV pole and invert it. Quickly
remove spike from old IV container.
7. Steady new container and insert spike. Hang on IV pole. Reopen
clamp and regulate flow, label container According to agency policy.
Discard used equipment and perform hand hygiene, document.
Terminate Intravenous Fluid Transfusion
8. Verified doctor’s order, perform hand hygiene. Explain procedure to
patient, close clamp of the IV tubing.
9. Carefully removed tape as indicated in the procedure then with
pressure placed a dry cotton ball at the insertion site. Inspect site, do
hand hygiene, then record.
10. Reports in proper uniform, grooming, and displays appropriate
decorum and shows resourcefulness.
Comments: (Strengths & Weaknesses)

Conforme: Evaluated by:

Margie M. Ebreo, RN, MAN,PhD

Student’s Signature CI’s Signature over Printed Name
Date: Date: