Pines City Colleges

College of Nursing
(Owned and Operated by THORNTONS INTERNATIONAL STUDIES, INC.)
Tel. nos.: (074) 445-2210, 445-2209 Fax: (074) 445-2208
www.pcc.edu.ph

Name: __________________________________ BSN III Sec.____________ Grade: ___________________

Group #:_________________________________ Semester: ____________ Date Performed: ___________

Performance checklist for IV Insertion, changing and IV solution, and PERFORMED

discontinuing and IV Infusion
A. ASSESS
1. Vital signs for baseline data.

2. Skin turgor and allergy to tape and iodine.

3. Bleeding tendencies.

4. Disease or injury to extremities.

5. Status of veins to determine appropriate venipuncture site.

B. SETTING UP
1. Verify written prescription and make administering IVF

2. Observe ten (10) R’s when preparing and administering IVF.

3. Explain procedure to reassure patient and/ or significant other, secure consent if necessary

4. Assess patient’s veins; choose appropriate site location, size/ condition.

5. Don hand hygiene before and after the procedure.

6. Prepare necessary materials for procedure (IV solution, administration set, IV cannula, forceps
soaked in antiseptic solution , alcohol, swabs, or cotton balls soaked in alcohol with cove ( this
should be exclusively used for IV ), plaster, tourniquet, gloves, splint, and IV hook, sterile 2x2
gauze or transparent dressing.
7. Check the sterility and integrity of the IV solution, IV set and other devices

8. Place IV label in IVF bottle duly signed by RN who prepared it (patient’s name, room no., solution,
drug, incorporation, bottle sequence and duration, time and date).

9. Open the seal of the IV infusion aseptically and disinfect rubber port with cotton balls with
alcohol
10. Open IV administration set aseptically and close the roller clamp and spice the infuscate
container aseptically.
11. Fill drip chamber to at least half and prime it with fluid aseptically.

12. Expel air bubbies if any and put back the cover to the distal end of the IV set (get ready to IV
insertion)
C. INSERTING IV
Prepare complete IV tray with infusion dummy arm and over –the-needle catheter or butterfly
needle.
1. Verify the written prescription for IV therapy; check prepared IVF and other things needed.
 Pines City Colleges
College of Nursing
(Owned and Operated by THORNTONS INTERNATIONAL STUDIES, INC.)
Tel. nos.: (074) 445-2210, 445-2209 Fax: (074) 445-2208
www.pcc.edu.ph

2. Explain procedure to reassure the patient and significant others and observe the 10 R’s.

3. Do hand hygiene before and after the procedure.

4. Chose site for IV.
5. Apply tourniquet 5 to 12 cm (2-6 in.) above injection site depending on the condition of the
patient.
6. Check radial pulse below tourniquet.
7. Prepare site with effective topical antiseptic according top hospital policy or cotton balls with
alcohol circular motion and allow 30 sec. to dry (no touch technique)
Note: CDC Universal precaution: always wear gloves when doing any venipuncture.
8. Using appropriate IV cannula, pierce skin with needle positioned on a 15-30 degree angle.
9. Upon flashback visualization decrease the angle, advance the catheter and style (1/4 inch) into
the vein, check if the tip of the catheter can be rotated freely inside the vein.
10. Position the IV catheter parallel to the skin. Hold the stlet stationary and slowly advance the
catheter until the hub is 1mm to the puncture site.
11. Slip the sterile gauze under the hub. Release the tourniquet, remove the stylet while applying
digital pressure over the catheter with one finger about 1-2 inch from the tip of the inserted
catheter
D. TAPE THE CATHETER
1. Tape the catheter by the “u” method, using the three strips of the adhesive tape, each about 7.5
cm (3 inches) long.
2. Place one strip, sticky-side up, under the catheter‘s hub.
3. Fold each end over so that the sticky sides are against the skin.
4. Place second strip, sticky –side down over the catheter hub.
5. Place the strip, sticky-side down, over the tubing hub.
E. CHANGING AN IV SOLUTION
1. Verify doctor’s prescription in doctors order sheet, counter check IV label, IV card, infusate
sequence, type, amount additives (if any).
2. Observe 10 R’s.
3. Explain procedure to reassure the patient and the significant others and assess IV site for
redness, swelling, pain etc.
4. Change IV tubings and cannula if 48-72 hrs. Has lapsed after insertion.
5. Wash hands before and after the procedure.
6. Prepare any necessary materials, place on an IV tray
7. Check sterility and integrity of IV solution.
8. Place IV label on the IV bottle.
9. Calibrate the IV bottle according to duration of the infusion as per prescription.
10. Open and disinfect rubber port of IV solution follow.
11. Close the roller clamp and spike the container aseptically.
12. Regulate the flow rate based on the prescribe infusion rate of solution. Expel air bubbles (if any)
13. Reiterate assurance to patients and significant others.
14. Discard all waste materials according to health care waste management (DOH/DENR)

Remarks:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

Student’s Name: ________________________________________ Date: _______________

Supervised by and Rated by: _______________________________ Date: _______________