Trinity University of Asia

St. Luke’s College of Nursing

SKILLS PERFORMANCE CHECKLIST: CHANGING INFUSION TUBING

Name of Student:_______________________________________________Date__________________

Level/ Section__________________________________________________Score:_________________

PROCEDURE DONE NOT REMARKS

DONE
ASSESSMENT
1. Noted date and time when IV tubing and solution
were last changed
2. Identified patient using at least two identifiers,
compared with information in Medication
Administration Record (MAR).
3. Performed hand hygiene, assessed tubing for
puncture, contamination or occlusion that
required immediate change.
4. Determined patient’s understanding of need for
continued IV therapy.
PLANNING
1. Prepared patient by explaining procedure, its
purpose and expectations of patient.
2. Coordinated IV tubing changes with solution
changes when possible.
3. Collected equipment.
IMPLEMENTATION
1. Performed hand hygiene, opened new infusion set
and add-on pieces, kept protective coverings in
place, placed roller clamp below drip chamber and
moved clamp to off, secured all connections.
2. Applied clean gloves, removed IV dressing if
necessary.
3. Prepared IV tubing with new IV container.
4. Prepared IV tubing with existing continuous IV
infusion bag:
a. Moved roller clamp on new IV tubing to off
position.
b. Slowed rate of infusion through old tubing
c. Compressed and filled drip chamber of old
tubing.
d. Inverted container, removed old tubing, kept
spike sterile and upright.
e. Inserted spike of new tubing into solution
container, hung solution bag on IV pole,
 compressed and released drip chamber on new
tubing, filled drip chamber appropriately.
f. Removed protective cover on end of tubing,
opened roller clamp, primed new tubing with
solution, stopped infusion, replaced cap, placed
end of adapter near patient’s IV site.
g.Stopped EID of turned roller clap on old tubing
to off position
5. Prepared tubing with extension set or saline lock:
a. Used sterile technique to connect new
injection cap to new extension set.
b. Scrubbed injection cap with antiseptic swab and
allowed to dry, attached syringe with saline flush solution,
injected into extension set.
6. Reestablish infusion.
a. Disconnected old tubing from extension set,
inserted Luer-Lock of new tubing or saline lock into
connection.
b. Opened roller clamp on new tubing for
continuous infusion, regulated drip using roller clamp or
EID.
c. Attached tape or label with date and time of
change onto tubing below drip chamber.
d. Formed a loop of tubing, secured to patient’s
arm with tape.
7. Removed and discarded old IV tubing, applied new
dressing if necessary, removed and disposed of gloves,
performed hand hygiene.
8. Taught patient how to move and tun properly with IV
tubing.
EVALUATION
1.Observed patient every 1 to 2 hours for function,
intactness and patency of IV system and leaking at
connection sites.
2. Evaluated patient for signs of IV-related complications.
3. Asked patient to explain how to prevent tubing from
being pinched and what signs should be reported to a
nurse.
RECORDING AND REPORTING
1. Recorded tubing change, type of solution, volume and
rate in appropriate record, recorded parenteral fluids
appropriately
2. Recorded what IV problems patient knows to report

Evaluator’s Name and Signature: ______________________________

Date: __________