NURSING EDUCATION ADMINISTRATION

COMPETENCY ASSESSMENT TOOL

TITLE: IV Cannulation.
Staff name: Job number: Job title: Unit:
Qualification: Diploma: ( ) BSN: ( ) Post-graduate: ( ) Contract date:

Self-assessment key: Evaluation: Validation:

0 – No experience/not competent M – Met V – Verbal
1 – Satisfactory/requires further development NM – Not met DO – Direct observation
2 – Competent R – Refer to improvement plan SP- Simulation Practice
Please tick (√) the appropriate box depending on the self-assessment key indicated above.
Self- EVALUATION
PERFORMANCE CRITERIA
assessment (ASSESSOR)
Date
0 1 2 KNOWLEDGE Validation M NM R &
Initial
1. Mentions the Indications of IV cannulation.
2. States Components of aseptic non touch technique
3. (ANTT).
4. Mentions the preferred sites of veins to be used.
5. Enumerates Signs of good veins
6. Knows the tool for difficult Intravenous access
(DIVA).
7. States the correct angle (Small ,Superficial and
deeper vein).
8. Mentions how many attempts for cannulation and
discuss what to do in case of difficult insertion.
SKILLS
9. Doctor’s order verified.
10. Patient was identified according to hospital policy.
11. Procedure explained to patient.
12. Assembles all necessary equipment.
13. Performs hand hygiene.
14. Perform venous palpation to evaluate the quality of
vein and select appropriate peripheral catheter
device.
15. Apply tourniquet. gently tap on the area to be inserted
(Vein Viewer maybe useful if available).
16. Wears sterile gloves for neonate otherwise non sterile
gloves.
17. Disinfect with chlorhexidine using circular motion
from inner to outer (Do not re –palpate after
disinfection).
18. Stabilizes vein below the site of insertion by pulling
the skin tight.

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 NURSING EDUCATION ADMINISTRATION

19. Holds cannula with bevel up then puncture the skin

with appropriate angle by using aseptic non touch
technique protecting the key parts and key sites.
20. Looks for venous blood for flash back chamber then
lower the angle of cannula and advance slowly into
the veins.
21. Maintains skin traction then Advance cannula and
withdraws needle slowly.
22. Releases tourniquet then apply pressure to the vein
above the tip of cannula and withdraws from cannula
and apply the connector.
23. Hold cannula in place and flush with normal saline by
using pulsatile motion. (Push and Pause).
24. Attach extension with 3 way stop cock if needed.
25. Secures with sterile semi permeable transparent
dressing.
26. Labels with date and time of insertion and initial of
the nurse.
27. Remove gloves and hand hygiene.
28. Do after care and dispose on proper waste disposal
bins.
29. Document's date and time and reason for insertion,
size of cannula used, rate and site of veins.
30. Doctor’s order verified.
31. Patient was identified according to hospital policy.
32. Procedure explained to patient.
33. Assembles all necessary equipment.
34. Performs hand hygiene.
35. Perform venous palpation to evaluate the quality of
vein and select appropriate peripheral catheter
device.
ATTITUDE
36. Introduce self to the patient, answer patient and
family question.
37. Considered comfort of the patient.
38. Privacy of patient was provided.
39. Patient right was respected.
Comments:
_______________________________________________________________________________________________
Improvement plan:
______________________________________________________________________________________________
Recommendation:
_______________________________________________________________________________________________
Evaluator’s Signature over printed name: Date: ________________________
Staff printed signature over printed name: Date: ________________________