Institute of Health Sciences

Name: Score:
Year: Date:

INTRAVENOUS CATHETERIZATION

PERIPHERAL CANNULATION 0 1 REMARKS

1. Check and verify the physician order

2. Identify and Explain procedure to . patient/parent
3. Wash hands with antiseptic soap.

4. •Don gloves •Strict adherence to hand washing and aseptic

technique remains the cornerstone of prevention of cannula related
infections

5. •Apply the tourniquet above insertion site

•For pediatric patient, an assistant’s hand used both as a tourniquet and

restraint, is often more acceptable to a child than a tourniquet.
6. •Disinfect the selected site with skin prep and allow to dry.

Do not touch the skin with the fingers after preparation solution has
been applied.
7. Inspect the cannula before insertion to ensure that the needle is
fully inserted into the plastic cannula and that the cannula tip is not
damaged
Nb: •Do not touch the shaft or tip of the cannula
8. • Ensure that the bevel of the cannula is facing upwards.

Student’s Name and Signature: Instructor’s Name and Signature:

Date: __________________ Date: __________________

Comments/Remarks:
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 Institute of Health Sciences
Name: Score:
Year: Date:

9. Rationale: Facilitates the piercing of the skin by the bevel.

10. •Hold the cannula in your dominant hand, stretch the skin over the
vein to anchor the vein with your non-dominant hand (Do not re
palpate the vein)
11. •Insert the needle (bevel side up) at an angle of 15- 30o to the skin
(this will depend on vein depth.)
12. Observe for blood in the flashback chamber
•Partially withdraw the needle and advance the cannula.
13. • Release the tourniquet
14. Apply gentle pressure over the vein (beyond the cannula tip)
remove the white cap from the needle
•Remove the needle from the cannula and dispose of it . into a sharps
container
15. •Attach the white lock cap
16. •Secure the hub of the cannula with clean adhesive tape.
17. •Do not cover the puncture site.
18. Cut tape immediately prior to use only
19. • Flush the cannula with normal saline
20.
21. • Cover the intravenous and surrounding area with a sterile
transparent dressing.
22. •Ensure that the insertion site and the area proximal to the site are
visible for inspection purposes.
23. • If infusion is ordered, prime the line and connect the intravenous
giving set to the cannula.
24. •If the site needs to be immobilized, use a well padded splint and
strapping if necessary.

Student’s Name and Signature: Instructor’s Name and Signature:

Date: __________________ Date: __________________

Comments/Remarks:
______________________________________________
______________________________________________
______________________________________________
 Institute of Health Sciences
Name: Score:
Year: Date:

25. Document the procedure . including

• Date & time
• Site and size of cannula
• Any problems encountered
• Review date (cannula should be in situ no longer than 72 hours
without appropriate risk assessment.)

26. • Clean up, dispose of rubbish

Student’s Name and Signature: Instructor’s Name and Signature:

Date: __________________ Date: __________________

Comments/Remarks:
______________________________________________
______________________________________________
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 Institute of Health Sciences
Name: Score:
Year: Date:

SETTING UP AN IV INFUSION 0 1 REMARKS

1. Verify written prescription and make IV label

2. Observe ten (10) Rs when preparing and administering IVF
3. Explain procedure to reassure patient and significant others, secure
consent.
4. Assess patient’s vein, choose appropriate site location, size and
condition
5. Do hand hygiene before and after the procedure
6. Prepare necessary materials for procedure:
IV Tray with IV solution
IV administration set
IV cannula
Alcohol swabs
Tourniquet
Plaster/ Tegaderm
Sterile 2 x 2 dressing
7. Check the sterility and integrity of the IV solution, IV set, and other
devices
8. Place IV label on IVF bottle duly signed by RN who prepared it
Patient’s name, Room no.
Solution, drug incorporation, bottle sequence,
Duration, time and date

Student’s Name and Signature: Instructor’s Name and Signature:

Date: __________________ Date: __________________

Comments/Remarks:
______________________________________________
______________________________________________
______________________________________________
 Institute of Health Sciences
Name: Score:
Year: Date:

9. Open the seal of the IVF infusion aseptically and disinfect rubber
port with cotton ball with alcohol
10. Open the IV administration set and close the roller clamp and spike
the infusate container aseptically
11. Fill the drip chamber to at least half and prime it with IVF
aseptically
12. Expel air bubble if any and put back the cover to the distal end of
the IV set (get ready for IV insertion)

CHANGING AN IV SOLUTION 0 1 REMARKS

◼ 1. Verify Drs written order; countercheck IV label, IV card, infusate

sequence, type, amount, additives (if any), duration of infusion
◼ 2. Observe 10 Rs

◼ 3. Explain procedure to reassure patient and significant others and

assess IV site for redness, swelling, pain, etc
◼ 4. Change an IV tubing/ cannula if 48-72 hours lapsed after
insertion
◼ 5. Wash hands before and after the procedure

◼ 6. Prepare necessary materials; place on IV tray

◼ 7. Check sterility and integrity of IV solution

◼ 8. Place IV label on IV bottle

Student’s Name and Signature: Instructor’s Name and Signature:

Date: __________________ Date: __________________

Comments/Remarks:
______________________________________________
______________________________________________
______________________________________________
 Institute of Health Sciences
Name: Score:
Year: Date:

◼ 9. Calibrate new IV bottle according to duration of infusion as per

prescription
◼ 10. Open and disinfect rubber port of IV solution to follow

◼ 11. Close the roller clamp and spike the container aseptically

◼ 12. Regulate the flow rate

◼ 13. Reiterate assurance to patient and family

◼ 14. Discard all waste materials according to Health Care Waste

Management
◼ 15. Document and endorse accordingly

ADMINISTERING IV DRUGS 0 1 REMARKS

INCORPORATION OF DRUG INTO IVF BOTTLE/BAG
1. Verify the written medication card against the Dr’s prescription;
observe hospital policy on drug administration
2. Observe 10 R’s when preparing and administering medication
3. Explain procedure (medication and action) to reassure patient and
significant others and check patency and IV site
4. Verify for skin test of drug for IV incorporation (if skin testing is
necessary)
5. Do hand hygiene before and after the procedure
6. Prepare necessary materials needed for the procedure such as
injection tray, syringes needed, right drug to be incorporated either in
vial or ampule

Student’s Name and Signature: Instructor’s Name and Signature:

Date: __________________ Date: __________________

Comments/Remarks:
______________________________________________
______________________________________________
______________________________________________
 Institute of Health Sciences
Name: Score:
Year: Date:

7. Disinfect injection port of the vial and the ampule before breaking
and then aspirate the right dose aseptically
8. Remove the cover of the administration set, maintain sterility and
incorporate prepared drug into the airway aseptically. Recap airway
If the administration set has no airway, pull out the set and
incorporate the prepared drug and respike the IV set to the bottle
then place the label. (All these should be done aseptically)

◼ 9. Swirl the IV bottle to mix the drug with IVF and regulate the
flow rate accordingly
◼ 10. Observe for 5-10 mins for any drug interaction while
reassuring the patient; monitor vital signs
◼ 11. Document in the patient’s chart

◼ 12. Discard sharps and other wastes according to Health Care

Waste Management

DRUG INCORPORATION INTO VOLUMETRIC CHAMBER

DRUG INCORPORATION INTO VOLUMETRIC CHAMBER 0 1 REMARKS

◼ 1. Verify the written MD prescription and follow hospital policy on

drug administration
◼ 2. Observe ten (10) Rs when preparing and administering
medications

Student’s Name and Signature: Instructor’s Name and Signature:

Date: __________________ Date: __________________

Comments/Remarks:
______________________________________________
______________________________________________
______________________________________________
 Institute of Health Sciences
Name: Score:
Year: Date:

◼ 3. Explain procedure (medication and action) to reassure patient

and significant others and check patency and IV site.
◼ Verify skin test of the drug for IV incorporation

◼ 4. Do hand hygiene before and after the procedure

◼ 5. Prepare the necessary materials such as right drug and dose,

right diluent needed, IV injection tray, syringes and needles
◼ 6. Check present IV Fluid label, level and the incorporated medicine
in the volumetric chamber or IV bottle if with incorporated
medicine
◼ - Check for drug-drug incompatibility and If the ongoing IVF in the
volumetric chamber is to be consumed in 6-8 hours, request a
prescription for IVF to be used solely for drug administration and
keep the whole set sterile for succeeding doses
◼ 7. Aspirate prepared right drug with correct dose

◼ 8. Add desired IVF diluent into volumetric chamber by opening the

sliding clamp from the bottle then close the clamp
◼ 9. Disinfect rubber injection port of the volumetric chamber and
incorporate drug. Mix gently
◼ 10. Open the clamp of the airway at the volumetric chamber

◼ 11. Regulate flow rate of IV fluid infusion accordingly

12. Place IV label on volumetric chamber indicating drug incorporated
and flow rate
13. Reassure/ monitor patient when incorporated medicine is
consumed, clamp airway of volumetric chamber. Add IVF and regulate
flow rate of main IVF as prescribed

Student’s Name and Signature: Instructor’s Name and Signature:

Date: __________________ Date: __________________

Comments/Remarks:
______________________________________________
______________________________________________
______________________________________________
 Institute of Health Sciences
Name: Score:
Year: Date:

14. Discard waste according to Health Care Waste Management

15. Document in patient’s chart of the drug administered and patient
condition
16. Document in patient’s chart IVF sheet and Kardex (of changes in IV
rate/ time due)

HEPARIN LOCK DEVICE

IV PUSH THROUGH HEPARIN LOCK DEVICE 0 1 REMARKS

1. Check medication card against Dr’s. written prescription

Student’s Name and Signature: Instructor’s Name and Signature:

Date: __________________ Date: __________________

Comments/Remarks:
______________________________________________
______________________________________________
______________________________________________
 Institute of Health Sciences
Name: Score:
Year: Date:

2. Observe ten (10) Rs when preparing and administering medication

3. Explain procedure to patient
4. Do hand hygiene before and after the procedure (Use gloves
especially for chemo drugs)
5. Gather equipment, to include but not limited to the following:
IV tray
Normal saline diluent
Heparin solution
3 pcs 2.5 cc syringes
1 pc tuberculin syringe
6. Prepare medication to be administered
7. Fill a tuberculin syringe with a heparin solution. NB Heparin solution
is usually prepared with 0.1 cc heparin plus 0.9 cc NSS
8. Fill the 2.5 cc syringe with NSS 1 cc each
9. If using hep lock device with 3 way stop cock with luer lock, rotate
the stop cock so that the line going to the pt is closed (to prevent
backflow of blood)
10. Remove the cover of the injection port aseptically and keep the
sterility of the cover
11. Check the patency, open the IV line, inject the NSS
12. Close the IV line and remove saline syringe and insert medication
syringe into the port
13. Open the IV line and inject medication into the vein, timing the
flow rate
14. Observe patient for any adverse reactions and do nursing
intervention accordingly
15. Close IV line and remove medication syringe

Student’s Name and Signature: Instructor’s Name and Signature:

Date: __________________ Date: __________________

Comments/Remarks:
______________________________________________
______________________________________________
______________________________________________
 Institute of Health Sciences
Name: Score:
Year: Date:

16. Insert the saline syringe, open the line, flush the catheter tubing/
IV cannula to flush the line
17. Close and remove saline syringe
18. Close the IV line, remove syringe, and return the cover of the
injection port aseptically
19. Document in the patient’s chart and Kardex
20. Discard waste according to Hospital Waste Management

Student’s Name and Signature: Instructor’s Name and Signature:

Date: __________________ Date: __________________

Comments/Remarks:
______________________________________________
______________________________________________
______________________________________________
 Institute of Health Sciences
Name: Score:
Year: Date:

Student’s Name and Signature: Instructor’s Name and Signature:

Date: __________________ Date: __________________

Comments/Remarks:
______________________________________________
______________________________________________
______________________________________________
 Institute of Health Sciences
Name: Score:
Year: Date:

BLOOD TRANSFUSION PROCEDURE 0 1 Remarks

1. Verify doctor’s written prescription and make a treatment card according to
hospital policy.

2. Observe ten (10) Rs when preparing and administering any blood or blood
component
3. Explain the procedure/rationale for giving blood transfusion to reassure patient
and significant others and secure consent. Get patient’s history regarding previous
transfusion.
4. Explain the importance of the benefits on Voluntary Blood Donation (RA 7719 –
National Blood Service Act of 1994).
5. Request prescribed blood/blood components from blood bank to include blood
typing, x-matching and blood results of transmissible disease
6. Using a clean lined tray, get compatible blood from hospital blood bank
7. Wrap blood bag with clean towel and keep it at room temperature
8. Have a doctor and a nurse assess pt.’s condition. Countercheck the compatible
blood to be transfused against x-matching sheet noting ABO grouping and Rh,
serial no. of each blood unit and expiry date with the blood bag label and other
laboratory exam as required before transfusion

9. Get the baseline vital signs. Refer to the M.D. accordingly

10. Give pre-med 30 minutes before transfusion as prescribed.

11. Do hand hygiene before and after the procedure.
12. Prepare equipment needed for BT:
IV injection tray, IV catheter/needle G18/19, plaster, tourniquet, gloves,
compatible BT set G 18 needle (only if
needed) blood component to be transfused Plain NSS 500 cc, IV set sterile 2x2
gauze or transparent dressing IV hook and stand
13. If main IVF is with dextrose 5% initiate an IV line with appropriate IV catheter
with Plain NSS on another site, anchor catheter properly and regulate IV drops.

Student’s Name and Signature: Instructor’s Name and Signature:

Date: __________________ Date: __________________

Comments/Remarks:
______________________________________________
______________________________________________
______________________________________________
 Institute of Health Sciences
Name: Score:
Year: Date:

14. Open compatible blood set aseptically and close roller clamp. Spike blood bag
carefully; fill the drip chamber at least half full; prime tubing and remove air
bubbles (if any). Use needle G18 or 19 for side drip (for adults) or G22 for pedia. (If
blood is given through the Y-injection port, the gauge of needle is disregarded)

15. Disinfect the y-injection port of IV tubing and insert the needle from blood
transfusion administration set and secure with adhesive tape
16. Close roller clamp of IV fluid of Plain NSS and regulate to KVO while transfusion
is going on
17. Transfuse the blood via the injection port and regulate at 10-15 gtts initially for
15 mins. and then at the prescribed rate
18. Observe patient for 10-15 minutes for any immediate reaction.
19. Observe patient on an on- going basis for any untoward S/Sx such as
flushed skin, chills, elevated temperature,itchiness, rticaria and dyspnea. If any of
these symptoms occurs stop the transfusion, open the roller clamp of the IV line
with Plain NSS, and report to doctor immediately. 
20. Swirl the bag hourly to mix the solid with the plasma. N.B. one BT set should be
used for 1-2 units of blood.
21. When blood is consumed, close the roller clamp of BT, and disconnect from IV
lines then regulate the IVF of plain NSS as prescribed
22. Continue to observe and monitor patient post transfusion for delayed reaction
could still occur.
23. Re-check Hgb and Hct, bleeding time, serial platelet count within specified
hours as prescribed &/or per institution’s policy.
24. Discard blood bag and BT set and sharps according to Health Care Waste
Management (DOH/DENR).
25. Document the procedure, pertinent observations and nursing intervention and
endorse accordingly.
26. Remind the doctor about the administration of Ca Gluconate if patient had
several units of blood transfusion (3-6 or more units of blood)

Student’s Name and Signature: Instructor’s Name and Signature:

Date: __________________ Date: __________________

Comments/Remarks:
______________________________________________
______________________________________________
______________________________________________