Western Leyte College of Ormoc City, Inc.

COLLEGE OF NURSING AND ALLIED HEALTH SCIENCES

Level II, NCM 107 LAB, First Semester, AY 2023-2024

CHECKLIST ON PRIMING IV TUBING

Name of Student Section Group Date

Safety Considerations:
Primary IV tubing can be macro-drip or micro-drip tubing.
The drop factor of the IV tubing is required to complete the IV drip rate calculation for a gravity infusion.
Remember to invert all access ports and backcheck valves whilst fluid is running past that location.

Note Done Needs Satisfactory Excellent Remarks

PROCEDURE (0) Practice (2) (3)
(1)
1) Check order to verify solution, rate, and frequency.
2) Gather supplies.
3) Perform hand hygiene
4) Remove IV solution from outer packaging. Check
expiry date. Assess for precipitates or cloudiness.
Hang IV bag on hook or IV pole in a way that will allow
gravity to help you to prime the line.
5) Remove primary IV tubing from out packaging.
6) Move the roller clamp to about 3 cm below the drip
chamber and close the clamp.
7) Remove the protective cover on the IV solution port
and keep sterile. Remove the protective cover on the
IV tubing spike. Follow principles of asepsis.
8) Remove the protective cover from the IV solution port.
Without contaminating the solution port or spike,
carefully insert the IV tubing spike into the port, gently
pushing and twisting.
9) Fill the drip chamber one-third to -one-half full by
gently squeezing the chamber.
10) With the distal end of the tubing over a
basin/sink/garbage, slowly open roller clamp to prime
the IV tubing.
11) Once IV tubing is primed, check the entire length of
tubing to ensure no air bubbles are present.
12) Close roller clamp. If removed earlier, cover distal end
with sterile dead-ender or sterile protective cover.
Hang tubing on IV pole to prevent from touching the
ground.
13) Label tubing and IV bag with date, time, and other
details to complete the IV tag details.
14) Perform hand hygiene.

Clinical Instructor
 Western Leyte College of Ormoc City, Inc.
COLLEGE OF NURSING AND ALLIED HEALTH SCIENCES
Level II, NCM 107 LAB, First Semester, AY 2023-2024

CHECKLIST ON CHANGING AN IV SOLUTION BAG

Name of Student Section Group Date

Note Done Needs Satisfactory Excellent Remarks

PROCEDURE (0) Practice (2) (3)
(1)
1) Verify and select correct IV solution bag and compare to the
medication administration record (MAR) or physician order.
2) Introduce yourself, identify patient, and explain procedure.
3) Perform hand hygiene.
4) Remove outer plastic packaging and check for leaks and
expiration date. Assess for precipitates or cloudiness. Hang
new IV solution on IV pole.
5) Close the roller clamp.
6) Remove the old IV solution bag from the IV pole. Turn IV
bag upside down, grasping the tubing port. With a twisting
motion, carefully remove IV tubing spike from old IV
solution bag.
7) Using a gentle twisting motion, firmly insert the spike into
the new IV bag.
8) Fill the drip chamber by compressing it between your thumb
and forefinger. Ensure the drip chamber is one-third to one-
half full. Check IV tubing for air bubbles.
9) Open clamp ang regulate IV infusion rate per physician
orders. Compute rate as necessary.
10) Label new IV solution bag using the IV tag, and time tape.
11) Dispose of used supplies, perform hand hygiene, and
document IV solution bag change.

Clinical Instructor
 Western Leyte College of Ormoc City, Inc.
COLLEGE OF NURSING AND ALLIED HEALTH SCIENCES
Level II, NCM 107 LAB, First Semester, AY 2023-2024

CHECKLIST ON FLUSHING AN IV CATHETER

Name of Student Section Group Date

Note Done Needs Satisfactory Excellent Remarks

PROCEDURE (0) Practice (2) (3)
(1)
1) Perform hand hygiene.
2) Place your supplies on the cleaned and dried work surface.
Lay them out in the order your will be using them.
3) Uncap a new bottle of the prescribed flush. If the bottle is
already open, clean the rubber stopper with an alcohol pad.
Or clean it with an antimicrobial or antiseptic swab.
4) Fill a syringe with the prescribed amount of saline or
heparin solution. Typically, the amount is 3 cc, but still
depends on the situation and hospital policy.
5) Wipe the port with an alcohol pad or a cotton ball wet with
alcohol.
6) Attach the syringe to the injection cap and twist to secure it.
7) Pull back on the syringe plunger and watch for blood to
appear in the catheter. If you don't see blood moving
through the catheter, stop and call your supervisor right
away. (Note: Only check for blood during the first flush. If
you're infusing medicine and then flushing the catheter
again, you don't need to check for blood with the second
flush).
8) Push the plunger in slowly so the solution goes into the
catheter. The plunger should be easy to push. If there is
resistance, don't force it. Make sure the syringe is twisted
securely into the injection cap and the tubing above the cap
is unclamped. If you still feel resistance, stop and call your
supervisor.
9) After injecting the solution, reclamp the tubing (if there is a
clamp).
10) Dispose of the syringe and needle.
11) Perform hand hygiene.

Clinical Instructor