Nepalese Army Institute of Health Sciences

College of Nursing
Sanobharyang, Kathmandu
Course: PCL Nursing Student Name:
Subject: Midwifery Full Marks: 5
Year: Third Pass Marks: 2.5
Area of practice: Maternity ward Obtained Marks:

Checklist for Intravenous Push

Direction: Each student will be evaluated according to the given criteria. The marks will be
provided as per the given check list.

S.N. Criteria for Evaluation YES NO Remarks

1 Check the physician’s order and
identify the patient.
2 Explain the procedure to the patient,
the purpose of medication, the site of
injection, expected effect and how he
has to cooperate.
3 Check the patient’s history of drug
allergies.
4 Assess the site of injection for any
swelling, phlebitis, infiltration.
5 Wash hands and prepare medication;
assemble equipment at the bed side.
6 Place the patient in a comfortable and
relaxed position suitable of
intravenous injection
7 Select the injection part of IV tubing
closest to patient and connect the
syringe to the I V line.
8 Occlude the intravenous line by
pinching tubing just above injection
port. Pull back gently on the syringe’s
plunger to aspirate for blood return.
9 After noting blood return, inject
medication slowly over several
minutes and place Hep-Lock.
10 Observe IV site during injection for
sudden swelling.
11 Replace tubing after injecting
medication, withdraw the syringe and
recheck fluid infusion rate.
12 Observe the patient for any allergic
conditions.
13 Dispose the needles and the syringe in
a proper container.
14 Wash hands and record drug dose,
route, time on medication forms.
15 Report any adverse reactions to the
nurse in-charge or physician.

Strength Areas: Areas to be improved:

Student Teacher’s Signature Date:

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