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    Performance Evaluation Checklist: Republic of The Philippines Isabela State University Echague, Isabela

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    Gemmalene Pacleb
    This document contains a performance evaluation checklist for starting an intravenous infusion. It lists the necessary preparation steps, including assessing the patient's vital signs, skin, allergies, veins and bleeding risks. It also lists the necessary equipment. The procedure sections outlines the 15 steps to take, including preparing the patient, setting up the IV line, selecting the venipuncture site, inserting the catheter and initiating the infusion. Ratings criteria are provided to evaluate performance on a scale from 0 to 2.

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    Performance Evaluation Checklist: Republic of The Philippines Isabela State University Echague, Isabela

    Uploaded by

    Gemmalene Pacleb
    72 views2 pages
    This document contains a performance evaluation checklist for starting an intravenous infusion. It lists the necessary preparation steps, including assessing the patient's vital signs, skin, allergies, veins and bleeding risks. It also lists the necessary equipment. The procedure sections outlines the 15 steps to take, including preparing the patient, setting up the IV line, selecting the venipuncture site, inserting the catheter and initiating the infusion. Ratings criteria are provided to evaluate performance on a scale from 0 to 2.

    Original Description:

    This is a checklist for intravenous infusion, reference, guide and notes.

    Original Title

    checklist-STARTING-IV-INFUSUION

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    This document contains a performance evaluation checklist for starting an intravenous infusion. It lists the necessary preparation steps, including assessing the patient's vital signs, skin, allergies, veins and bleeding risks. It also lists the necessary equipment. The procedure sections outlines the 15 steps to take, including preparing the patient, setting up the IV line, selecting the venipuncture site, inserting the catheter and initiating the infusion. Ratings criteria are provided to evaluate performance on a scale from 0 to 2.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    72 views2 pages

    Performance Evaluation Checklist: Republic of The Philippines Isabela State University Echague, Isabela

    Uploaded by

    Gemmalene Pacleb
    This document contains a performance evaluation checklist for starting an intravenous infusion. It lists the necessary preparation steps, including assessing the patient's vital signs, skin, allergies, veins and bleeding risks. It also lists the necessary equipment. The procedure sections outlines the 15 steps to take, including preparing the patient, setting up the IV line, selecting the venipuncture site, inserting the catheter and initiating the infusion. Ratings criteria are provided to evaluate performance on a scale from 0 to 2.

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    © All Rights Reserved
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    Republic of the Philippines

    Isabela State University


    Echague, Isabela

    PERFORMANCE EVALUATION CHECKLIST

    Name: Rating:
    Course/Year/Group:

    SKILL: Starting an Intravenous Infusion


    PREPARATION 0 1 2 Comments
    1. Assess:
     Vital signs for baseline data.
     Skin turgor.
     Allergy to tape or iodine.
     Bleeding tendencies
     Disease or injury to extremities.
     Status of veins to determine appropriate
    venipuncture site.
    2. Consider:
     How long the patient is likely to have the IV.
     What kind of fluids will be infused
     What medications the patient will be receiving or
    is likely to receive
    3. Assemble equipment:
     Infusion set
     Container of sterile parenteral solution
     IV pole
     Adhesive or non-allergenic tape
     Clean gloves
     Tourniquet
     Antiseptic swabs
     Intravenous catheter; see Variation at the end of
    this procedure for use of a butterfly (winged-tip)
    needle
     Sterile gauze dressing or transparent occlusive
    dressing
     Arm splint, if required.
    PROCEDURE
    1. Prepare the client: Introduce yourself and verify
    the client’s identity. Explain the procedure to the
    client.
    2. Perform hand hygiene
    3. Open and prepare the infusion set.
    4. Spike the solution container
    5. Apply a medication label to the solution
    container, if a medication was added. Apply a
    timing label on the solution container.
    6. Hang the solution container on the pole.
    7. Partially fill the drip chamber with solution.
    8. Prime the tubing
    9. Select the venepuncture site.
    Unless contraindicated, use the client’s non-dominant
    arm. Check agency protocol about shaving, if the site is
    very hairy. Place a towel or bed protector under the
    extremity to protect linens.
    10. Dilate the vein.
    11. Insert the catheter and initiate the infusion. Use
    the non-dominant hand to pull the skin below the
    entry site.
    12. Tape the catheter.
    13. Dress and label the venepuncture site and tubing
    according to agency policy.
    14. Ensure appropriate infusion flow
    15. Document relevant data.

    Note: You are rated using the criteria below:

    0 – Missed/Failed to do the procedure.


    1 – Performed procedure but failed to explain the rationale for doing the procedure.
    2 – Performed procedure with confidence and explained the reason for doing said procedure.

    Rating: RS x 100
    N Name and Signature of Professor

    Where: RS = Raw Score Date:


    N = Total number of items

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