Makati Medical Center College of Nursing

EVALUATION OF STUDENTS CLINICAL PERFORMANCE IN INTRAVENOUS THERAPY Nursing ______ Semester 1st 2nd Summer SY _____ NAME _________________________________________ Inclusive Dates __________________________________ Section ____________ Rating ____________

INSTRUCTIONS: Please check () on the space provided to assure whether the participants is able to perform the procedure correctly or whether it is incorrectly done CD Correctly Done ID Incorrectly Done CD ID REMARKS

STEPS I. A. Setting up B. Inserting IV Utilizing the Dummy Arm C. Changing an IV Solution D. Discontinuing an IV infusion A. SETTING UP 1. Verify written prescription and make I.V. label. 2. Observe ten rights when preparing and administering IVF. 3. Explain procedure to reassure patient and/or significant other, secure consent if necessary. 4. Assess patient's vein; choose appropriate site location, size/condition 5. Do hand hygiene before and after the procedure. 6. Prepare necessary materials for procedure. (.I.V. start pack, tray, I.V. solution, I.V. cannula, alcohol swab, bandage scissor, gloves, splint, micropore, microset / macroset) 7. Check the sterility and integrity of the I.V. solution, I.V. set and other devices. 8. Place gummed label on IVF bottle 9. Open the seal of the I.V. solution and disinfect port with cotton balls with alcohol. 10. Open IV administration set aseptically and close the roller clamp and spike the infusate container aseptically. 11. Fill drip chamber to at least half and prime it with IV fluid aseptically. 12. Expel air bubbles if any and put back the cover of the distal end of the I.V. tubing (get ready for I.V insertion) 13. Do hand hygiene after the procedure

B. INSERTING IV UTILIZING THE DUMMY ARM 1. Verify written prescription for IV Therapy, check prepared IVF and other things needed. 2. Explain procedure to reassure patient and/or significant others and observe 10 Rs. 3. Do hand hygiene before the procedure. 4. Choose site for IV insertion. 5. Apply tourniquet 5 to12 cm.(2 to 6 in) above injection site depending on condition of the patient 6. Check for radial pulse below tourniquet. 7. Prepare site alcohol swab in circular motion and allow 30 seconds to dry. ( No touch technique) Note: CDC Universal Precaution: Always wear gloves when doing any venipuncture. 8. Using the appropriate IV cannula, pierce the skin with needle positioned on a 15-30 degree angle. 9. Upon flashback visualization decrease the angle, advance the catheter and stylet (1/4 inch) into the vein, check if the tip of the catheter can be rotated freely inside the vein 10. Position the IV catheter parallel to the skin. Hold stylet stationary and slowly advance the catheter until the hub is 1 mm to the puncture site. 11. Slip a sterile gauze under the hub. Release the tourniquet, remove the stylet while applying digital pressure over the catheter with one finger about 1-2 inch from the tip of the inserted catheter. 12. Connect the infusion tubing of the prepared IVF aseptically to the IV catheter 13. Open the clamp, regulate the flow rate 14. Reassure patient 15. Anchor needle firmly in place with the use of tegaderm Note: Never place unsterile tape directly on IV insertion site, instead place a small piece of sterile gauze & then secure it with adhesive tape. 16. Tape a small loop of IV tubing using tegaderm for additional anchoring; apply splint (if needed). 17. Calibrate the IVF bottle and regulate flow of infusion according to prescribed duration. 18. Label on IV tape near the IV site to indicate the date of insertion, type, gauge of IV catheter and countersign. 19. Label with plaster on the IV tubing to indicate the date when to change the IV tubing. 20. Observe patient and report any untoward effect. 21. Document in the patients chart and endorse to incoming shift. 22. Discard sharps and wastes according to hospital protocols 23. Do hand hygiene after the procedure

C. CHANGING AN I.V SOLUTION 1. Verify doctors order in the Doctors label, IV card, bottle number or bottle sequence, type, amount, additives (if any), duration of infusion. 2. Observe 10 Rs. 3. Explain procedure to the patient and assess IV site for redness, swelling, pain etc. 4. Change IV tubings & cannula if 72 hours has lapsed after IV insertion. 5. Wash hands before the procedure. 6. Prepare necessary materials; place on an IV tray. 7. Check sterility and integrity of IV solution. 8. Place IV label on the IV bottle. 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 based on the prescribed infusion rate as per prescription. 13. Reiterate assurance to patient and significant others. 14. Discard all waste materials according to hospital protocols 15. Wash hands before and after procedure. 16. Document and endorse accordingly D. DISCONTINUING AN IV INFUSION 1. Verify written doctors order to discontinue IV including medicines. 2. Observe 10 Rs. 3. Assess and inform the patient of the discontinuation of IV infusion & of any medicine. 4. Prepare necessary materials: IV tray, alcohol swab, micropore, cotton balls 5. Wash hands before the procedure. 6. Close roller clamp of the IV administration set. 7. Moisten adhesive tapes around the I.V. catheter with alcohol swab; Remove plaster gently. 8. Use pick-up forceps to get alcohol swab and without applying pressure remove I.V. catheter then immediately apply pressure over the venipuncture site. 9. Inspect I.V. catheter for completeness. 10. Place dressing over the venipuncture site. 11. Discard all waste materials including the I.V. cannula according to hospital protocols 12. Reassure patient. 13. Wash hands after the procedure. 14. Document time of discontinuance, status of insertion site and integrity of I.V. catheter and endorse accordingly. Average ________ x 80% = _________

WRITTEN REQUIREMENTS 1. Post Exam ______________ Average ________ x 20% = __________

GENERAL AVERAGE _____________ ATTENDANCE Number of days absent ________ Number of days tardy ________

Reason __________________________________ Reason __________________________________

REMARKS A. Strengths (Refers to understanding personal / professional characteristics) Assertive Compassionate Helpful Works independently Responsible Cooperative Respectful Diligent Honest Persevering With initiative With leadership ability Friendly Others ______________ B. Weakness With disciplinary problem

Without disciplinary problem

C. Other liabilities ______________________________________________________________ ______________________________________________________________ STUDENTS REMARKS ________________________________________________________ ________________________________________________________

_______________________________ Students Signature

___________________________ C.Is Signature

_______________________ Date

____________________ Date