Name

IV Skills
ASSESSMENT

1. Assesses for potential IV site.

2. Reviews medical order for IV. Follows six rights.
3. Patients prior experience with IV therapy.
4. Assessed new IV site.
COMMUNICATION
5. Explains to client that IV needs to be placed.
6. Documents attempt, client response, gauge size,
location and assessment of site.
CRITICAL THINKING
7. Recognizes signs and symptoms of IV infiltration.
8. Able to explain interventions for infiltration and/or
phlebitis.
TECHNICAL SKILLS
9. Performs hand hygiene.
10.Applies clean gloves.
11.Organize equipment on bedside stand or over the
bed table.
12.Open sterile packages, keeping sterile the parts that
will be connected to the IV system.
13.Prepare NS lock for infusion.
14.Identify site for IV placement and place tourniquet 46 above insertion site.
15.Select well dilated vein. Foster vein dilation
techniques.
16.Clean insertion site using antiseptic solution.
17.Apply gloves.
18.Anchor vein by placing thumb over vein and
stretching skin against the direction of insertion.
19.Insert catheter with bevel up 15-30 degree angle.
20.Look for blood flashback and advance very slightly.
21.Advance catheter into vein until hub rests at
venipuncture site. Remove stylet and lock into
safety mechanism.
22.Release tourniquet.
23.Secure with transparent dressing.
24.Apply gentle pressure above insertion site.
25.Connect tubing to the catheter. Tape securely.
26.Flush with 3 mL sterile saline.
27.Write date, time, and initials on dressing.
28.Dispose of used needles in sharps container.
29.Remove gloves and wash hands.

Yes

NO

Y
Y

N
N

Method
of
evaluati
on
D
D/V

Y
Y

N
N

V
D/V

Y
Y

N
N

V
D

Y
Y

N
N

V
V

Y
Y
Y

N
N
N

D
D
D

Y
Y

N
N

D
D

D/V

Y
Y
Y

N
N
N

D
D
D

Y
Y
Y

N
N
N

D
D
D

Y
Y
Y
Y
Y
Y
Y
Y

N
N
N
N
N
N
N
N

D
D
D
D
D
D
D
D

Name
30.Write date, time, and initials on dressing.
31.Prepare IV tubing and solution.
32.Prime infusion tubing.
33.Connect end of infusion tubing set to cannula.
34.Set up pump and select correct volume per hour.
35.Begin infusion by slowly opening clamp of tubing.
36.Prepares for IV Push (IVP) medication per order
37.Checks for compatibility with IV fluids
38.Administers through port closest to patient after
scrubbing the hub
39.IV infusion rate to same rate as medication
40.Resets IV infusion rate
41.Turns pump off and roller clamp to off.
42.Discontinues fluids, scrubs the hub and performs
normal saline flush and lock
43.Prepares for IVP medication
44.Flushes with normal saline after scrubbing the hub
45.Administers IVP at correct rate/min
46.Flushes with Normal Saline at same rate as
medication and locks mechanism for saline lock
47.Removes IV site dressing.
48.Applies pressure over VP site using clean sterile
gauze.
49.Verbalizes need to assess catheter for intactness

Y
Y
Y
Y
Y
Y
Y
Y
Y

N
N
N
N
N
N
N
N
N

D
D
D
D
D
D
D
D/V
D

Y
Y
Y
Y

N
N
N
N

D
D
D
D

Y
Y
Y
Y

N
N
N
N

D
D
D
D

Y
Y

N
N

D
D

D/V

N = does not demonstrate competency

Y = demonstrates competency
Method of evaluation for competency: Verbalizes = V
Demonstrates= D

Faculty Signature _________________________________

Fail

Pass