Uploaded by John Niño Casuela


San Sebastian College Recoletos de Cavite
Nursing Department
Performance Checklist
Name of Student:
Year & Section:
1. IV cannula/catheter
2. Torniquet
3. Alcohol wipes or cotton balls with alcohol
4. Cotton balls (dry)
5. Micropore tape
6. Clean gloves
7. Saline flush (3cc syringe with PNSS)
1. Verify written order for IV therapy. Select
appropriate catheter and gather all needed
equipment. Prepare IV infusion or saline lock.
2. Introduce self and verify patient’s identity. Explain
procedure to patient and provide privacy.
3. Perform hand hygiene.
4. Apply tourniquet 5 to 12cm. (2-6in.) above the
injection site depending on the patient’s condition.
Check the radial pulse below tourniquet. Apply
torniquet tight enough to impede venous return but
not occlude arterial flow.
5. Choose site for IV insertion. Select appropriate vein.
6. Don clean gloves. Cleanse venipuncture site with
antiseptic solution according to hospital policy or
cotton balls with alcohol in circular motion and allow
to dry (no touch technique)
NOTE: CDC Universal precaution: Always wear gloves when doing
any venipuncture
7. Stabilize vein with non-dominant hand distal to the
venipuncture site.
8. With the dominant hand, insert catheter stylet with
bevel up at a 15-30 degrees angle and in the
direction of the vein.
9. Confirm blood return in the flashback chamber.
Upon confirmation of blood return, decrease the
angle, and advance the catheter and the stylet about
¼ inch into the vein.
Revised 2022
10. Position the IV Catheter parallel to the skin. Hold the
stylet stationary and slowly advance the catheter,
until the hub nearly meets the venipuncture site (by
1 hand tech or 2 hand tech).
11. Stabilize catheter while applying digital pressure over
the catheter with 1 finger about ½ inch from the tip of
the inserted catheter with one hand and release the
tourniquet with the free hand.
12. Remove the stylet and dispose of it in an appropriate
sharp’s container.
13. Connect the infusion tubing of the IVF prepared or
saline lock to the catheter hub without contaminating
14. Open the clamp, regulate the flow rate. Or check for
blood return and flush site to check for patency.
15. Securely anchor the needle firmly in place with the use
of specific agency policy:
a. Transparent tape/dressing directly on the puncture
b. Tape (using any appropriate anchoring style)
16. Label the IV site and tubing according to agency policy.
Label the tape near the IV site indicate the date of
insertion, type and gauze of IV catheter and
countersign. Label with plaster on the IV tubing to
indicate the date when to change the tubing
17. Dispose of supplies appropriately.
18. Position patient for comfort with call light within reach.
19. Perform hand hygiene.
20. Document procedure and patients’ response on
patient’s chart and endorse to incoming shift.
Instructor’s Signature / Date:
Revised 2022