UNIVERSITY OF SAINT ANTHONY

(Dr. Santiago G. Ortega Memorial)

Dr. Ortega St., Iriga City, Philippines

HEALTH CARE EDUCATION DEPARTMENT

Discontinuing an IV Infusion

Name: ___________________________________ Year & Section: _____________

Date Performed: ___________________________ Rating /Grade: _____________
Clinical Instructor: __________________________ Signature of CI: _____________
Legend 3 - Able to Perform
2 - Able to Perform, with Assistance
1 - Unable to Perform

Grading: Knowledge - 35%

Skills - 35%
Attitude - 30%

Procedures 3 2 1 CI’s Comments

1. Gather supplies: gauze, tape, cotton balls w/

alcohol
2. Perform safety steps:
a. Wash hands or perform hand hygiene
b. Introduce yourself, your role, the purpose
of your visit, and an estimate of the time it
will take.
c. Check the prescription chart or the
doctors order
d. Confirm patient ID using two patient
identifiers (e.g., name and date of birth).
e. Explain the process to the patient.
f. Be organized and systematic.
g. Use appropriate listening and questioning
skills
h. Listen and attend to patient cues.
i. Ensure the patient’s privacy and dignity
j. Assess ABCs.

3. Prepare the gauze or dry cotton ball and tape.

4. Place the IV clamp to the “off” position
(clamped).
5. Loosen the edges of the transparent dressing
and tape in the direction of the IV site.
6. Place a gauze pad over the IV site and gently
pull the IV out parallel to the skin in a slow and
steady motion
7. Hold pressure on the IV site for 2-3 minutes. If
the patient is on anticoagulant medication, you
may need to hold for 5-10 minutes.
8. Inspect the catheter to ensure it is intact and
dispose of it in an appropriate container.
 UNIVERSITY OF SAINT ANTHONY
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines

HEALTH CARE EDUCATION DEPARTMENT

9. Remove the gauze pad once bleeding has

stopped and assess for any signs of infection at
the site, such as redness, swelling, warmth,
tenderness, or purulent drainage.
10. Tape the gauze or apply a Band-Aid over the IV
site.
11. Assist the patient to a comfortable position, ask
if they have any questions.
12. Ensure safety measures when leaving the room:
a. BED: Low and locked (in lowest position
and brakes on)
b. SIDE RAILS: Secured
c. TABLE: Within reach
d. ROOM: Risk-free for falls
13. Discard the materials in proper waste
segregations
14. Perform hand hygiene

15. Document the procedure and related

assessment findings. Report any concerns
according to hospital policy
 UNIVERSITY OF SAINT ANTHONY
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines

HEALTH CARE EDUCATION DEPARTMENT

Setting-Up an IV Infusion

Name: ___________________________________ Year & Section: _____________

Date Performed: ___________________________ Rating /Grade: _____________
Clinical Instructor: __________________________ Signature of CI: _____________

Legend 3 - Able to Perform

2 - Able to Perform, with Assistance
1 - Unable to Perform

Grading: Knowledge - 35%

Skills - 35%
Attitude - 30%

Performance Points 3 2 1 CI’s Comments

1. Perform hand hygiene.
2. Verify the provider order with the medication
administration record (eMAR/MAR).
3. Gather supplies:
 IV fluid, primary tubing,
 tubing change label, and
 Alcohol pads
 Basin

4. Remove the IV solution from the packaging

and gently apply pressure to the bag while
inspecting for tears or leaks
5. Check the color and clarity of the solution.
6. Enter the patient room and greet the patient
7. Perform safety steps:
a. Perform hand hygiene.
b. Check the room for transmission-
based precautions.
c. Introduce yourself, your role, the
purpose of your visit,
d. Confirm patient ID using two patient
identifiers (e.g., name and date of
birth).
e. Explain the process to the patient
and ask if they have any questions.
f. Be organized and systematic.
g. Use appropriate listening and
questioning skills.
h. Listen and attend to patient cues.
i. Ensure the patient’s privacy and
dignity.
 UNIVERSITY OF SAINT ANTHONY
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines

HEALTH CARE EDUCATION DEPARTMENT

j. Assess ABCs.
8. Remove the IV tubing from the packaging. If
administering IV fluid by gravity, note the drip
factor on the package and calculate
drops/min. Perform the necessary
calculations for the infusion rate.
9. Move the roller clamp so that it is halfway up
the tubing and clamp it.
10. Remove the cover from the tubing port on
the bag of IV fluid.
11. Remove the cap from the insertion spike on
the tubing. While maintaining sterility, insert
the spike into the tubing port of the bag of IV
fluid.
12. Squeeze the drip chamber two or three times
to fill the chamber halfway.
13. Loosen the cap from the end of the IV tubing
and open the clamp to prime the tubing over
the sink:
a. If using multiple port tubing, invert
the ports to prime them and to
prevent air accumulation in line.
b. If the solution is an antibiotic, take
care to not waste solution while
priming the tubing to ensure the
patient receives the correct dosage

14. Once primed, clamp the IV tubing and check

the entire length of the tubing for air bubbles.
Tap the tubing gently to remove any air

15. Label the IV fluid bottle with the date and

time. Place the tubing label on the tubing
near the drip chamber.

16. Assess the patient’s venipuncture site for

signs and symptoms of vein irritation or
infiltration. Do not proceed with administering
fluids at this site if there are any concerns.

17. Assess IV site patency according to agency

policy. Purge a prefilled normal saline
syringe of air. Attach the syringe onto the
saline lock cap. Undo the clamp on the
extension tubing. Inject 3 to 5 mL of normal
saline using a turbulent stop-start technique.
If resistance is felt, do not force the flush and
do not proceed with IV solution
administration; follow up according to agency
policy:
 UNIVERSITY OF SAINT ANTHONY
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines

HEALTH CARE EDUCATION DEPARTMENT

18. Remove the syringe from the IV cap and

then clamp the extension tubing.

19. Vigorously cleanse the catheter cap on the

patient’s IV port with an alcohol pad (or the
agency required cleansing agent) for at least
five seconds and allow it to dry.

20. Remove the protective cap from the end of

the primary tubing and attach it to the IV port
while maintaining sterility

21. Move the slide clamp on the saline lock to

open the tubing.

22. Set the infusion rate based on the provider

order:
a. For infusion pump: Set volume to be
infused and rate (mL/hr) to be
administered.
b. For gravity: Calculate drop per
minute.

23. Assess the patient’s IV site for signs and

symptoms of vein irritation or infiltration after
infusion begins.

24. Secure the tubing to the patient’s arm

25. Assist the patient to a comfortable position,

ask if they have any questions, and thank
them for their time.

26. Ensure safety measures when leaving the

room:
a. CALL LIGHT: Within reach
b. BED: Low and locked (in lowest
position and brakes on)
c. SIDE RAILS: Secured
d. TABLE: Within reach
e. ROOM: Risk-free for falls (scan
room and clear any obstacles)

27. Perform hand hygiene.

28. Document the procedure and related

assessment findings. Report any concerns
according to agency policy. Include IV fluids
on patient’s input/output documentation.
 UNIVERSITY OF SAINT ANTHONY
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines

HEALTH CARE EDUCATION DEPARTMENT

Performance Points 3 2 1 CI’s Comments

29. Perform hand hygiene.
30. Verify the provider order with the medication
administration record (eMAR/MAR).
31. Gather supplies:
 IV fluid, primary tubing,
 tubing change label, and
 Alcohol pads
 Basin

32. Remove the IV solution from the packaging

and gently apply pressure to the bag while
inspecting for tears or leaks
33. Check the color and clarity of the solution.
34. Enter the patient room and greet the patient
35. Perform safety steps:
k. Perform hand hygiene.
l. Check the room for transmission-
based precautions.
m. Introduce yourself, your role, the
purpose of your visit,
n. Confirm patient ID using two patient
identifiers (e.g., name and date of
birth).
o. Explain the process to the patient
and ask if they have any questions.
p. Be organized and systematic.
q. Use appropriate listening and
questioning skills.
r. Listen and attend to patient cues.
s. Ensure the patient’s privacy and
dignity.
t. Assess ABCs.
36. Remove the IV tubing from the packaging. If
administering IV fluid by gravity, note the drip
factor on the package and calculate
drops/min. Perform the necessary
calculations for the infusion rate.
37. Move the roller clamp so that it is halfway up
the tubing and clamp it.
38. Remove the cover from the tubing port on
the bag of IV fluid.
39. Remove the cap from the insertion spike on
the tubing. While maintaining sterility, insert
the spike into the tubing port of the bag of IV
fluid.
 UNIVERSITY OF SAINT ANTHONY
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines

HEALTH CARE EDUCATION DEPARTMENT

40. Squeeze the drip chamber two or three times

to fill the chamber halfway.
41. Loosen the cap from the end of the IV tubing
and open the clamp to prime the tubing over
the sink:
a. If using multiple port tubing, invert
the ports to prime them and to
prevent air accumulation in line.
b. If the solution is an antibiotic, take
care to not waste solution while
priming the tubing to ensure the
patient receives the correct dosage

42. Once primed, clamp the IV tubing and check

the entire length of the tubing for air bubbles.
Tap the tubing gently to remove any air

43. Label the IV fluid bottle with the date and

time. Place the tubing label on the tubing
near the drip chamber.

44. Assess the patient’s venipuncture site for

signs and symptoms of vein irritation or
infiltration. Do not proceed with administering
fluids at this site if there are any concerns.

45. Assess IV site patency according to agency

policy. Purge a prefilled normal saline
syringe of air. Attach the syringe onto the
saline lock cap. Undo the clamp on the
extension tubing. Inject 3 to 5 mL of normal
saline using a turbulent stop-start technique.
If resistance is felt, do not force the flush and
do not proceed with IV solution
administration; follow up according to agency
policy:

46. Remove the syringe from the IV cap and

then clamp the extension tubing.

47. Vigorously cleanse the catheter cap on the

patient’s IV port with an alcohol pad (or the
agency required cleansing agent) for at least
five seconds and allow it to dry.

48. Remove the protective cap from the end of

the primary tubing and attach it to the IV port
while maintaining sterility

49. Move the slide clamp on the saline lock to

open the tubing.
 UNIVERSITY OF SAINT ANTHONY
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines

HEALTH CARE EDUCATION DEPARTMENT

50. Set the infusion rate based on the provider

order:
a. For infusion pump: Set volume to be
infused and rate (mL/hr) to be
administered.
b. For gravity: Calculate drop per
minute.

51. Assess the patient’s IV site for signs and

symptoms of vein irritation or infiltration after
infusion begins.

52. Secure the tubing to the patient’s arm

53. Assist the patient to a comfortable position,

ask if they have any questions, and thank
them for their time.

54. Ensure safety measures when leaving the

room:
a. CALL LIGHT: Within reach
b. BED: Low and locked (in lowest
position and brakes on)
c. SIDE RAILS: Secured
d. TABLE: Within reach
e. ROOM: Risk-free for falls (scan
room and clear any obstacles)

55. Perform hand hygiene.

56. Document the procedure and related

assessment findings. Report any concerns
according to agency policy. Include IV fluids
on patient’s input/output documentation.
 UNIVERSITY OF SAINT ANTHONY
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines

HEALTH CARE EDUCATION DEPARTMENT

Changing an IV Infusion

Name: ___________________________________ Year & Section: _____________

Date Performed: ___________________________ Rating /Grade: _____________
Clinical Instructor: __________________________ Signature of CI: _____________
Legend 3 - Able to Perform
2 - Able to Perform, with Assistance
1 - Unable to Perform

Grading: Knowledge - 35%

Skills - 35%
Attitude - 30%

Performance Points 3 2 1 CI’s Comments

1. Verify and select correct IV solution bag, and
compare to the medication administration
record (MAR) or prescriber’s orders.
2. Introduce yourself, identify patient, and explain
procedure.
3. Perform hand hygiene.
4. Remove IV solution from outer packaging and
gently squeeze. Check expiration date. Assess
for precipitates or cloudiness. Hang new IV
solution on IV pole.
5. If infusing the IV by EID, pause the device. If
infusing the IV via gravity, close the roller
clamp on the infusion set.
6. Remove the protective cover from the IV
solution (new bag) port.
7. Remove the old IV solution bag from the IV
pole. Turn old IV bag upside down, grasping
the bag with the non-dominant hand and the
spike with the dominant hand. With a twisting
motion, carefully remove IV tubing spike from
old IV solution bag.
8. Using a gentle back and forth twisting motion,
firmly insert the spike into the new IV bag.
9. If necessary, fill the drip chamber by
compressing it between your thumb and
forefinger. Ensure the drip chamber is one-
third to one-half full. Check IV tubing for air
bubbles.
10. If using gravity: Open clamp and regulate IV
infusion rate with the roller clamp.
 UNIVERSITY OF SAINT ANTHONY
(Dr. Santiago G. Ortega Memorial)
Dr. Ortega St., Iriga City, Philippines

HEALTH CARE EDUCATION DEPARTMENT

If using EID: Confirm rate and volume to be

infused, press start to resume the infusion.
11. Label new IV solution bag as per agency
policy.
12. Dispose of used supplies, perform hand
hygiene, and document IV solution bag
change according to agency policy.
13. Document time, date, type of solution, rate,
and total volume.