Name: ___________________________

Columbus State Community College
Nursing Department
Critical Item Checklist

SETTING UP AN INTRAVENOUS SOLUTION

_____1.	Wash hands.
_____2.	Gather proper equipment.
a.	IV solution as ordered.
b.	IV tubing.
c.	IV pole.
d.	Tape & labels.
_____3.	* Assess equipment for sterility.
a.	* Check expiration date.
b.	* Check IV fluid for clarity.
c.	Open IV tubing, check GTT factor.
d.	Clamp roller clamp.
_____4.	Time tape bag, date and time tubing.
_____5.	* Spike bag without contaminating.
_____6.	Squeeze drip chamber until 1/3 full with solution.
_____7.	* Prime line without contaminating the bag or tubing.
_____8.	Attach tubing to IV catheter or saline well.
_____9.	*Regulate IV at appropriate rate (problems to be given in class).
_____10.	Secure tubing with tape.
_____11.	Clean up supplies, wash hands.
_____12.	Chart procedure.

 

S __________

U __________

Faculty Signature ________________________

Referral ________________________________