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HEALTHCARE
- Nursing
- Therapy
SCHOOLS
TELEPRACTICE

About Us
Employees
Employers
Contact
Blog

HEALTHCARE
- Nursing
- Therapy
SCHOOLS
TELEPRACTICE

IV Therapy RN Skills Checklist

Please rate your experience / frequency within the last year
0 = No Experience / Observed Only
1 = Limited Experience / Rarely Done (<6 times/year)
2 = May Need Some Review / Occasionally Done (1-2 times/month)
3 = Experienced / Frequently Done (daily or weekly)

Please rate your experience / frequency within the last year

0 = No Experience / Observed Only

1 = Limited Experience / Rarely Done (<6 times/year)

2 = May Need Some Review / Occasionally Done (1-2 times/month)

3 = Experienced / Frequently Done (daily or weekly)

"*" indicates required fields

Please rate your experience / frequency within the last year
0 = No Experience / Observed Only
1 = Limited Experience / Rarely Done (<6 times/year)
2 = May Need Some Review / Occasionally Done (1-2 times/month)
3 = Experienced / Frequently Done (daily or weekly)

Full Name*

Email*

Todays Date*

MM slash DD slash YYYY

Iv Therapy Experience With The Following Ages:

Newborn/Neonate (birth to 30 days)

0

1

2

3

Infant (31 days to 12 months)

0

1

2

3

Toddler/Preschool (13 months to 5 years)

0

1

2

3

School Age Child/adolescent (6 years to 18 years)

0

1

2

3

Young Adults/Middle Adult (19 years to 64 years)

0

1

2

3

Older Adults/Elderly (65+ years)

0

1

2

3

General Skills

Care of Patient in Restraints

0

1

2

3

Automated Med Dispensing Systems

Accudose

Metro

Omnicell

Promanager Rx

Pyxis

N/A

Other Automated Med Dispensing Systems:

Electronic Documentation

Allscripts

Care360

Cerner

eCLinicalWorks

EPIC

MACLAB

McKesson

Meditech

PACS

Soarian

N/A

Other Electronic Documentation:

Access/Management of Implanted Ports

0

1

2

3

Access/Management of Central Lines (CVL, Hickman, Broviac, Groshong, etc.)

0

1

2

3

Titration of drips

0

1

2

3

Administration of Blood/Blood Products

0

1

2

3

Leading Code Teams

0

1

2

3

Use of Computerized Patient ID Systems

0

1

2

3

Knowledge of Current IV Therapy Guidelines (INS, ISMP, CDC, State, Etc.)

0

1

2

3

Knowledge of Anatomy

0

1

2

3

Moderate Conscious Sedation

0

1

2

3

Sedation Reversal Agents

0

1

2

3

Knowledge of "Do Not Use Abbreviations"

0

1

2

3

Do you have charge/supervisor experience?

Yes

No

Knowledge of current Joint Commission National Patient Safety Goals

0

1

2

3

Knowledge/familiarity with HCAHPS scores

0

1

2

3

Insertion Of:

Peripheral IV-Adult

0

1

2

3

Peripheral IV-Child

0

1

2

3

Peripheral IV-Neonate

0

1

2

3

Vein Selection - Peripheral IV's

0

1

2

3

Interosseous Needles

0

1

2

3

Midline's/picc Lines:

Midline Catheter Insertion - Adult

0

1

2

3

Midline Catheter Insertion - Child

0

1

2

3

Indications for Midline/PICC Placement

0

1

2

3

Contraindications for Midline/PICC Placement

0

1

2

3

Vein Selection

0

1

2

3

Measuring Techniques

0

1

2

3

Catheter and Introducer Device Selection

0

1

2

3

Correct Tip Placement

0

1

2

3

Insertion Technique - Basic (Vein)

0

1

2

3

Insertion Technique - Seldinger

0

1

2

3

Insertion Technique - Ultrasound

0

1

2

3

Assist with Insertion in Interventional Radiology

0

1

2

3

Insertion Site Preparation

0

1

2

3

Maintaining Sterile Field

0

1

2

3

Securing Insertion Site Post Placement

0

1

2

3

X-ray Assessment for Tip Location

0

1

2

3

Repositioning After X-ray

0

1

2

3

Care And Maintenance:

Peripheral IV

0

1

2

3

Scalp IV

0

1

2

3

Heparin/Saline Lock

0

1

2

3

Groshong PICC

0

1

2

3

Groshong CVL

0

1

2

3

Hickman/Broviac

0

1

2

3

Port-a-Cath

0

1

2

3

Vascath

0

1

2

3

Multilumen Catheters

0

1

2

3

Subclavian Line

0

1

2

3

IJ Line

0

1

2

3

Femoral Line

0

1

2

3

Power PICC

0

1

2

3

Power PORT

0

1

2

3

Dressing Changes

0

1

2

3

Cap Changes

0

1

2

3

Flushing Lines (Frequency/Solutions)

0

1

2

3

Medication Administration

Chemotherapy

0

1

2

3

Heparin

0

1

2

3

Streptokinase

0

1

2

3

TPA (Alteplase)

0

1

2

3

Lidocaine

0

1

2

3

TPN/Lipids

0

1

2

3

Ativan (Lorazepam)

0

1

2

3

Valium (Diazepam)

0

1

2

3

Versed (Midazolam)

0

1

2

3

Fentanyl

0

1

2

3

Equipment:

IV Pumps (check all that apply)

Alaris

Alibaba

Bard

Baxter

Braun

CADD

IVAC

Zynomed

N/A

Other IV Pumps:

Needleless Systems

0

1

2

3

Blood Warmer

0

1

2

3

PCA Pumps

0

1

2

3

Pressure Lines

0

1

2

3

Troubleshooting/ Complications:

Repair PICC

0

1

2

3

Repair Midline

0

1

2

3

Air Embolism

0

1

2

3

Bleeding

0

1

2

3

Brachial Plexus Injury

0

1

2

3

Cardiac Arrhythmia

0

1

2

3

Cardiac Tamponade

0

1

2

3

Catheter Erosion

0

1

2

3

Catheter Embolism

0

1

2

3

Catheter Occlusion

0

1

2

3

Catheter-Related Sepsis

0

1

2

3

Endocarditis

0

1

2

3

Exit Site Infection

0

1

2

3

Exit Site Necrosis

0

1

2

3

Extravasation

0

1

2

3

Hematoma

0

1

2

3

Laceration of Vessels or Viscus

0

1

2

3

Myocardial Erosion

0

1

2

3

Perforation of Vessels or Viscus

0

1

2

3

Phlebitis

0

1

2

3

Catheter Tip Malposition or Retraction

0

1

2

3

Thromboembolism

0

1

2

3

Venous Thrombosis

0

1

2

3

Ventricular Thrombosis

0

1

2

3

Vessel Erosion

0

1

2

3

Declotting Peripheral Site

0

1

2

3

Complications from Sedation

0

1

2

3

Discontinuing Iv Therapy

Peripheral IV's

0

1

2

3

PICC/Midline

0

1

2

3

Central Lines

0

1

2

3

awards updated 2022

SIA_CM_Member_2018

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