PERFORMANCE CHECKLIST

INITIATE AN INTRAVENOUS INFUSION

Situation: A casualty is in hypovolemic shock. You have taken care of any major wounds and are preparing to administer fluids intravenously.

GO NO GO

Puts on gloves.

Removes protective covering from I.V. bag and checks for passed expiration date, leaks, and clarity of solution.

Removes infusion set from box, checking for cracks, watermarks, etc.

Moves clamp on tubing 6 to 8 inches from the drip chamber and tightens the clamp.

Removes protective covering from outlet port without touching port tip.

Removes spike protective cap on infusion set with twisting motion without touching spike.

Inserts spike fully into I.V. outlet port with a twisting motion without touching the spike or port tip.

Holds (hangs) bag up and fills the drip chamber half full by squeezing drip chamber.

Holds tubing above bottom of bag.

Loosens clamp on tubing and loosens protective cap over the adapter.

Gradually lowers tubing until solution reaches the tip of the adapter.

Reclamps tubing and retightens cap on adapter.

Protects I.V. tubing (loop over stand, etc.)

Tears/cuts four strips of tape and hangs strips on bag.

Looks and feels for vein (usually on arm or hand).

Selects appropriate vein for infusion (not over a joint: free of scars, moles, and hair; etc.).

Applies constricting band 6 to 8 inches above site in the manner described in the subcourse.

Instructs casualty to clench and relax his fist several times, then to leave fist clenched.

Palpates selected vein again.

Opens a povidone-iodine impregnated cotton pad and cleanses the selected infusion site, beginning at the center of the site and spiraling outward. Uses an alcohol pad to wipe the site once from proximal to distal.

Does not touch the site after cleansing.

Removes protective cap from catheter and needle unit without touching the needle or catheter.

Pulls skin taut by pressing approximately one inch above or below injection site with thumb of nondominant hand.

Positions needle with bevel up slightly to side of the selected vein at a 20^o to 30^o angle.

Inserts bevel of needle into skin.

Lowers angle to almost parallel to skin surface.

Advances catheter and needle alongside vein and inserts needle into vein.

Checks flash chamber for blood. (If no blood present in chamber, withdraws catheter and needle slightly and inserts the needle into the vein.)

Advances catheter and needle unit 1/8 inch farther to ensure the catheter is in vein.

Threads the catheter into vein to hub without advancing the needle.

Presses lightly on skin over catheter.

Removes flash chamber/needle.

Asks casualty to unclench fist and releases constricting band.

Constricting band has not been in place for more than 2

Removes adapter cap and inserts adapter into catheter hub.

Opens clamp about half way (simulated in performance test).

Checks flow of solution into drip chamber and adjusts clamp if needed (simulated in test).

Checks for infiltration by asking casualty about pain and checking site for swelling, redness, coolness, and leaking of clear fluid.

Secures hub by making a diagonal cross over hub using two strips of tape.

Secures adapter with a strip of tape.

Loops tubing on extremity distal to infusion site and secures looped tubing with tape.

Checks for infiltration again.

(If infiltration is present, discontinues I.V. and tries again at a proximal site.)

Sterility maintained with no additional injury to the casualty.

Question: What should you do if the infusion site is red and cool to

the touch?

Answer:

OVERALL EVALUATION GO NO GO

(A no go on any step gives an overall evaluation of NO GO for.

the entire task.)