Intravenous Therapy
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:
Hour
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30
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50
Minutes
What class is the student in?
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A
B
C
Evening
A
*
Please Select
Brown
Crown
Downs
Friedman
Fuentes
Gonzales
Gosnell
Lombardi
Mccolgan
Patterson
Robinson
Stidham
B
*
Please Select
Chimenian
Clark
Collins
Cooper
Fowler
Lally
Pauley
Pavelka
Staub
Stoddard
Sword
C
*
Please Select
Begosh
Decker
Eckroade
Keeney
Kough
Leonard
Peterson
Santucci
Shaffer
Swann
Wigmore
Evening
*
Please Select
Ale
Dana
Decamp
Flanary
Gunawardana
Hunt
Kaffi
Knoyer
Lopez-Puentes
Manon
Mejias
Olson
Sahadzic
Sakaria
Who is the Evaluator?
*
Instructor
A Shift Student Evaluator
B Shift Student Evaluator
C Shift Student Evaluator
Evening Student Evaluator
Instructor
*
Please Select
Burkhammer, Michele
Cleveland, Susan
Cordero, Jennifer
Cousins, Robert
Dugan, Pete
Gorodetsky, Nelly
Hayunga, Joe
Herman, Geoffrey
Hutchinson, David
Kauffman, Mike
Kinna, Donald
Le Renard, Yann
Leigh, Michael
Lipp, Troy
Lofland, Larry
Luger, Brian
Martino, Chris
Newman, David
Ney, Kirk
Nosbisch, Nick
Oliveira, Rae
Ruff, Greg
Scott, Tony
Shawl, Jon
Singer, Arye
Stottlemyer, Ty
Strudwick, Rosni
Sweder-Gold, David
Touzeau, Chris
Turcotte, Jeremy
Weinstock, Sam
Wooden, Andrew
Zea, Alejandro
A Shift Student Evaluator
*
Please Select
Brown
Crown
Downs
Friedman
Fuentes
Gonzales
Gosnell
Lombardi
Mccolgan
Patterson
Robinson
Stidham
B Shift Student Evaluator
*
Please Select
Chimenian
Clark
Collins
Cooper
Fowler
Lally
Pauley
Pavelka
Staub
Stoddard
Sword
C Shift Student Evaluator
*
Please Select
Begosh
Decker
Eckroade
Keeney
Kough
Leonard
Peterson
Santucci
Shaffer
Swann
Wigmore
Evening Shift Student Evaluator
*
Please Select
Ale
Dana
Decamp
Flanary
Gunawardana
Hunt
Kaffi
Knoyer
Lopez-Puentes
Manon
Mejias
Olson
Sahadzic
Sakaria
Selects, checks, assembles equipment
IV solution
Administration set
Catheter
Sharps container
Universal start kit (antiseptic swabs, gauze pads, venous tourniquet, occlusive bandage, antibiotic gel, syringe, etc.)
Spikes bag
Checks solution for: Proper solution
Checks solution for: Clarity or particulate matter
Checks solution for: Expiration date
Checks solution for: Protective covers on tail ports
Checks administration set for: Drip rate
Checks administration set for: Tangled tubing
Checks administration set for: Protective covers on both ends
Checks administration set for: Flow clamp up almost to drip chamber and closed
Removes protective cover on drip chamber while maintaining sterility
Removes protective cover on IV bag tail port while maintaining sterility
Inserts IV tubing spike into IV solution bag tail port by twisting and pushing until inner seal is punctured while maintaining sterility
Turns IV bag upright
Squeezes drip chamber and fills half-way
Turns on flow and bleeds line of all air while maintaining sterility
Shuts flow off after assuring that all large air bubbles have been purged
Performs venipuncture
Takes or verbalizes appropriate PPE precautions
Tears sufficient tape to secure IV
Opens antiseptic swabs, gauze pads, occlusive dressing
Identifies appropriate potential site for cannulation
Applies tourniquet properly
Palpates and identifies suitable vein
Cleanses site
Removes IV needle and catheter from package and while maintaining sterility
Inspects for burrs
Loosens catheter hub with twisting motion
Stabilizes the vein and extremity by grasping and stretching skin while maintaining sterility
Warns patient to expect to feel the needle stick
Inserts stylette with bevel up at appropriate angle while maintaining sterility
Feels “pop” as stylette enters vein and observes dark, red blood in flash chamber
Lowers stylette and inserts an additional 1/8 – 1/4"
Stabilizes stylette and slides catheter off of stylette until hub touches skin
Palpates skin just distal to tip of catheter and applies pressure to occlude vein
Removes stylette and immediately disposes in sharps container
Attaches syringe and draws venous blood sample if ordered while maintaining sterility
Removes protective cap from IV tubing and attaches to hub of catheter while maintaining sterility
Releases constricting band
Opens flow clamp and runs for a brief period to assure a patent line
Secures catheter and IV tubing to patient
Adjusts flow rate as appropriate
Assesses site for signs of infiltration, irritation
Assesses patient for therapeutic response or signs of untoward reactions
Affective
Accepts evaluation and criticism professionally
Shows willingness to learn
Interacts with simulated patient and other personnel in professional manner
Critical Criteria
Failure to take or verbalize appropriate PPE precautions
Failure to dispose of blood-contaminated sharps immediately at the point of use
Contaminates equipment or site without appropriately correcting situation
Performs any improper technique resulting in the potential for uncontrolled hemorrhage, catheter shear or air embolism
Failure to manage the patient as a competent EMT
Exhibits unacceptable affect with patient or other personnel
Uses or orders a dangerous or inappropriate intervention
Evaluator Comments
Was the student successful or unsuccessful in this skill?
*
Successful
Unsuccessful
Signature
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