Intravenous Drip
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:
Hour
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10
20
30
40
50
Minutes
What class is the student in?
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A
B
C
Evening
A Shift
*
Please Select
Brown
Crown
Downs
Friedman
Fuentes
Gonzales
Gosnell
Lombardi
Mccolgan
Patterson
Robinson
Stidham
B Shift
*
Please Select
Chimenian
Clark
Collins
Cooper
Fowler
Lally
Pauley
Pavelka
Staub
Stoddard
Sword
C Shift
*
Please Select
Begosh
Decker
Eckroade
Keeney
Kough
Leonard
Peterson
Santucci
Shaffer
Swann
Wigmore
Evening Class
*
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 Class 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
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 Class Student Evaluator
*
Please Select
Ale
Dana
Decamp
Flanary
Gunawardana
Hunt
Kaffi
Knoyer
Lopez-Puentes
Manon
Mejias
Olson
Sahadzic
Sakaria
Selects, checks, assembles equipment
Medication
IV solution
Administration set
Needle(if needleless set is not available)
Sharps container
Alcohol swabs
Tape
Medication label
Adds medication to secondary IV solution and spikes bag
Clearly explains procedure to patient
Assures that patent primary IV line is established
Confirms medication order
Asks patient for known allergies
Explains procedure to patient
Check medication for: Right patient
Check medication for: Right medication
Check medication for: Right dosage/concentration
Check medication for: Right rate
Check medication for: Right route
Check medication for: Clarity
Check medication for: Expiration date
Assembles prefilled syringe correctly and dispels air while maintaining sterility
Checks IV solution for: Proper solution
Checks IV solution for: Clarity or particulate matter
Checks IV solution for: Expiration date
Checks IV 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
Flow clamp up almost to drip chamber and closed
Removes protective cover on secondary IV bag medication port and cleanses while maintaining sterility
Reconfirms medication
Injects medication into secondary IV bag while maintaining sterility
Disposes/verbalizes proper disposal of syringe in proper container
Gently agitates secondary bag to mix medication
Removes protective cover on drip chamber while maintaining sterility
Removes protective cover on secondary IV bag tail port while maintaining sterility
Inserts IV tubing spike into secondary IV bag tail port by twisting and pushing until inner seal is punctured while maintaining sterility
Turns secondary IV solution bag upright
Squeezes drip chamber and fills half-way
Turns on flow of secondary line and bleeds line of all air while maintaining sterility with minimal loss of fluid
Shuts flow off after assuring that all large air bubbles have been purged from secondary line
Infuses medication
Takes or verbalizes appropriate PPE precautions
Attaches needle to adapter end of secondary line administration set while maintaining sterility (if needleless set is not available)
Reconfirms medication
Identifies and cleanses most proximal injection site of primary line (Y-port or hub if needleless set is not available)
Inserts needle into port of primary line while maintaining sterility
Turns on flow, calculates and adjusts flow rate of secondary line as necessary
Stops flow of primary line
Securely tapes needle to injection port of secondary line while maintaining sterility (if needleless set is not available)
Checks and adjusts flow rate of secondary line
Labels medication fluid bag (date, time, medication, concentration, dosage, initials)
Verbalizes need to observe patient for desired effect and adverse side effects
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 any blood-contaminated sharp immediately at the point of use
Contaminates equipment or site without appropriately correcting situation
Injects improper medication or dosage (wrong medication, incorrect amount, administers at an inappropriate rate)
Performs any improper technique resulting in the potential for air embolism (failure to flush tubing of secondary line, etc.)
Recaps needle or failure to dispose/verbalize disposal of syringe and other material in proper container
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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