IV Drip Set up

Candidate Name: _________________________________________ Date: ______________________

Examiner Name and Signature: _________________________________________________________

Time Started: __________ Time Ended: __________ Points: _____/19 PASS/FAIL (Circle One)

Points Possible Points Awarded
Ensure proper PPE 1
Gather supplies:
  • Proper tubing
  • IV fluid
  • Alcohol pads
Remove IV solution from packaging and gently apply pressure to the bag while inspecting for tears of leaks 1
Check color and clarity of solution 1
Perform the 5 rights of medication administration 5
Remove the primary IV tubing from the packaging and note the drip factor 1
Position the roller clamp near the drip chamber and clamp it 1
Remove the cover from the tubing port on the bag of IV fluid 1
Remove the cap from the insertion spike on the tubing. 1
While maintaining sterility, insert spike into the tubing port of the bag of IV fluid 1
Squeeze the drip chamber 2-3 times to fill the chamber halfway 1
Loosen the cap from the end of the IV tubing and open the clamp to prime the tubing 1
Once primed, clamp IV tubing and check the entire length of the tubing for air bubbles. Tap tubing gently to remove any air. 1
Replace or tighten the cap on the end of the tubing 1

Points Possible: 19                    Total Points Awarded_______________

Critical Criteria

●      Failure to maintain aseptic technique

●      Failure to perform 5 rights

●      Failure to check color, clarity & expiration date

●      Improperly assembles IV Tubing

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