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Infusion Checklist

WORK SETTING EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *
Inpatient Acute Care Facility
Clinic/Ambulatory
Trauma Center
Post Acute Setting (long term care)
Other Setting (Hospice, Home Health)
GENERAL SKILLS:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *
Advanced directives
Awareness of HCAHPS
Accurate Patient Identification
Patient/family education
Computerized Documentation
Care of patient in Restraints
Lift/Transfer Devices
End of Life/Palliative Care
Bar Coding for medication administration
National Patient Safety Goals
Interpretation and communication of lab values
Medication Administration 5 Rights
Interpretation and communication of lab values
Collection of lab/specimens
Medication Reconciliation
Pain Assessment and management
Infection Control
Universal Precautions
Isolation Precautions
CPR/BLS
Minimize fall risks
Crash Cart
Defibrillator
Use proper body mechanics
Obtain Vital Signs
Ensures HIPPA compliance
Demonstrates knowledge of anatomy
Maintain Sterile Field
EQUIPMENT:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *
CADD Pump
Syringe Pump
Rate flow Regulator
Management of IV Infusion Pumps (Alaris, Baxter)
Management of elastomeric infusion
Pressurized Lines
Needless Systems
Curlin Pump
Blood Warmer
PCA Pumps
Computerized Charting
Automated Medication Dispensing Machines
Pulse oximetry
Use of Doppler/pulse checks
Automatic/manual Blood Pressure checks
Oxygen Delivery Device
ASSIST WITH INSERTION & MANAGEMENT OF:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *
Peripheral IV -Adult
Peripheral IV Child
Peripheral IV Neonate
Vein Selection- Peripheral IV’s
Interosseous Needles
Midline Catheter- Adult
Midline Catheter- Child
Indications for Midline/Picc Placement
Contraindications for Midline/Picc Placement
Proper vein selection
Measuring technique
Catheter and Introducer Device Selection
Correct Tip Placement
Insertion technique Basic Vein
Insertion technique Ultrasound
Insertion site preparation
Maintaining sterile field
Securement post placement
Xray assessment for tip location
Repositioning after Xray
CARE AND MAINTENANCE:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *
Peripheral IV
Scalp IV
Heparin/Saline Lock
Groshong PICC
Hickman/Broviac
Port A Catheter
Vascath
Multilumen catheter
Subclavian Line
IJ
Femoral Line
Power Picc
Power Port
Dressing Changes
Cap Changes
Line flushing maintenance (Frequency)
MEDICATION ADMINISTRATION:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *
Administer Chemotherapy
Lidocaine
TPN/Lipids
TPA (Alteplase)
Versed
Streptokinase
IVF
IV antibiotics
Blood and Blood products
TROUBLESHOOTING/COMPLICATIONS:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *
Air Embolism
Bleeding from site
Brachial Plexus Injury
Cardiac Arrythmia
Catheter Embolism
Catheter Related Sepsis
Catheter Tip Malposition or Retraction
Catheter Occlusion
Declotting Central Venous Lines
Declotting Hemodialysis Catheter
Declotting Implantable Port a Catheter
Declotting Groshong Central Line
Declotting Jugular Central Line
DeclottingSubclavian Central Line
Declotting PICC
Declotting Peripheral Site
Endocarditis
Extravasation
Hematoma
Myocardial Erosion
Perforation of Vessels
Phlebitis
Site Necrosis
Site Infection
Thromboembolism
Venous Thrombosis
Vessel Erosion
DISCONTINUATION OF IV THERAPY:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *
Peripheral IV
PICC/Midline
AGE SPECIFIC CHECKLIST:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *
Newborn/neonate (birth-30 days)
Infant (31 days- 1 year)
Toddler (ages 2-3 yrs)
Preschool (ages 4-5 yrs)
School Age (ages 6-12 yrs)
Adolescent (ages 13-21 yrs)
Young Adult (ages 22-39)
Adult (ages 40-64)
Older Adult (ages 65+)
GENERAL SKILLS EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *
National Patient Safety Goals/Core Measures
Use of transfer/lifting Devices
Patient/Family education