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\n\n| SCORING |  |\n| --- | --- |\n| N/A | Not applicable for this patient |\n| 0 | Unsuccessful; required critical or excessive prompting; inconsistent; not yet competent |\n| 1 | Not yet competent, marginal or inconsistent, this includes partial attempts |\n| 2 | Successful; competent; no prompting necessary |\n\n\n| Actual Time Started:   | SCORE |\n| --- | --- |\n| Clearly explains procedure to patient | N/A |\n| Selects, checks, assembles equipment |  |\n| IV solution | N/A |\n| Administration set | N/A |\n| Catheter | N/A |\n| Sharps container | N/A |\n| Universal start kit (antiseptic swabs, gauze pads, venous tourniquet, occlusive bandage, antibiotic gel, syringe, etc.) | N/A |\n| Spikes bag |  |\n| Checks solution for: |  |\n| Proper solution | N/A |\n| Clarity or particulate matter | N/A |\n| Expiration date | N/A |\n| Protective covers on tail ports | N/A |\n| Checks administration set for: |  |\n| Drip rating | N/A |\n| Tangled tubing | N/A |\n| Protective covers on both ends | N/A |\n| Flow clamp up almost to drip chamber and closed | N/A |\n| Removes protective cover on drip chamber while maintaining sterility | N/A |\n| Removes protective cover on IV bag tail port while maintaining sterility | N/A |\n| Inserts IV tubing spike into IV solution bag tail port by twisting and pushing until inner seal is punctured while maintaining sterility | N/A |\n| Turns IV bag upright | N/A |\n| Squeezes drip chamber and fills half-way | N/A |\n| Turns on flow and bleeds line of all air while maintaining sterility | N/A |\n| Shuts flow off after assuring that all large air bubbles have been purged | N/A |\n| Performs venipuncture |  |\n| Tears sufficient tape to secure IV | N/A |\n| Opens antiseptic swabs, gauze pads, occlusive dressing | N/A |\n| Takes appropriate PPE precautions | N/A |\n| Identifies appropriate potential site for cannulation | N/A |\n| Applies tourniquet properly | N/A |\n| Palpates and identifies suitable vein | N/A |\n| Cleanses site, starting from the center and moving outward in a circular motion | N/A |\n| Removes IV needle and catheter from package and while maintaining sterility | N/A |\n\n\n| Inspects for burrs | N/A |\n| --- | --- |\n| Loosens catheter hub with twisting motion | N/A |\n| Stabilizes the vein and extremity by grasping and stretching skin while maintaining sterility | N/A |\n| Warns patient to expect to feel the needle stick | N/A |\n| Inserts stylette with bevel up at appropriate angle (35 – 45°) while maintaining sterility | N/A |\n| Feels “pop” as stylette enters vein and observes dark, red blood in flash chamber | N/A |\n| Lowers stylette and inserts an additional 1/8 – 1/4\" | N/A |\n| Stabilizes stylette and slides catheter off of stylette until hub touches skin | N/A |\n| Palpates skin just distal to tip of catheter and applies pressure to occlude vein | N/A |\n| Removes stylette and immediately disposes in sharps container | N/A |\n| Attaches syringe and draws venous blood sample if ordered while maintaining sterility | N/A |\n| Removes protective cap from IV tubing and attaches to hub of catheter while maintaining sterility | N/A |\n| Releases tourniquet | N/A |\n| Opens flow clamp and runs for a brief period to assure a patent line | N/A |\n| Secures catheter and IV tubing to patient | N/A |\n| Adjusts flow rate as appropriate | N/A |\n| Assesses site for signs of infiltration, irritation | N/A |\n| Assesses patient for therapeutic response or signs of untoward reactions | N/A |\n| Affective |  |\n| Accepts evaluation and criticism professionally | N/A |\n| Shows willingness to learn | N/A |\n| Interacts with simulated patient and other personnel in professional manner | N/A |\n\nActual Time Ended:    \nTOTAL  \n0 /100  \nCritical Criteria  \n  Failure to take or verbalize appropriate PPE precautions  \n  Failure to dispose of blood-contaminated sharps immediately at the point of use   Contaminates equipment or site without appr","cbCaii0WESGyeARl","https://ap.wps.com/l/cbCaii0WESGyeARl","pdf",212257,"English","# Scoring Rubric\n## N/A to 2 Levels\n# Procedure Checklist\n## Explain to Patient\n## Equipment and Sterile Setup\n## Solution and Administration Set Checks\n## Venipuncture and Catheter Placement\n## Line Purging and Flow Control\n## Securement and Site Assessment\n# Critical Criteria and Comments\n# Student Self-Evaluation","[{\"question\":\"How is the skill performance scored on this form?\",\"answer\":\"Items are scored using N/A, 0 (unsuccessful), 1 (not yet competent), or 2 (successful without prompting).\"},{\"question\":\"What critical issues can lead to failing the evaluation?\",\"answer\":\"Failure to use appropriate PPE, improper disposal of blood-contaminated sharps, contamination without corrective action, unsafe technique causing hemorrhage/catheter shear/air embolism risk, inadequate EMT-level patient management, unacceptable affect, dangerous or inappropriate interventions, or not reaching a total score of 76 or greater.\"},{\"question\":\"What does the student self-evaluation section ask?\",\"answer\":\"The examiner asks whether the student was successful or unsuccessful in the skill, and the student documents the response.\"}]","INTRAVENOUS THEARPY SKILLS LAB - Student Self-Evaluation Form | PDF",1790199874]