Infusion Pump Checklist PDF

hello CENTRO ESCOLAR UNIVERSITY Manila * Makati * Malolos SKILLS LABORATORY PERFORMANCE CHECKLIST...

hello CENTRO ESCOLAR UNIVERSITY Manila * Makati * Malolos SKILLS LABORATORY PERFORMANCE CHECKLIST BSN Level IV – NCM 106 Using An – Intra – Venous Infusion Pump Machine Name of Student Score Year/Section/Group/Number Rate the student's performance by checking the appropriate box using the following criteria: - 5 - Excellent (Carries out procedures efficiently, systematically, and independently) - 4 - Very Satisfactory (Carries out procedures efficiently and systematically but requires minimal guidance and supervision) - 3 - Satisfactory (Carries out the procedures efficiently and systematically but requires moderate guidance and supervision) - 2 - Fair (Carries out the procedures efficiently and systematically but requires close guidance and supervision) - 1 - Poor (Carries out the procedures inefficiently, unsystematically even under close guidance and supervision) * Average mean shall be computed and multiplied by factor 20. The product shall be transmuted using the table for 100 points. Passing cut-off score is 65%. Criteria 5 4 3 2 1 ASSESSMENT 1. Check the IV site if intact and free from infection. 2. Identify the type and amount of medication. 3. Compute for the flow rate. PLANNING 1. Gather all the equipment. 1.1. Infusion pump machine, check if functioning. 1.2. Compatible IV tubing 1.3. IV pole 1.4. Micropore 1.5. Bandage Scissor 1.6. Alcohol swabs 1.7. Hypodermic needle, if needed IMPLEMENTATION 1. Identify the patient. 2. Explain the use of the machine to the patient. Bring equipment to the patient’s room. 3. Wash hands. 4. Attach the infusion pump to the IV pole then plug the machine. 5. Place the IV solution container and tubing on the IV pole. 6. Fill the drip chamber of the IV tubing at least one – third full. 7. Prime the tubing to expel all air bubbles. 8. Raise the IV pole to ensure that the drip chamber is at least 30 inches above the infusion site. 9. Attach the drip sensor device to the drip chamber. 10. Lift the door handle and open the door of the infusion pump. 11. Place the IV tubing through the guide of the machine. 12. Close the door and push the handle down. 13. Press the power button ON. 14. Set the Volume To Be Infused (VTBI) and flow rate using the key pad. Hello Copy to: Faculty AAF-NU 00/00/000 Page 1 of 2  hello Criteria 5 4 3 2 1 15. Connect the IV tubing to the venipuncture site. 16. Open the IV controller pump completely. 17. Assess the drops being delivered, the condition of the tubing in the guide, and the fluid level in the drip chamber at least every 4 hours. 18. Change the guide in the tubing at least every 8 hours. 19. Listen to the alarm and respond immediately to determine the problem. 20. If alarm sounds, check the following: 20.1. Ensure that the drip chamber is one – third full 20.2. Assess the height of the IV container 20.3. Examine the IV tubing in the guide to ensure that it is not pinched down. 20.4. Assess the drip sensor is placed properly to sense the drips. 20.5. Evaluate the position of the needle and tubing to prevent kinking. 21. Make sure that the IV controller or regulator is completely clamped or closed before opening the door of the pump. EVALUATION 1. Documentation that the infusion has met the desired amount to be infused. 2. Periodically check the infusion rate to determine response of the patient if there is overhydration or dehydration. Total Score: Comments/ Suggestions: ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Computation: Total Score divided by 17 (number of items) x 20 (factor) = ________________________ Equivalent Numeric Grade: ________________ Interpretation: __________________ Evaluator: Conforme: _____________________________ _____________________________ __________________ Clinical instructor’s Student’s Signature Date Printed Name & Signature Copy to: Faculty AAF-NU 00/00/000 Page 2 of 2