IV Therapy RN Skills Checklist One program to handle all talent management needs from acquisition to development Personal Information HiddenOverall ScoreOut of 4Name(Required) First Middle Last Last 4 Digits of Social Security Number Email(Required) HiddenDate MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyAGE OF PATIENTS CARED FORNewborn/Neonate (birth to 30 days)(Required) 1 2 3 4 Infant (1 month to 1 year)(Required) 1 2 3 4 Toddler (1 year to 3 years)(Required) 1 2 3 4 Preschooler (3 years to 5 years)(Required) 1 2 3 4 School Age Child (5 years to 12 years)(Required) 1 2 3 4 Adolescents (12 years to 18 years)(Required) 1 2 3 4 Young Adults (18 years to 39 years)(Required) 1 2 3 4 Middle Adults (39 years to 64 years)(Required) 1 2 3 4 Older Adults (64 years to 79 years)(Required) 1 2 3 4 Elderly Adults (over 79+ years)(Required) 1 2 3 4 GENERAL SKILLSStandard Precautions(Required) 1 2 3 4 Isolation Precautions(Required) 1 2 3 4 Pediatric Respiratory/Cardiac Arrest(Required) 1 2 3 4 Adult Respiratory/Cardiac Arrest(Required) 1 2 3 4 Crash Carts(Required) 1 2 3 4 Defibrillators(Required) 1 2 3 4 Participation on Code Teams(Required) 1 2 3 4 Leading Code Teams(Required) 1 2 3 4 Care of patient in restraints(Required) 1 2 3 4 Pain Management(Required) 1 2 3 4 Automated Med Dispensing Systems(Required) 1 2 3 4 Patient/Family Education(Required) 1 2 3 4 Electronic Documentation(Required) 1 2 3 4 Use of Computerized Patient ID Systems(Required) 1 2 3 4 Patient Head to Toe Assessment(Required) 1 2 3 4 Knowledge of Current IV Therapy Guidelines (INS, ISMP, CDC, State, Etc.)(Required) 1 2 3 4 Infusion PumpCalculate mcg/min and mcg/kg/min(Required) 1 2 3 4 Titrating Medications(Required) 1 2 3 4 INSERTION OFPeripheral IV- Adult(Required) 1 2 3 4 Peripheral IV- Child(Required) 1 2 3 4 Peripheral IV- Neonate(Required) 1 2 3 4 Vein Selection- Peripheral IV’s(Required) 1 2 3 4 Intraosseous Needles(Required) 1 2 3 4 Midlines(Required) 1 2 3 4 PICC Placement(Required) 1 2 3 4 Midline Catheter Insertion- Adult(Required) 1 2 3 4 Midline Catheter Insertion- Child(Required) 1 2 3 4 Indication for Midline/PICC Placement(Required) 1 2 3 4 Contraindications for Midline/PICC Placement(Required) 1 2 3 4 Vein Selection(Required) 1 2 3 4 Measuring Techniques(Required) 1 2 3 4 Catheter and Introducer Device Selection(Required) 1 2 3 4 Correct Tip Placement(Required) 1 2 3 4 Insertion Technique- Basic (vein)(Required) 1 2 3 4 Insertion Technique- Seldinger(Required) 1 2 3 4 Insertion Technique- Ultrasound(Required) 1 2 3 4 Assist with Insertion in Interventional Radiology(Required) 1 2 3 4 Conscious Sedation Procedures(Required) 1 2 3 4 Insertion Site Preparation(Required) 1 2 3 4 Maintaining Sterile Field(Required) 1 2 3 4 Securing Insertion Site Post Placement(Required) 1 2 3 4 X-ray Assessment for Tip Location(Required) 1 2 3 4 Repositioning After X-ray(Required) 1 2 3 4 CARE AND MAINTENANCEPeripheral IV(Required) 1 2 3 4 Scalp IV(Required) 1 2 3 4 Heparin/Saline Lock(Required) 1 2 3 4 Subcutaneous Needles(Required) 1 2 3 4 Groshong PICC(Required) 1 2 3 4 Groshong CVL(Required) 1 2 3 4 Hickman/Broviac(Required) 1 2 3 4 Vascath(Required) 1 2 3 4 Multilumen Catheters(Required) 1 2 3 4 Subclavian Line(Required) 1 2 3 4 IJ Line(Required) 1 2 3 4 Femoral Line(Required) 1 2 3 4 Power PICC(Required) 1 2 3 4 Dressing Changes(Required) 1 2 3 4 Cap Changes(Required) 1 2 3 4 Flushing Lines (Frequency/Solutions)(Required) 1 2 3 4 KNOWLEDGE AND USE OFIV Fluids(Required) 1 2 3 4 Blood Products(Required) 1 2 3 4 Chemotherapy(Required) 1 2 3 4 Heparin(Required) 1 2 3 4 Streptokinase(Required) 1 2 3 4 TPA (Alteplase)(Required) 1 2 3 4 Lidocaine(Required) 1 2 3 4 TPN/Lipids(Required) 1 2 3 4 Ativan (Lorazepam)(Required) 1 2 3 4 Valium (Diazepam)(Required) 1 2 3 4 Versed (Midazolam)(Required) 1 2 3 4 Fentanyl(Required) 1 2 3 4 EQUIPMENTIV Pumps(Required) 1 2 3 4 Needleless Systems(Required) 1 2 3 4 Baxter Pumps(Required) 1 2 3 4 CADD Pumps(Required) 1 2 3 4 IVAC Pumps(Required) 1 2 3 4 Blood Warmer(Required) 1 2 3 4 PCA Pumps(Required) 1 2 3 4 Pressure Lines(Required) 1 2 3 4 TROUBLESHOOTING/COMPLICATIONSRepair PICC(Required) 1 2 3 4 Repair Midline(Required) 1 2 3 4 Air Embolism(Required) 1 2 3 4 Bleeding(Required) 1 2 3 4 Brachial Plexus Injury(Required) 1 2 3 4 Cardiac Arrhythmia(Required) 1 2 3 4 Cardiac Tamponade(Required) 1 2 3 4 Catheter Erosion(Required) 1 2 3 4 Catheter Embolism(Required) 1 2 3 4 Catheter Occlusion(Required) 1 2 3 4 Catheter-Related Sepsis(Required) 1 2 3 4 Endocarditis(Required) 1 2 3 4 Exit Site Necrosis(Required) 1 2 3 4 Extravasation(Required) 1 2 3 4 Hematoma(Required) 1 2 3 4 Laceration of Vessels or Viscus(Required) 1 2 3 4 Myocardial Erosion(Required) 1 2 3 4 Perforation of Vessels or Viscus(Required) 1 2 3 4 Phlebitis(Required) 1 2 3 4 Catheter Tip Malposition or Retraction(Required) 1 2 3 4 Thromboembolism(Required) 1 2 3 4 Venous Thrombosis(Required) 1 2 3 4 Ventricular Thrombosis(Required) 1 2 3 4 Vessel Erosion(Required) 1 2 3 4 Declotting Peripheral Site(Required) 1 2 3 4 Complications from Sedation(Required) 1 2 3 4 DISCONTINUING IV THERAPYPeripheral IV’s(Required) 1 2 3 4 PICC/Midline(Required) 1 2 3 4 Central Lines(Required) 1 2 3 4 AuthorizationsLegal Consent(Required) I agree to the terms and conditions.Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. 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