Anonymous

peripheral Intravenous insertion

iv insertions audit tool

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Information

Document No.
Audit Title
Client / Site
Conducted on
Prepared by
Location
Personnel

HCW performing insertion?
Patient cleans their hands & arms
Hand hygiene performed
Dressing packed used
Tray or kidney dish cleaned
All equipment gathered
Hand hygiene performed
Flush prepared
Patient arm placed on drape & pillow
Tourniquet applied
Vein located
Tourniquet released
Hand hygiene performed
Tourniquet reapplied
Gloves donned
Type of skin prep applied
Skin prep allowed to dry for min 30 seconds
No further repalpation
IV cannula successfully inserted
Sharp disposed immediately into container
Cannula flushed
Sterile dressing applied
Gloves removed & disposed
Hand hygiene performed
IV insertion site & date documented in medical records or care plan

Anonymous

peripheral Intravenous insertion

iv insertions audit tool

Use this Template

Print as PDF

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