Home
Health Services
PIV Extravasation Audit - duplicate
PIV Extravasation Audit - duplicate
Anonymous

PIV Extravasation Audit - duplicate

CHCO Extravasation audit

Use this Template
Print as PDF
graphic of a hand making an okay sign ×

Free PIV Extravasation Audit - duplicate Checklist

Use this Template

Information

  • Conducted on

  • Client/Site

  • Prepared by

Audit 1

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 2

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 3

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 4

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 5

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 6

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 7

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 8

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 9

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 10

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 11

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 12

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 13

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 14

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 15

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 16

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 17

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 18

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 19

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 20

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 21

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 22

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 23

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 24

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 25

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 26

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 27

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 28

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 29

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 30

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 31

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 32

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 33

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 34

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 35

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 36

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 37

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 38

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 39

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

Audit 40

  • Do another audit on this floor?

  • Room number

  • Is peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a second peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

  • Is a third peripheral IV present?

  • Is the insertion site visible?

  • Is there Coban or Coflex used to secure the PIV site?<br>

  • Is there Coban or tape wrapped circumferentially around the limb?

  • Is the dressing intact?

  • Are fluids running at time of audit?

  • When was the IV last assessed?

PIV Extravasation Audit - duplicate
Anonymous

PIV Extravasation Audit - duplicate

CHCO Extravasation audit

Use this Template
The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.

Related checklists

Incident Report
Anonymous
Incident Report
26,803 Downloads
Daily Temperature Log
Anonymous
Daily Temperature Log
20,437 Downloads
Heavy Vehicle Inspection
Anonymous
Heavy Vehicle Inspection
19,776 Downloads
Employee File Checklist
Anonymous
Employee File Checklist
10,142 Downloads
Mine Site Safety Inspection
Anonymous
Mine Site Safety Inspection
9,529 Downloads
Food Safety & HACCP Audit
Anonymous
Food Safety & HACCP Audit
7,984 Downloads
Rig Inspection
Anonymous
Rig Inspection
6,824 Downloads
Residence Inn Guest room inspection
Anonymous
Residence Inn Guest room inspection
6,621 Downloads
equipment log
Anonymous
equipment log
6,492 Downloads
Injury, Accident, Incident Report
Anonymous
Injury, Accident, Incident Report
6,398 Downloads
back arrow for carousel
back arrow for carousel
iAuditor Logo Icon ©SafetyCulture 2022