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    Peripheral IV Line Checklist

    Uploaded by

    aashika15
    This document provides a checklist for monitoring and maintaining a peripheral intravenous (IV) line. It includes sections for documenting patient information, line insertion details including date, time, and inserter, and a maintenance checklist to assess the line daily for issues like leakage, extravasation, pain, or erythema. Any issues identified on the maintenance checklist would require immediate line removal and doctor assessment. The final section is for documenting line removal details.

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    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd

    Peripheral IV Line Checklist

    Uploaded by

    aashika15
    131 views3 pages
    This document provides a checklist for monitoring and maintaining a peripheral intravenous (IV) line. It includes sections for documenting patient information, line insertion details including date, time, and inserter, and a maintenance checklist to assess the line daily for issues like leakage, extravasation, pain, or erythema. Any issues identified on the maintenance checklist would require immediate line removal and doctor assessment. The final section is for documenting line removal details.

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    This document provides a checklist for monitoring and maintaining a peripheral intravenous (IV) line. It includes sections for documenting patient information, line insertion details including date, time, and inserter, and a maintenance checklist to assess the line daily for issues like leakage, extravasation, pain, or erythema. Any issues identified on the maintenance checklist would require immediate line removal and doctor assessment. The final section is for documenting line removal details.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    131 views3 pages

    Peripheral IV Line Checklist

    Uploaded by

    aashika15
    This document provides a checklist for monitoring and maintaining a peripheral intravenous (IV) line. It includes sections for documenting patient information, line insertion details including date, time, and inserter, and a maintenance checklist to assess the line daily for issues like leakage, extravasation, pain, or erythema. Any issues identified on the maintenance checklist would require immediate line removal and doctor assessment. The final section is for documenting line removal details.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    of 3

    PERIPHERAL I.V.

    LINE CHECKLIST

    Patient Name: MR No:

    Age: Gender:

    Department: Bed No:

    All Peripheral Lines should be removed or replaced within 72 hours of insertion


    INSERTION
    Inserted by
    Date of Insertion (to be also Aseptic technique
    written on the tegarderm used while inserting Name Designation Signature
    dressing) lines Yes / No

    Time of Insertion: Site of Insertion;

    Note : One person should not attempt more than once.


    Date

    Maintenance checklist
    Morning Noon Night Morning Noon Night Morning Noon Night
    (ENTER : YES/NO)

    1. Assessment of need for the line

    2.Leakage of IV fluid under


    dressing

    3. Extravasation into soft tissue

    4. Pain at ( or near) the line


    insertion site when the line is
    being used.

    5.Erythemia at or near the line


    insertion site.

    6. Evidence of thrombophlebitis
    or a palpable cord along the vein
    near the cannula.

    Name

    Signature

    Designation

    if items 2 - 6 are identified the IV line should be removed immediately. If required, inform the Doctor for assessment under further
    management.

    Line Removel : Date __________________________ Time : __________________AM / PM

    MIOT/Nsg/IV-Line / / / 2019
    V. I. P. Score (Visual Infusion Phlebitis Sc
    usion Phlebitis Score)

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