Peripheral IV Line Checklist
Peripheral IV Line Checklist
Peripheral IV Line Checklist
LINE CHECKLIST
Age: Gender:
Maintenance checklist
Morning Noon Night Morning Noon Night Morning Noon Night
(ENTER : YES/NO)
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.
MIOT/Nsg/IV-Line / / / 2019
V. I. P. Score (Visual Infusion Phlebitis Sc
usion Phlebitis Score)