1. Registry Skills Review Compiled and presented by IHCC EHS 1999 paramedic students: Matt Nielson Mary Sticha Kerstin Buettner Krista Hornish Kevin Harty Erin Nosko Amy O’Dell Joe Gossman Nick Sosso

2. Equipment Needed Equipment List: Gloves Tape Alcohol Preps 4x4 Gauze Pads Band-aids IV catheter Tourniquet IV fluid and drip set Sharps container

3. Critical Criteria These are actions that will result in automatic failure of station! Exceeding the 6 minute time limit in establishing a patent and properly adjusted IV Failure to take or verbalize infection control precautions prior to performing venipuncture Contaminates equipment or site without appropriately correcting situation Any improper technique resulting in the potential for catheter shear or air embolism Failure to successfully establish IV within 3 attempts during 6 minute time limit Failure to dispose/verbalize disposal of needle in proper container

4. Checks Selected IV Fluid For: Proper Fluid Clarity Expiration date

5. Catheter/Administration Set Choose appropriate gauge catheter for: –medications –volume replacement Choose appropriate drip set –macro (10, 15, 20 gtts/min) –micro (60 gtts/min)

6. Connect Drip Set to IV Bag Connect set to bag by removing plastic cover from bag port and piercing it with tubing spike. –Be careful not to contaminate the tubing spike or bag port.

7. Fill Chamber/Flush Line Ensure chamber is 1/2 filled with fluid prior to flushing line to prevent air from entering tubing.

8. Cut or Tear Tape Cut three pieces of tape prior to starting venipuncture for easier securement of the catheter once the IV is in place.

9. Body Substance Isolation Take/Verbalize Infection Control Precautions. Check For Proper Fit, Tears or Holes. *Prior to venipuncture

10. Apply Tourniquet Apply tourniquet above elbow to back up blood in veins, this causes the veins to pop up making it easier to choose potential sites.

11. Palpate Suitable Vein Visualize and palpate veins for proper size and placement of catheter.

12. Cleanse The Site Clean the site with a circular motion widening out from the chosen site with an alcohol swab. –Be careful not to touch the site once it has been sterilized.

13. Perform Venipuncture Insert stylette while holding tension on vein. Note/Verbalize flashback of blood into flash chamber. –This verifies proper placement into vein

14. Advance Catheter Advance catheter into vein. Remove tourniquet Tamponade vein proximal to catheter. Place 4x4 under needle port and remove stylette.

15. Connect IV Tubing Ensure IV tubing is securely connected to catheter and twist or lock into place.

16. Assure Patent Line Adjust rate dial to allow fluid to run through line. Make sure fluid is running. Check for fluid infiltration and d/c fluid if evident.

17. Secure IV Catheter Secure IV catheter Using two sections of tape Place U-Shaped chevron beneath IV catheter hub. Place second piece of tape above IV catheter hub and secure to hand and skin

18. Secure IV Tubing Loop tubing so that the injection port is secured near IV site. Continue tubing up patients arm, securing once more with tape.

19. Adjust Flow Rate Turn dial to adjust the fluid flow to the appropriate drip rate

20. Dispose of Needle Assure safe disposal of the needle in a proper sharps container. Avoid recapping the contaminated needle

21. INTRAVENOUS BOLUS MEDICATIONS 21

22. Critical Criteria These are actions that will result in automatic failure of station! Failure to begin administration of medication within 3 minute of time limit Contaminates equipment or site without appropriately correcting situation Failure to adequately dispel air resulting in potential for air embolism Injects improper drug or dosage (Wrong drug, incorrect amount, or pushes at inappropriate rate) Failure to flush IV tubing after injecting medication Recaps needle or failure to dispose/verbalize disposal of syringe and needle in proper container 22

23. Asks Patient for Known Allergies 23

24. Selects Medication/Concentration Selects correct medication assures correct concentration of drug Check for expiration date 24

25. Assemble Syringe Assembles pre- filled syringe correctly and dispels any air before injection 25

26. Infection Control Continues infection control precautions Cleanses injection site (Y-port or hub) 26

27. Ready For Injection Reaffirms medication for patient Stops IV flow (pinches tubing from IV bag) Administers correct dose at proper push rate

28. Flush and Adjust Flushes tubing (runs wide open for brief period) Adjust drip rate to TKO (KVO) Adjust to protocols or medications

29. Dispose and Observe Voices proper disposal of syringe and needle Verbalizes need to observe patient for desired effect or adverse side effects

30. Piggyback 30

31. Critical Criteria These are actions that will result in automatic failure of station! Failure to begin administration of medication within five minute time limit. Contaminates equipment or site without appropriately correcting situation. Administers improper drug or dosage. Failure to flush I.V. tubing of secondary line resulting in potential for air embolism. Failure to shut off flow of primary line. 31

32. Check IV Fluid Checks selected IV fluid for: –Proper fluid –Clarity 32

33. Selects Medication/Concentration Selects correct medication assures correct concentration of drug Check for expiration date 33

34. Inject Medication Injects correct amount of medication into IV solution given scenario. 34

35. Connect/Set Up Drip set Connects appropriate administration set to medication solution Prepares administration set (fills drip chamber and flushes tubing) 35

36. Infection Control Continues infection control precautions Cleanses injection site (Y-port or hub) 36

37. Insert Piggyback Needle Insert needle into proper port without contamination 37

38. Connect Piggyback Inserts needle into port without contamination 38

39. Adjust Medication Flow Adjusts flow rate of secondary line as required Stops flow of primary line 39

40. Tape Needle Securely tape needle to prevent movement and possible loss of site 40

41. Label IV Bag Verbalizes need to observe patient for desired effect or adverse side effects Labels medication/fluid bag (include medication, date, time given and initial bag) 41