Kingdom of Saudi Arabia

Ministry of Health
General Directorate of Health Affairs- Aseer Region
Prince Faisal bin Khalid Cardiac Center

NURSING COMPETENCY CHECKLIST

PERIPHERAL INTRAVENOUS CANNULA INSERTION AND THERAPY

Competency Statement:
The nurse shall be competent in safe insertion of peripheral intravenous cannula and administration of IV therapy.

Mandatory Learning Resources

 Review the Policy on Insertion and Management of Intravenous Cannula.
 Successful insertion of at least three (3) intravenous cannula witnessed by preceptor.
 Attends In- Service orientation on IV therapy.

Score
No. Performance Criteria/Evidence Methodology
1 2 3
Demonstrate knowledge of the indications and contraindications of IV
1. □ VE □ DO □ WE □ RD
therapy.
Demonstrate knowledge and skills in identifying the three (3) types of
2. □ VE □ DO □ WE □ RD
intravenous solution and their clinical significance.
3. Demonstrate skills in setting-up an IV infusion line. □ VE □ DO □ WE □ RD
4. Demonstrate knowledge and skills in insertion of a peripheral IV cannula:
4.1. Significance of strict aseptic technique. □ VE □ DO □ WE □ RD
4.2. Identify patient and providing essential education about the reason
□ VE □ DO □ WE □ RD
for IV therapy before the procedure.
4.3. Prepare necessary equipment. □ VE □ DO □ WE □ RD
4.4. Identify considerations in selecting site for IV insertion. □ VE □ DO □ WE □ RD
4.5. Identify appropriate IV cannula size. □ VE □ DO □ WE □ RD
4.6. Identify methods to dilate vein for ease in insertion. □ VE □ DO □ WE □ RD
4.7. Apply appropriate IV dressing. □ VE □ DO □ WE □ RD
4.8. Correctly label the IV insertion site. □ VE □ DO □ WE □ RD
5. Demonstrate ability to calculate IV infusion rates. □ VE □ DO □ WE □ RD
6. Demonstrate skills in setting-up an IV or Syringe infusion pump. □ VE □ DO □ WE □ RD
7. Demonstrate knowledge and skills in managing IV cannula:
7.1. Flushing and locking the line with a saline solution or Heparin □ VE □ DO □ WE □ RD
7.2. Changing IV solutions and tubing □ VE □ DO □ WE □ RD
7.3. Observe aseptic technique □ VE □ DO □ WE □ RD
7.4. Indications to change or replace an IV cannula □ VE □ DO □ WE □ RD
8. Demonstrate knowledge and skills in recognizing and managing IV

Methodology: VE: Verbal Exam DO: Direct Observation WE: Written Exam RD: Return Demonstration
Scoring System:
 Novice (1 point)- when a need to teach the staff nurse of the general rule on how to perform a task is established.
 Competent (2 points)- when a perspective to perform a task with efficiency is exhibited.
 Expert (3 points)- when performances are fluid, flexible, and highly-proficient.
 Kingdom of Saudi Arabia
Ministry of Health
General Directorate of Health Affairs- Aseer Region
Prince Faisal bin Khalid Cardiac Center

NURSING COMPETENCY CHECKLIST

PERIPHERAL INTRAVENOUS CANNULA INSERTION AND THERAPY

complications:
8.1. Infiltration/extravasation □ VE □ DO □ WE □ RD
8.2. Phlebitis □ VE □ DO □ WE □ RD
8.3. Infection □ VE □ DO □ WE □ RD
8.4. Circulatory overload □ VE □ DO □ WE □ RD
8.5. Air embolism □ VE □ DO □ WE □ RD
8.6. Mechanical failure □ VE □ DO □ WE □ RD
8.7. Venous thrombosis □ VE □ DO □ WE □ RD
8.8. Bleeding/hemorrhage □ VE □ DO □ WE □ RD
Demonstrate knowledge of the implication and skills in performing
9 □ VE □ DO □ WE □ RD
peripheral intravenous cannula removal.
Correctly label IV cannula site with the following:
 Date/time of insertion and dressing
□ VE □ DO □ WE □ RD
 Size of the cannula
10.  Name of the performer of the procedure
Correctly document the conduct of the procedure including the date/time
of insertion, vein used, patency of the line, complication (if any) and □ VE □ DO □ WE □ RD
11 patient's response in the patient file.
Total Score / 84

REMARKS:

Assessor’s Evaluation: □ Independent □ Supervision Required □ Dependent (for re-evaluation)

Assessor’s Name/Employee No.: ________________________ Signature: __________ Date: ____________

Employee Name/Employee No.: ________________________ Signature: __________ Date: ____________

Legend:
INDEPENDENT : Scores above 90%
SUPERVISION REQUIRED : Scores 80%-89%
DEPENDENT : Scores below 80%

Methodology: VE: Verbal Exam DO: Direct Observation WE: Written Exam RD: Return Demonstration
Scoring System:
 Novice (1 point)- when a need to teach the staff nurse of the general rule on how to perform a task is established.
 Competent (2 points)- when a perspective to perform a task with efficiency is exhibited.
 Expert (3 points)- when performances are fluid, flexible, and highly-proficient.