Student Name ___________________________________ Date _____________________

Reconstitution & IVPB Delivery of Medication Check Off1. Calculate the amount of drug to be drawn into the syringe.

________

2. Verify the medication ordered.

_________3. Verify the amount and type of diluent to use.

_________4. Gather equipment (IV tubing, IVPB bag fluid, syringe(s), vials of diluent and medication, alcohol swabs)

_________5. Perform hand hygieneaaaaaa

_________

6. Compare the label on vial with medication ordered.

_________7. Remove the plastic / metal cap covering the rubber stopper

_________

on vials of diluent and medicationaa. 8. Clean the rubber stopper on vials of diluent and medication with an antimicrobial swab for each and allow to dry.

_________aaa9. Touching the plunger on the handle only, draw air into the syringe that is equal to the amount of diluent to be withdrawn from the diluent vial. _________10. With vial on a flat surface, pierce the raaaaubber stopper and inject the air into the diluent vial above the fluid level.

_________11. Invert the vial and withdraw the accurate amount of appropriate diluent into the syringe.

_________12. With the medication vial on a flat surface, pierce the rubber stopper and inject the withdrawn diluent into the medication vial above the powder level.

_________13. Following direction on vial, mix medication.

_________14. Invert the medication vial and keeping the tip of the needle below the fluid level, withdraw the accurate amount of medication into the syringe while holding the syringe vertically at eye level.

_________15. If any air bubbles have formed in the syringe, sharply tap the syringe to force the bubbles to top of the syringe. Inject the bubbles back into the medication vial. Finish withdrawal of the correct amount of medication. _________16. Recap the syringe using the one-handed scoop method.

_________17. Holding the IV fluid bag, use an antimicrobial swab to clean the medication port. Allow to dry.

_________18. With the IV bag held vertically, pierce the medication port and inject the medication into the IV bag. Discard syringe properly, or recap using one

handed scoop method . Repeatedly invert the IV bag to mix the

medication in the IV fluid.

_________19. Label the IV bag accurately.

_________20. Close the clamp on the IV tubing and using aseptic technique, and remove both the cover of the IV tubing spike and the plastic cover

on the port of the IV bag.

_________21. Pierce the IV bag port with the spike and firmly attach the tubing to the bag, maintaining aseptic technique.

_________22. Hang the piggyback IV bag on an IV pole and squeeze & release the drip chamber to the fill line or about way up the chamber.

_________23. Open the clamp, prime the tubing without wasting medication .

_________24. Use an antimicrobial swab to clean the access port of the Main IV line. Allow to dry.

_________25. Connect the IVPB setup to the access port of the Main IV line.

_________26. Accurately set the drip rate to infuse at rate as per order.

_________

Students Signature: ____________________________ Date: ___________________

Instructors Signature: _________________________Date: ___________________

Student must correctly perform each step of this procedure. If any step is incorrect, the student will not receive a passing grade for this competency . The student may have 3 attempts in a semester to complete this successfully .

Trial # 1 _________ Trial # 2 _________ Trial # 3 _________

Date ____________ Date ____________ Date ____________