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IV Therapy RN

Infusion RN

  • Date Format: MM slash DD slash YYYY
  • Self-Assessment Rating Scale:

    No Experience
    Theory or observation only during the past 12 months

    Limited Experience
    Performed less than 12 times within the past 12 months and may need a review

    Experienced
    Performed at least once per month within the past 12 months and may need minimal assistance

    Highly Skilled
    Performed on at least a weekly basis over the past 12 months; proficient
  • No ExperienceLimited ExperienceExperiencedHighly Skilled
    Subcutaneous Insertion
    Subcutaneous Removal
  • No ExperienceLimited ExperienceExperiencedHighly Skilled
    Midline Catheter Insertion
    Midline Catheter Removal
    Peripheral - Short Catheter Insertion (over the needle)
    Peripheral - Short Catheter Insertion (winged steel needle)
    Peripheral - Short Catheter Removal (over the needle)
    Peripheral - Short Catheter Removal (winged steel needle)
  • No ExperienceLimited ExperienceExperiencedHighly Skilled
    Nontunneled/Noncuffed Central Venous Access Catheter Removal
    PICC Care and Access
    PICC Removal
    Port-a-Cath - Access
    Port-a-Cath - Deaccess
  • No ExperienceLimited ExperienceExperiencedHighly Skilled
    Change of Administration Set
    Conversion from Continous VAD to Intermittent Infusion
    Conversion from Continous VAD to Continous Infusion
    Dressing Application - Central Venous Access Device
    Dressing Application - Intraspinal Access Device
    Dressing Application - Nonvascular Access Device
    Dressing Application - Peripheral Vascular Access Device
    Flushing Using SASH Technique
  • No ExperienceLimited ExperienceExperiencedHighly Skilled
    Administration of Blood and Blood Products
    Administration of Hypodermoclysis
    Administration of Local Anesthesia via Subdermal Injection
    Application of Local Anesthesia via Transdermal Analgesic
    Application of Local Anesthesia via Sonification
    Instillation of Fibrinolytic Agent to Restore Catheter Patency
    Obtaining Blood Cultures via Vascular Access Device
    Obtaining Blood via Central Venous Access Device
    Obtaining blood via PICC
    Phlebotomy via Venipuncture
    Ultrasound and Modified Seldinger Technique (MST)