PIVA Preventing Infections

Audit Tool for I.V. Insertion

in Vascular Access and Management
Please refer to National Guidelines if necessary Save As

Ward: For each patient score Y for each correct item,

N for incorrect items and X for not applicable
Patient no.: 1 2 3 4 5 6 7 8 9 10 11 12 No. of Y Total items (Y + N) % Score

Patient involvement
Patient given information/leaflet 0 0 0.00
Patient given instructions on care 0 0 0.00
I.V. insertion
Personnel – scrub/barrier precautions 0 0 0.00
Appropriate site used 0 0 0.00
Adjacent skin free from infection 0 0 0.00
Appropriate skin preparation 0 0 0.00
Sterility of catheter maintained 0 0 0.00
Sterile dressing used 0 0 0.00
Aseptic connection to I.V. lines, etc. 0 0 0.00
I.V. management
Aseptic technique – line manipulation 0 0 0.00
Minimal line connections 0 0 0.00
Appropriate lumen for additives 0 0 0.00
Appropriate connection devices 0 0 0.00
Appropriate duration 0 0 0.00
I.V. assessment
Site assessed – daily at a minimum 0 0 0.00
Appropriate dressing 0 0 0.00
Dressing secure 0 0 0.00
Dressing intact, dry, clean 0 0 0.00
No sign of phlebitis, site infection 0 0 0.00
No pyrexia 0 0 0.00
No bacteraemia 0 0 0.00
I.V. documentation
Specific documentation system/form in use 0 0 0.00
Information readily accessible 0 0 0.00
Admission, transfer, discharge data 0 0 0.00
Insertion of I.V. recorded 0 0 0.00
Removal of I.V. recorded 0 0 0.00
Decisions to retain I.V. recorded 0 0 0.00
Infection episodes recorded 0 0 0.00

Total:
Total number of Y 0 0 0 0 0 0 0 0 0 0 0 0 0

Total number of items (Y + N) 0 0 0 0 0 0 0 0 0 0 0 0 0

Percentage Score 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Infection Control Nurses Association Please see Instructions for using the Audit Tools M1-[08]2006 Developed in collaboration with
N2-[12]2006