Student Name ___________________________________

Date _____________________

Reconstitution & IVPB Delivery of Medication Check Of

1. 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.
_________
aaa
9. 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is equal to the amount of diluent to be withdrawn from the diluent vial.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and inject the withdrawn diluent into the medication vial above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

Student Name ___________________________________

Date _____________________

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.
24.

Open the clamp, prime the tubing without wasting medication .

_________
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.

_________
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

Student Name ___________________________________

Date _____________________

Students Signature: ____________________________

Date: ___________________

Instructors Signature: _________________________

Date: ___________________