ELLIS MEDICAL LIBRARY
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PIV Audits
*
Indicates required field
Auditor Name
*
AUDIT ID Number
*
C1-01
C1-02
C1-03
C2/C3-01
C2/C3-02
C2/C3-03
C5-01
C5-02
C5-03
C6-01
C6-02
C6-03
A3-01
A3-02
A3-03
A4-01
A4-02
A4-03
A5-01
A5-02
A5-03
A6-01
A6-02
A6-03
B3-01
B3-02
B3-03
E1-01
E1-02
E1-03
E2-01
E2-02
E2-03
BR-01
BR-02
Br-03
Please choose the audit ID that corresponds to your unit name and the # of the audit you are completing.
Date of Audit (MM/DD/YYYY)
*
ROOM #
*
Audit of chart/EMR
Date Inserted (MM/DD/YYYY)
*
Unit/Area of Origin
*
C1
C2/C3
C4
C5
C6
A3
A4
A5
A6
E1
E2
ED/MCCP
Bruggerman
OR
Emergent Care
External Facility
B3
EMS/EMT
Unable to Identify
# of Days in Place (Day 1 is date IV was inserted)
*
1
2
3
4
5
6
7
8
9
10
If >4 days, documentation exists for need of extension?
*
Yes
No
Nurse has documented patency of line on flush within the last 8 hrs
*
Yes
No
Issues documentation in site assessments
*
Site Inspection
PIV Gauge
*
#14
#16
#18
#20
#22
#24
Other
If other, please specify
*
PIV Location on the Body
*
Redness?
*
Yes
No
Swelling?
*
Yes
No
Drainage?
*
Yes
No
Hematoma?
*
Yes
No
Bruising?
*
Yes
No
Leaking?
*
Yes
No
Pain on Palpitation?
*
Yes
No
S/S of Phlebitis?
*
Yes
No
Blood in Tubing/Debris under dressing?
*
Yes
No
Is date of insertion written on dressing?
*
Yes
No
Is ALL IV tubing dated and timed?
*
Yes
No
Not Applicable
Comments
*
Submit
Home
EBP
Searching for Evidence
EBPModel
Practice Question
Translating
Services
Article Requests
Literature Searches
Table of Contents Emails
Technology Lending
Training
Resources
>
Current Nursing Journals
ASL
Catalog
Databases
E-Books
Journals
CE Resources for Nurses
JournalClub
Phone Apps
Technology Tutorials
End of Life Resources
BestPractices
About
News
Librarian's Hours
Contact