Name: ____________________________________ Score: ___________
Year and Section: ___________________________ Date: ____________
Group: ________
Intravenous Cannulation (Return Demonstration)
Procedure 5 4 3 2 1
1. Identify the client and explain the procedure.
2. Gather all the equipment needed.
3. Perform hand washing.
4. Position the arm of the patient and select the venipuncture site.
5. Apply a tourniquet 15-20 cm (6-8 inches) above the venipuncture site.
6. Encourage the client to clench and unclench his/her fist.
7. Lightly tap the vein with your fingertips.
8. Put on clean gloves and clean the venipuncture site.
9. Insert the needle, bevel upwards at about 15-30-degree angle. Advance
the needle until a flashback of blood is seen in the hub at the back of the
cannula.
10. Once the flashback of blood is seen, advance the needle and catheter
approximately 0.5-1 cm further, then fix the needle advancing the rest of the
cannula into the vein.
11. Release the tourniquet.
12. Dress and label the venipuncture site according to agency policy.
13. Apply pressure to the vein at the tip of the cannula and remove the
needle fully. Remove the cap from the needle and put this on the end of the
cannula.
14. Flush the cannula for patency.
15. If there is any resistance, or if it causes any pain, or you notice any
localized tissue swelling; immediately stop flushing, remove the cannula and
start again.
16. Perform hand washing
17. Document relevant data.
TOTAL
Student’s Signature: ______________________ Clinical Instructor: ________________________
*Legend: 5 - expert/ outstanding;
4 – very good/ very satisfactory;
3 – good/ satisfactory;
2 – needs improvement/ fair;
1 - progress unacceptable/ unsatisfactory
Name: ____________________________________ Score: ___________
Year and Section: ___________________________ Date: ____________
Group: ________
Procedure for ECG Placement (Return Demonstration)
Objective: To ensure proper placement of ECG electrodes for accurate monitoring of heart activity.
Procedure 5 4 3 2 1
1. Identify the client.
2. Gather all the equipment needed such as ECG Machine, ECG Electrodes,
conductive gel (if required), disposable wipes or alcohol pads, and ECG leads.
3. Perform hand washing.
4. Explain the procedure.
5. Position the patient by having the patient lie on their back (supine) on the
examination table.
6. Skin preparation. Clean the skin using disposable wipes or alcohol pads on
the areas where electrodes will be placed.
Electrode Placement
7. V1 place the electrode in the 4th intercostal space at the right sternal
border.
8. V2 place the electrode in the 4th intercostal space at the left sternal
border.
9. V3 place the electrode midway between V2 and V4.
10. V4 place the electrode in the 5th intercostal space at the midclavicular
line.
11. V5 place the electrode horizontally even with V4 at the anterior axillary
line.
12. V6 place the electrode horizontally even with V5 at the midaxillary line.
Limb Electrodes
13. Right Arm (RA) place the electrode on the right forearm or upper arm.
14. Left Arm (LA) place the electrode on the left forearm or upper arm.
[Link] Leg (RL) place the electrode on the right lower leg or ankle.
16. Left Leg (LL) place the electrode on the left lower leg or ankle.
17. Attach the ECG lead wires to the electrodes, matching the color-coded
leads to their corresponding electrodes.
18. Ensure that all electrodes are properly placed and connected.
19. Verify that ECG Machine is detecting the signal correctly. Look for a clear
baseline and proper lead connections on the ECG display.
20. Start the ECG. Initiate recording. Follow the ECG machine’s instructions
to start recording.
21. Observe the patient for any discomfort and ensure they remain still
during the test.
22. Remove the electrodes. After recording is complete, carefully remove
the electrodes from the patient’s skin.
23. Disposed the used electrodes and any other waste materials. Clean the
patient’s skin if necessary.
24. Record any relevant information from the ECG and note the procedure in
the patient’s chart.
TOTAL
Student’s Signature: ______________________ Clinical Instructor: ________________________
*Legend: 5 - expert/ outstanding;
4 – very good/ very satisfactory;
3 – good/ satisfactory;
2 – needs improvement/ fair;
1 - progress unacceptable/ unsatisfactory