Fillable Printable Manage An Intravenous Infusion
Fillable Printable Manage An Intravenous Infusion
Manage An Intravenous Infusion
DA FORM 7595-3-2, MAY 2014
APD LC v1.00
MANAGE AN INTRAVENOUS INFUSION
For use of this form see TC 8-800; the proponent agency is TRADOC.
TABLE:
REFERENCE:
III
STP 21-1-SMCT, Task: 081-833-0034, Manage an Intravenous Infusion
SCENARIO:
You are working in a patient hold area in a battalion aid station. You have a patient with an established intravenous (IV) in place. You must manage
the IV infusion.
GRADING SHEET
f. Replaced the solution container and tubing.
COMPLETED
a. Assessed for signs and symptoms of IV therapy complications.
b. Performed interventions for IV therapy complications.
1ST 2ND 3RD
TASK
P F P F FP
c. Documented the IV therapy.
d. Replaced the solution container (only).
e. Changed the dressing.
g. Discontinued the infusion.
1. Soldier (Last Name, First Name, MI) 2. Date (YYYYMMDD)
3. Performance Measures
Yes No4. Demonstrated Proficiency
5. Start Time 6. Stop Time 7. First Evaluator
8. Start Time 9. Stop Time 10. Retest Evaluator
11. Start Time
12. Stop Time 13. Final Evaluator
14. Evaluator's Comments
This form was prepared by U.S. Government employees for use in the 68W MOS. Although it contains, in part, copyrighted material from National
Registry of Emergency Medical Technicians, Inc. (NREMT), skill sheets ©2011, this form has neither been prepared nor approved by NREMT. Use is
restricted to guidelines contained in the Preface to TC 8-800.
AUTHORITY:
PRINCIPAL PURPOSE:
ROUTINE USES:
DISCLOSURE:
10 U.S.C.
§ 3013 Secretary of the Army; AR 350-1, Army Training Leadership and Development.
To ensure that accomplishment of training is properly credited to the correct individual for NREMT certification IAW AR
40-68, AR 220-1 and AR 350-1.
Used by Unit personnel to monitor training. The DOD "Blanket Routine uses" set forth at the beginning of the Army's
compilation of system of records notices may apply to this system.
Voluntary. Failure to provide your name may result in a loss of credit for accomplishing the training or error in processing
applicable favorable personnel actions. For Official Use Only.
PRIVACY ACT STATEMENT
h. Documented the procedure on the appropriate medical form.
