VENIPUNCTURE/IV COMPETENCY SURVEY FOR RNS - (copy) - (copy)

The Education Department is surveying levels of experience/expertise and comfort level in performing Venipuncture and IV Skills. Please fill out the following survey form and send it back to Luisita Graff in Education by Thursday, August 23, 2007. Thank you for your help.
Name (optional): 


  1. A. DIRECTIONS: Please rate your level of expertise in performing the following skills.

    Performing Venipuncture for Blood Draws.
    No Experience
    Little Experience
    Experienced


  1. Please rate your level of expertise in performing the following skills.

    1= No Experience
    2= Little Experience
    3= Experienced

    Central Line Identification/differentiation:



          1 2 3    
      Midline   
      PICC Line   
      Groshong PICC   
      Non-Tunneled Central Line (Groshong/non Groshong)   
      Tunneled Central Line (Groshong/ nonGroshong)   
      Portacath   
      Flushing Central Line   
      Central Line Dressing Change   
      Drawing Blood from Central Line   
      Accessing implanted Venous Access Port   
      Subcutaneous Infusion (Use of Sub-q button)   
      Hickman Catheter   
      Triple Lumen   


  1. Starting IV Access (Heplock)
    No Experience
    Little Experience
    Experienced


  1. Peripheral IV Dressing Change
    No Experience
    Little Experience
    Experienced


  1. FOR HOSPICE NURSES:
    CADD PCA Infusion Pump Set-up

    No Experience
    Little Experience
    Experienced


  1. FOR HOME HEALTH NURSES:
    Ready Med Infusion Device Set-up

    No Experience
    Little Experience
    Experienced


  1. FOR HOME HEALTH NURSES:
    Body Guard Infusion Pump Set-up
    No Experience
    Little Experience
    Experienced


  1. Please rate your level of comfort in performing the following skills, as well as listing your comfort level in demonstrating or teaching these skills to another nurse.

    Performing Venipuncture for Blood Draws
    Uncomfortable Performing
    Comfortable Performing
    Uncomfortable Demonstrating to another clinician
    Comfortable Demonstrating to another clinician


  1. Starting IV Access (Heplock)
    Uncomfortable Performing
    Comfortable Performing
    Uncomfortable Demonstrating to another clinician
    Comfortable Demonstrating to another clinician


  1. Central Line Identification/differentiation: Midline

    Uncomfortable Performing
    Comfortable Performing
    Uncomfortable Demonstrating to another clinician
    Comfortable Demonstrating to another clinician


  1. Central Line Identification/differentiation: PICC Line
    Uncomfortable Performing
    Comfortable Performing
    Uncomfortable Demonstrating to another clinician
    Comfortable Demonstrating to another clinician


  1. Central Line Identification/differentiation: Groshong PICC
    Uncomfortable Performing
    Comfortable Performing
    Uncomfortable Demonstrating to another clinician
    Comfortable Demonstrating to another clinician


  1. Central Line Identification/differentiation: Non-Tunneled Central Line (Groshong/non Groshong)
    Uncomfortable Performing
    Comfortable Performing
    Uncomfortable Demonstrating to another clinician
    Comfortable Demonstrating to another clinician


  1. Central Line Identification/differentiation: Tunneled Central Line (Groshong/ non-Groshong)

    Uncomfortable Performing
    Comfortable Performing
    Uncomfortable Demonstrating to another clinician
    Comfortable Demonstrating to another clinician


  1. Central Line Identification/differentiation: Portacath
    Uncomfortable Performing
    Comfortable Performing
    Uncomfortable Demonstrating to another clinician
    Comfortable Demonstrating to another clinician


  1. Central Line Identification/differentiation: Triple Lumen
    Uncomfortable Performing
    Comfortable Performing
    Uncomfortable Demonstrating to another clinician
    Comfortable Demonstrating to another clinician


  1. Central Line Identification/differentiation: Hickman Catheter
    Uncomfortable Performing
    Comfortable Performing
    Uncomfortable Demonstrating to another clinician
    Comfortable Demonstrating to another clinician


  1. Drawing blood from a Central Line
    Uncomfortable Performing
    Comfortable Performing
    Uncomfortable Demonstrating to another clinician
    Comfortable Demonstrating to another clinician


  1. Flushing a Central Line
    Uncomfortable Performing
    Comfortable Performing
    Uncomfortable Demonstrating to another clinician
    Comfortable Demonstrating to another clinician


  1. Central Line Dressing Change
    Uncomfortable Performing
    Comfortable Performing
    Uncomfortable Demonstrating to another clinician
    Comfortable Demonstrating to another clinician


  1. Peripheral IV Dressing Change
    Uncomfortable Performing
    Comfortable Performing
    Uncomfortable Demonstrating to another clinician
    Comfortable Demonstrating to another clinician


  1. Accessing implanted Venous Access Port
    Uncomfortable Performing
    Comfortable Performing
    Uncomfortable Demonstrating to another clinician
    Comfortable Demonstrating to another clinician


  1. Subcutaneaous Infusion (Use of Sub-q button)
    Uncomfortable Performing
    Comfortable Performing
    Uncomfortable Demonstrating to another clinician
    Comfortable Demonstrating to another clinician


  1. For Hospice Nurses:
    CADD PCA Infusion Pump Set-Up
    Uncomfortable Performing
    Comfortable Performing
    Uncomfortable Demonstrating to another clinician
    Comfortable Demonstrating to another clinician


  1. FOR HOME HEALTH NURSES:
    Ready Med Infusion Device Set-up

    Uncomfortable Performing
    Comfortable Performing
    Uncomfortable Demonstrating to another clinician
    Comfortable Demonstrating to another clinician


  1. FOR HOME HEALTH NURSES:
    Body Guard Infusion Pump Set-up
    Uncomfortable Performing
    Comfortable Performing
    Uncomfortable Demonstrating to another clinician
    Comfortable Demonstrating to another clinician


  1. Are you interested in specialized training to be the IV Resource in your Team?
    Yes
    No


  1. If YES, please tell us your name and contact information.





Abbe Leffel
IL