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IV Catheter Insertion
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Date & Time of Insertion
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Type of device
• • •
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Gauge
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Number of Insertion Attempts
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IV Site Location
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IV Patency
• • •
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Site Assessment (Surround Skin)
• • •
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IV Site Care
• • •
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Patient/Caregiver Teaching
• • •
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IV Insertion Comments
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Patient Response
• • •
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