IV Flush and VIP Score: OSCE Station Checklist

This station is two skills stapled together: an assessment (the VIP score) and a procedure (the flush). Candidates lose it by doing them in the wrong order. The site is assessed before anything is pushed through it, every time.

The VIP score

Visual Infusion Phlebitis, 0 to 5:

• 0: site healthy. Observe, continue use.
• 1: possible first signs, slight pain or slight redness. Observe closely.
• 2: two of pain, erythema, swelling. Early phlebitis: resite the cannula.
• 3: pain along the cannula path, erythema, induration. Established phlebitis: remove, resite, consider reporting.
• 4 to 5: advanced, with palpable venous cord, pyrexia at the top end. Remove, escalate, treat per policy.

The working boundary is 2: from there, the cannula comes out. The station scenario frequently paints a VIP 2 site precisely to see whether you’ll flush it anyway.

The flush

1. Prescription or policy check for the flush itself: 0.9% sodium chloride, typically 5 to 10 mL, in date, intact packaging.
2. Hand hygiene, identity, consent. Expose the site respectfully.
3. Inspect and VIP-score, out loud, before touching the line.
4. Clean the needle-free port: chlorhexidine/alcohol wipe, friction, air dry.
5. Attach the syringe without touching key parts (this station is ANTT applied).
6. Flush pulsatile: push-pause, push-pause, watching the site and the patient’s face for pain, swelling or leakage.
7. Finish under positive pressure so blood can’t reflux into the tip.
8. Disconnect, dispose, hand hygiene, document: VIP score, flush given, patency, patient response.

Resistance is the exam’s favourite plant. The only right response is stopping. Small syringes generate high pressures, so “try a 2 mL syringe” is a trap, not a tip; forcing a clot onwards or blowing a vein are both real harms. A cannula that won’t flush freely has finished its career.

Where the marks sit

Half in the assessment (score named, action matched), half in the micro-technique: the scrubbed hub, the pause rhythm, the positive-pressure ending, the eyes on the site during the push. Narration ties it together, because most of these are invisible unless you say them: “port cleaned and dry, flushing with push-pause, no pain, no swelling, finishing with positive pressure.”

Documentation closes it: score, action, volume flushed, patency, and anything the patient reported.

Five questions below, then the technique that underlies every aseptic moment in the exam: ANTT.