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Department: upFront: I.V. ROUNDS

Are you up-to-date with the infusion nursing standards?

Rosenthal, Kelli RN, BC, ANP, APRN, BC, CRNI, MS

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doi: 10.1097/01.NURSE.0000279405.92998.a6
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IS YOUR PRACTICE current with the Infusion Nurses Society (INS) revised standards of practice? When a nurse faces allegations of infusion therapy malpractice, these standards often are cited as the benchmark for establishing whether that nurse has violated the standard of care.

If you administer infusion therapy, it's your responsibility to follow the INS standards, even if infusion therapy isn't your primary area of practice. Your facility's policies and procedures should also reflect the most recent standards. To order a complete copy of the standards, visit http://www.INS1.org.

Let's review some key changes to the INS standards.

  • Site selection. To minimize the number of needle sticks the patient must undergo in the course of I.V. line placement, use visualization technologies, such as bedside portable ultrasound, if available and you're trained to use them. Document the use of ultrasound or other imaging technology in the patient's medical record.
  • Catheter stabilization. Use a manufactured catheter stabilization device to minimize unscheduled restarts and loss of vascular access. A catheter dressing is no longer considered adequate to secure the vascular access device. Sterile tape, surgical strips, or a manufactured securement device must be used to preserve the patient's and your safety. Proper catheter stabilization minimizes the need for unplanned restarts, reducing infection risk and helping to prevent loss of access and infiltration and extravasation. If you use sterile tape or surgical strips, apply them only to the catheter adapter—not directly on the catheter-skin junction site.
  • Site rotation. Peripheral catheters in adult patients may now routinely dwell for 72 hours, as long as they're free from observable complications. Replace a peripheral catheter inserted under emergency conditions as soon as feasible because of infection risk from a breach in aseptic insertion technique. Forty-eight hours is the maximum recommended dwell time under these circumstances. Restart or remove a peripheral I.V. catheter if the patient complains of discomfort or pain related to the catheter that can't be corrected, or if the site develops complications.
  • I.V. administration set changes. Change primary administration sets and any piggyback (secondary) tubing that remains continuously attached to them every 72 hours to minimize breaks in the closed administration system. Also replace them whenever the sterile fluid pathway may have been compromised. You should change intermittent infusion sets without a primary infusion every 24 hours or whenever their sterility is in question.
  • Blood administration sets should be replaced with every unit of blood (or every 4 hours, whichever comes first), but parenteral nutrition tubing for infusions without fat emulsions should now be changed every 72 hours. Replace parenteral nutrition tubing used to administer fat emulsions every 24 hours.
  • Remember, you should change add-on devices used with I.V. administration sets (filters, stopcocks, needleless system devices) whenever the administration sets are changed. All I.V. tubing and add-on devices must have a twist-lock design to prevent accidental disconnection, which can result in infection or other serious complications.
  • Sterile infusion product preparation. If you must mix parenteral medications before administration, make sure you're properly trained to use equipment specific for admixing medications. Many facilities now choose to use closed add-on systems consisting of minibags of I.V. solutions and medication vials to remove the risk of contamination when mixing while preserving the stability benefits associated with admixing each dose at the time of administration.

The new standards help every nurse become an advocate for providing the safest possible care for patients who require vascular access and infusion therapy, based on evidence-based best practices. Be sure to share the revisions with your colleagues, managers, and risk managers to ensure that your facility provides infusion care that measures up to the standards.

Resources

Infusion Nurses Society. Infusion Nursing Standards of Practice. Journal of Infusion Nursing. 29(l, Suppl.):S1–S92, January/February 2006.
    Schears G. Summary of product trials in 10,164 patients: Comparing an intravenous stabilization device to tape. Journal of Infusion Nursing. 29(4):225–231, July/August 2006.
    © 2007 Lippincott Williams & Wilkins, Inc.