Do Your Infusion Policy and Procedures follow the Current Standards of Infusion Practice?
The Infusion Nurses Society (INS) publishes the “Infusion Nursing Standards of Practice” document that has been legally recognized as the standard for infusion practice. In a court of law it is these guidelines that will be cited and referenced as the benchmark for establishing if the standards of care were met or violated.
If you administer infusion therapy of any type, it is your responsibility to know and follow the infusion standards, as well as your facility policy. It is also imperative that the facility or institutional policy and procedures are updated to follow the current practice standards.
In January of 2011 the Infusion Nurses Society released their latest version of Infusion Nursing Standards of Practice and with it updated new infusion care standards. It is now up to every home healthcare agency, long term care and skilled nursing facility, each hospital, and clinic to obtain these standards and to update their policies in infusion.
The INS Standards of Practice list the body of evidence to support their recommendations as well as a new ranking system as to the strength of the evidence. The research based evidence comes from a variety of sources. The manual also includes regulatory agency’s recommendation, such as state boards, OSHA, CMS, and other federal agencies.
Most state boards of nursing indicate it is the nurse’s responsibility to stay current in their knowledge of practice, therefore it becomes vital to choose education that is current and teaches the current standards of infusion practice. If developing your own education, it is vital to incorporate the latest standards into your teaching.
The list of current standards of infusion practice is very long, but it would be beneficial to review some of the most common practices that I have encountered and listed, as not being up to the INS standards. These would rank highest on my list of policies that need updating for most facilities.
Education: LVN/LPN’s in many states have long been required to complete additional post licensure education on infusion principles and techniques, many times this is referred to as “IV Certification”. The INS now states that due to the variance of education that is received in the basic nursing curricula, they also recommend that RN’s obtain further infusion education.
IV administration set changes: Primary and secondary (piggy back) continuous administration sets should be changed no more frequently than every 96 hours. There is very strong evidence that more frequent tubing changes do not decrease the chance of infection, but increase the chance of blood stream infections. Please remember if a secondary administration set is ever disconnected from a primary administration set, it then becomes a primary intermittent administration set and should be changed every 24 hours. The key here is not disconnecting a piggy back administration set from the primary; by adhering to this practice, the “life” of the tubing may be extended with no adverse consequences to the infusion patient. For continuous TPN infusions that do not contain lipids, these tubing changes may also be extended to every 96 hours.
For the complete updated list and to obtain a printable poster on administration set changes you may click on the link: “Administration Set Change Resource”
Remember that the needleless access device connectors, or “end caps” of the catheter are considered add on devices and should be replaced each time an administration set is replaced. All infusion administration sets should be covered with a sterile end cap if disconnected for any reason and should be changed if contamination or product integrity is questioned.
Site rotation: Peripheral catheters in adult and pediatric patients may now remain in place, as long as they’re free from observable and patient reported complications. Replace a peripheral catheter inserted under emergency conditions as soon as possible because of infection risk from a breach in aseptic insertion technique. The restart of an emergent peripheral IV should occur within 48 hours. Remove a peripheral I.V. catheter if the patient complains of discomfort or pain relating to the catheter that can’t be corrected, or if the site develops complications.
Central Venous Access Device (CVAD) Dressing Changes: Dressing change frequency to central lines is dependent upon what type dressing that is in use. For the Transparent Semi-permeable Membrane (TSM), the dressing change frequency is every 5-7 days, and for gauze dressings the frequency is every 48 hours. There is no evidence to support one type of dressing is superior to the other, but gauze is preferable if the patient is diaphoretic. Remember, CVAD site care consists of; removing the “old” dressing, cleansing the catheter skin junction with appropriate antiseptic(s), replacement of stabilization device, and application of a sterile dressing.
While these are some of the most common policies that I frequently see not updated, it is by no means an exhaustive list. There have been many standards revised within the latest release of standards from the INS. A copy of the complete list of standards may be found on the INS website. Please share these updates with your managers, colleagues, and risk managers to ensure your institution policies are up to date and your facility is providing the safest care possible to those patients, residents, and clients that require vascular access.
AlixaRx guest blog written by Capra Dalton, RN. Capra Dalton is the CEO and author of Pedagogy Education infusion continuing education courses.
Capra Dalton, Registered Nurse, has more than 28 years of experience in infusion therapy and the instruction of licensed nurses in infusion therapy continuing education. Her experience comes from multiple infusion settings: acute care, ambulatory infusion centers, home infusion, long term care continuing education provider, and long term care pharmacy quality assurance consultant. As the CEO, Capra is responsible for all operational aspects of Pedagogy, including education course content, author recruitment, and management. She is a member of the National Nurses in Business Association and received her nursing education from Lamar University in Beaumont, Texas. Capra has an avid interest in holistic healing, nutrition, herbs, and alternative therapies for the treatment of disease in humans as well as animals. She and her husband, Patrick, live on a ranch near Tyler, Texas.