| Update on Infusion Nursing Standards |
By Kelli Rosenthal, MS, RN, BC, CRNI, ANP, APRN, BC
The Standards of Practice for Infusion Nursing, published by the Infusion Nurses’ Society, set the criteria for safe and competent infusion practice across the continuum of care. They are often cited in IV-related malpractice lawsuits as the benchmark for whether or not a nurse has met the standard of care. After several years of intensive review and revision, updated Standards were published in 2006. The revised Standards incorporate best practice information based on published references from sources like the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration.
Here are some of the key changes in this revision:
Site Selection: The use of visualization technologies, such as bedside portable ultrasound, is encouraged. This minimizes the number of needlesticks the patient must undergo for IV placement, which also benefits the nurse by reducing the number of opportunities for exposure to bloodborne pathogens. Of course, if ultrasound or some other imaging technology is used in site selection, its use must be documented in the patient’s medical record.
Catheter stabilization: The Standards now recommend the use of a manufactured catheter stabilization device to minimize unscheduled restarts and loss of vascular access. The catheter dressing is no longer considered adequate to secure the vascular access device – sterile tape, sterile wound closure strips, or a manufactured securement device MUST be used in order to comply with this standard aimed at preserving patient and nurse safety.
IV Site Rotation: Under the updated Standards, peripheral catheters in adult patients may now routinely dwell for 72 hours, provided they’re free from observable complications. Those inserted under emergent conditions (i.e., if there’s the potential for a breach in aseptic insertion technique) should be replaced as soon as feasible, although they may dwell for up to 48 hours. Of course, peripheral IV sites should be restarted whenever the patient complains of discomfort or pain related to the IV and interventions to correct the discomfort are unsuccessful, or if the site appears to have developed complications.
IV Administration Set Changes: Primary administration sets (and piggyback tubings that remain continuously attached to them) should be changed every 72 hours to minimize breaks in the closed administration system. They should also be replaced whenever their sterile fluid pathway may have been compromised. Secondary sets without a primary infusion should be changed every 24 hours, or whenever their sterility is in question. Parenteral nutrition tubing for infusions without fat emulsions should now be changed every 72 hours. Those used to administer IV fat emulsions should be replaced every 24 hours. Blood administration sets should continue to be replaced with every unit of blood. Remember, add-on devices (i.e., filters, stopcocks, needleless system devices) must be changed whenever administration sets are changed. All tubings and add-on devices must luer lock together to prevent accidental disconnection, which can result in infection or other serious complications like exsanguination or air embolus.
Preparing sterile infusion products: As previously set forth by the FDA’s Standard, USP 797, all infusions and medications should be compounded in a controlled-air environment, such as a laminar flow hood, biological safety cabinet, etc. Nurses who mix parenteral medications for administration must be properly trained to use equipment specific for admixing of medications. Many institutions now choose to use closed "add on" systems consisting of mini-bags of IV solutions and medication vials that remove the risk of contamination when mixing.
If you provide infusion care to patients as part of your nursing practice, it may be useful for you to obtain a copy of the Standards themselves. They can be ordered online from the Infusion Nurses Society.
Reference
Infusion Nurses Society: "Infusion Nursing Standards of Practice," Journal of Infusion Nursing. Vol. 29, No. 1(S), Jan./Feb. 2006.
| 
