Volume 34, Number 1S
Supplement to
January/February 2011
Volume 34, Number 1S
ISSN 1533-1458
www.journalofinfusionnursing.com
Supplement to Journal of Infusion Nursing
Infusion Nursing
Standards of Practice
January/February 2011
Funded by an educational grant from BD Medical–Medical Surgical Systems
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INFUSION NURSING
STANDARDS OF PRACTICE
Developed by
Infusion Nurses Society
REVISED 2011
315 Norwood Park South, Norwood, MA 02062
www.ins1.org
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Journal of
Infusion Nursing
JANUARY/FEBRUARY 2011
Editor
Mary Alexander, MA, RN, CRNI®,
CAE, FAAN
Editorial Office
INS
315 Norwood Park South
Norwood, MA 02062
(781) 440-9408
(781) 440-9409 (fax)
www.ins1.org
INS Board of Directors
President
Nancy Mortlock, BSN, RN,
CRNI®, OCN®
President-Elect
Jeanette Adams, PhD, ACNS,BC,
CRNI®
Presidential Advisor
Lynn Phillips, MSN, RN, CRNI®
Secretary/Treasurer
Marvin Siegel, RN, CRNI®
Directors-at-Large
Angie Sims, RN, CRNI®, OCN®
Mary Zugcic, MS, RN, ACNS-BC,
CRNI®
Public Member
David Schmick, RPh
INS Chief Executive Officer
Mary Alexander, MA, RN, CRNI®,
CAE, FAAN
Infusion Nursing Standards of
Practice Reviewers
Jeanette Adams, PhD, RN,
ACNS,BC, CRNI®
Teri Aguiar, BSN
Steve Bierman, MD
Corrine Bishop, RN, CRRN, CRNI®
Volume 34 • Number 1S
Paul Blackburn, MNA, RN
Beth Bonilla, BSN, MEd, RN
Cynthia Brown, RN, ARNP, GNPBC, CCRN, CRNI®
Heather Buxton, BSN, MSN,
CNSRN, CRNI®
Gwen Cole, RN, CRNI®
Ann Corrigan, BSN, MS, RN,
CRNI®
Ann Earhart, MSN, ACNS-BC,
CRNI®
Charles Edmiston, PhD, CIC
Seth Eisenberg, BSN, RN, OCN®
Nina Elledge, MBA, RN, CRNI®
Beth Fabian, BA, RN, CRNI®
Michelle Fox, RN
Gina Gilbert, RN
Kevin Glover, MS, MEd
Donna Gordon, MSN, RN, CRNI®
Richelle Hamblin, MSN, RN, CRNI®
Mark Hunter, RN, CRNI®
Pamela Jacobs, BSN, MHA, RN,
CRNI®, OCN®
William Jarvis, MD
Kenn Jones, BSN, RN, CRNI®,
Debra Kovasevich, MPH, RN
Sandra Kronn, BSN, RN, CRNI®
Elizabeth Krzywda, MSN, ANP
Melissa Leone, RN
Alicia Mares, BSN, RN, CRNI®
Elizabeth Martinez, RN
Mary McGoldrick, MS, RN, CRNI®
Karen McKeon, RN, CRNI®
Katherine McKrill, RN
Paula McMahon, RN, CRNI®
Nita Meaux, RN, CRNI®
Geno Merli, MD
Britt Meyer, RN, CRNI®
Jeannette Meyer, MSN, RN, CCRN,
CCNS, PCCN
Crystal Miller, BSN, MA, RN,
CRNI®
Susan Miller-Hoover, DNP, RN,
CCNS, CCRN
Libby Montoya, MSN, APN, CNSBC
Nancy Mortlock, BSN, RN, CRNI®,
OCN®
Robin Nelson, MEd, RN, CRNI®
Barbara Nickel, APRN-CNS, CRNI®,
CCRN
Thomas Nifong, MD
Shirley Otto, RN, CRNI®, AOCN
Roxanne Perucca, MSN, RN,
CRNI®
Lynn Phillips, MSN, RN, CRNI®
Susan Poole, BSN, MS, RN,
CRNI®, CNSN, CIC
Debbie Potts, RN, CRNI®, OCN
Kathy Puglise, MEd, RN, CRNI®
Laura Rutledge, RN, CRNI®
Pam Sabatino-Holmes, ARNP, RN,
CRNI®
Ofelia Santiago, BSN, RN, CRNI®
Marvin Siegel, RN, CRNI®
Angie Sims, RN, CRNI®
Marc Stranz, PharmD
Virginia Strootman, MSN, RN,
CRNI®
Anne Swanson, RN
Joseph Thomas, BSN, RN
Alan Tice, MD
Cora Vizcarra, MBA, RN, CRNI®
Jeffrey Wagner, BSN, RN
Timothy Weimken, MPH, CIC
Sharon Weinstein, MS, RN, CRNI®,
FACW, FAAN
Marcia Wise, RN
Mary Zugcic, MS, RN, APRN,BC,
CRNI®
*CRNI is a registered trademark of the Infusion Nurses Certification Corporation.
Proud Platinum Sponsor of
The Journal of Infusion Nursing, the official publication of the Infusion Nurses Society (INS), seeks to promote excellence in infusion
nursing by presenting new research, clinical reviews, case studies, and professional development information relevant to the practice of infusion therapy. Articles selected for publication represent the broad scope of the infusion specialty and draw on the expertise of all healthcare providers who participate in the delivery of infusion.
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Journal of
Infusion Nursing
Contents
Note: The “S” in page numbers denotes supplement issue and does not refer to a specific standard.
Acknowledgments
About the Standards of
Practice Committee
Preface
Strength of the Body of Evidence
S1
S2
S4
S5
STANDARDS OF PRACTICE
NURSING PRACTICE
1. Practice Setting
2. Neonatal and Pediatric
Patients
3. Older Adult Patients
4. Ethics
5. Scope of Practice
6. Competence and Competency
Validation
7. Quality Improvement
8. Research and
Evidence-based Practice
9. Policies, Procedures, and/or
Practice Guidelines
S6
S6
S7
S8
S8
S11
S12
S13
S14
PATIENT CARE
10. Orders for the Initiation
and Management of
Infusion Therapy
11. Patient Education
12. Informed Consent
13. Plan of Care
S15
S16
S17
S18
DOCUMENTATION
14. Documentation
15. Unusual Occurrence and
Sentinel Event Reporting
16. Product Evaluation, Integrity,
and Defect Reporting
17. Verification of Products
and Medications
S20
S21
S22
S24
INFECTION PREVENTION AND
SAFETY COMPLIANCE
18. Infection Prevention
19. Hand Hygiene
VOLUME 34
|
NUMBER 1S
S25
S26
|
20. Compounding of Parenteral
Solutions and Medications
21. Scissors
22. Safe Handling and Disposal
of Sharps, Hazardous Materials,
and Hazardous Waste
23. Disinfection of Durable
Medical Equipment
24. Transmission-based Precautions
25. Latex Sensitivity or Allergy
S27
S27
34.
S28
35.
S29
S29
S30
INFUSION EQUIPMENT
26.
27.
28.
29.
30.
31.
Add-on Devices
Needleless Connectors
Filters
Flow-Control Devices
Blood and Fluid Warmers
Tourniquets
S31
S32
S33
S34
S35
S36
VASCULAR ACCESS DEVICE
SELECTION AND PLACEMENT
32. Vascular Access Device Selection S37
I. Short Peripheral Catheters S37
II. Midline Catheters
S37
III. Central Vascular Access
Devices (CVADs)
(Nontunneled, PICC,
Tunneled, Implanted Port) S38
IV. Arterial Catheters
S38
33. Site Selection
S40
I. Peripheral Venous Access via
Short Peripheral Catheters S40
II. Peripheral Venous Access
via Midline Catheters
S41
III. Central Venous Access
via Peripherally Inserted
Central Catheters (PICCs) S41
IV. Central Venous Access via
Nontunneled Central Vascular
Access Devices (CVADs)
S42
V. Central Venous Access via
Tunneled Central Vascular
Access Devices and
Implanted Ports
S42
JANUARY/FEBRUARY 2011
36.
37.
38.
VI. Peripheral Arterial Access
VII. External Jugular Vein
Access
Local Anesthesia for Vascular
Access Device Placement
and Access
Vascular Access Site
Preparation and Device
Placement
I. General
II. Short Peripheral and
Midline Catheters
III. Central Vascular Access
Devices (CVADs)
IV. Arterial Catheters
Vascular Access Device
Stabilization
Joint Stabilization
Site Protection
S42
S42
S43
S44
S44
S44
S45
S45
S46
S47
S48
ACCESS DEVICES
39. Implanted Vascular Access
Ports
40. Hemodialysis Vascular Access
Devices
41. Umbilical Catheters
42. Apheresis and Ultrafiltration
Catheters
S50
S51
S52
S53
SITE CARE and MAINTENANCE
43. Administration Set Change
I. General
II. Primary and Secondary
Continuous Infusions
III. Primary Intermittent
Infusions
IV. Parenteral Nutrition
V. Intravenous Fat Emulsions
(IVFE) and Other Lipid
Product Infusions
VI. Blood and Blood
Components
VII. Hemodynamic and Arterial
Pressure Monitoring
S55
S55
S55
S55
S56
S56
S56
S56
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Journal of
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Contents
Note: The “S” in page numbers denotes supplement issue and does not refer to a specific standard.
S57
S57
S57
S58
S58
S58
S59
S63
INFUSION-RELATED
COMPLICATIONS
47.
48.
49.
50.
51.
Phlebitis
Infiltration and Extravasation
Infection
Air Embolism
Catheter Embolism
The Infusion Nursing Standards of
Practice is intended to reflect
current knowledge and practices
of the clinical nursing specialty of
infusion therapy. Because clinical
practice continually evolves based
on ongoing research, users should
make an independent assessment
of the appropriateness and
applicability of a standard in any
specific instance, and should also
consider the applicable federal and
state laws and regulations, as well
as the standard of care in a
particular jurisdiction, as these
may take precedence. INS is not
responsible for injury to persons
or property, or other harm, arising
from the use of the Standards.
S65
S66
S68
S69
S70
52. Catheter-Associated Venous
Thrombosis
S71
53. Central Vascular Access Device
Malposition
S72
OTHER INFUSION-RELATED
PROCEDURES
54. Vascular Access Device Repair
55. Central Vascular Access
Device Exchange
56. Catheter Clearance: Occluded
Central Vascular Access Devices
57. Phlebotomy
I. Phlebotomy via Direct
Venipuncture
II. Blood Sampling via a
Vascular Access Device
III. Therapeutic Phlebotomy
S75
S75
S76
S77
S78
S78
S79
NONVASCULAR INFUSION DEVICES
58. Intraspinal Access Devices
59. Intraosseous Access Devices
60. Continuous Subcutaneous
Infusion and Access Devices
S84
INFUSION THERAPIES
61. Parenteral Medication and
Solution Administration
62. Antineoplastic Therapy
63. Biologic Therapy
64. Patient-Controlled Analgesia
65. Parenteral Nutrition
66. Transfusion Therapy
67. Moderate Sedation/Analgesia
Using Intravenous Infusion
68. Administration of Parenteral
Investigational Drugs
Illustrations
Glossary
Index
S86
S87
S89
S89
S91
S93
S95
S96
S97
S101
S109
S81
S82
Journal of Infusion Nursing (ISSN: #1533-1458) is published bimonthly for the Infusion Nurses Society by Lippincott Williams &
Wilkins, Inc., at 16522 Hunters Green Parkway, Hagerstown, MD 21740-2116. Business and production offices are located at
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Text printed on acid-free paper.
8
44. Vascular Access Device
Removal
I. Short Peripheral Catheters
II. Midline Catheters
III. Nontunneled Central
Vascular Access Devices
(CVADs)
IV. Surgically Placed CVADs:
Tunneled/Implanted Ports
V. Arterial Catheters
45. Flushing and Locking
46. Vascular Access Device Site
Care and Dressing Changes
Journal of Infusion Nursing