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Infusion Therapy: Acute Care Policies and Procedures for Infusion Therapy: Acute Care 6th edition Policies and Procedures for Infusion Therapy: Acute Care 6th edition Copyright © 2021 by the Infusion Nurses Society, Inc. All rights reserved. No part of this book may be reproduced without written permission from the Infusion Nurses Society. Contents 1. General Organizational Policies Organization of Infusion and Vascular Access Services ....................................... 8 Competency and Competency Assessment ...................................................... 12 Product Evaluation, Integrity, and Defect Reporting ......................................... 18 Informed Consent .............................................................................................. 20 Latex Sensitivity or Allergy ................................................................................. 24 Adverse and Serious Adverse Events ................................................................ 26 2. Infection Prevention and Safety Compliance Hand Hygiene .................................................................................................... 30 Standard Precautions ........................................................................................ 32 Aseptic Non Touch Technique (ANTT®) .............................................................................34 Transmission-Based Precautions ........................................................................ 37 Hazardous Drugs and Waste ............................................................................. 39 Medical Waste and Sharps Safety...................................................................... 44 3. Preparing for Vascular Access Device Placement Key Definitions ................................................................................................... 48 Vascular Access Device Planning ....................................................................... 50 Site Selection ..................................................................................................... 56 Vascular Visualization ......................................................................................... 60 Vascular Access Site Preparation and Skin Antisepsis ....................................... 63 Pain Management for Venipuncture and Vascular Access Procedures .............. 65 4. Vascular Access Device Placement Policy Statements .............................................................................................. 70 Key Definitions ................................................................................................... 72 Short Peripheral Intravenous Catheter Insertion ................................................ 73 Short Peripheral Intravenous Catheter Insertion via the External Jugular Vein ............................................................................. 80 Ultrasound-Guided Long Peripheral Intravenous Catheter Insertion .......................................................................... 85 Ultrasound-Guided Midline Catheter Insertion ................................................. 93 Central Vascular Access Device Tip Location .................................................. 101 Ultrasound-Guided Peripherally Inserted Central Catheter Insertion Using Modified Seldinger Technique ................................................ 104 Ultrasound-Guided Nontunneled Central Vascular Access Device Insertion Using Modified Seldinger Technique ............................................... 113 Ultrasound-Guided Nontunneled Central Vascular Access Device Insertion Using Seldinger Technique ............................................................... 122 5. Site Care and Management Administration Set Management .................................................................... 132 Maintaining Vascular Access Device Patency: Flushing and Locking .............. 136 Vascular Access Device Assessment, Care, and Dressing Changes ................ 143 Vascular Access Device Removal ..................................................................... 151 6. Vascular Access Device-Related Complications: Identification and Intervention Phlebitis ........................................................................................................... 160 Infiltration and Extravasation ........................................................................... 165 Nerve Injury ..................................................................................................... 176 Infection ........................................................................................................... 179 Air Embolism ................................................................................................... 185 Central Vascular Access Device Occlusion ...................................................... 188 Catheter Damage (Embolism, Repair, Exchange) ............................................ 196 Catheter-Associated Deep Vein Thrombosis ................................................... 200 Central Vascular Access Device Malposition ................................................... 204 Catheter-Associated Skin Injury ....................................................................... 208 Allergic Reaction and Anaphylactic/Anaphylactoid Reactions ........................ 211 7. Infusion-Related Procedures and Access Implanted Vascular Access Port: Accessing and Deaccessing ......................... 216 Subcutaneous Access Device: Placement and Infusion Administration ........................................................... 223 Intraspinal Access Device: Care and Management ......................................... 228 Intraosseous Access Device: Placement, Care, and Management .................. 237 Blood Sampling from a Vascular Access Device .............................................. 242 Therapeutic Phlebotomy ................................................................................. 251 8. Infusion Therapies Medication Verification .................................................................................... 258 Compounding and Preparation of Parenteral Solutions and Medications .............................................................................................. 261 First Dose Administration ................................................................................ 265 Infusion Medication and Solution Administration............................................ 267 Blood Administration ....................................................................................... 281 Parenteral Nutrition ......................................................................................... 288 Antineoplastic Therapy .................................................................................... 293 Biologic Therapy .............................................................................................. 301 Patient-Controlled Analgesia ........................................................................... 304 Moderate Sedation/Analgesia Using Intravenous Infusion .............................. 308 Policies and Procedures for Infusion Therapy: Acute Care is a companion product to the Infusion Therapy Standards of Practice (the Standards), 8th edition. Evidence-based guidance for clinical practice has been derived directly from the Standards, including associated references, glossary of terms, abbreviations, and acronyms.1 Policies and Procedures for Infusion Therapy: Acute Care is intended to reflect current knowledge and practices of the clinical specialty of infusion therapy. Because clinical practice continuously evolves based on ongoing research, clinicians should make an independent assessment of the appropriateness and applicability of a policy or procedures in any specific instance. Applicable federal and state laws and regulations should also be considered, 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 exercising guidelines outlined in this publication. Suggested citation for this publication: Infusion Nurses Society. Policies and Procedures for Infusion Therapy: Acute Care. 6th ed. Infusion Nurses Society; 2021. Reference 1. Gorski LA, Hadaway L, Hagle ME, et al. Infusion therapy standards of practice. J Infus Nurs. 2021;44(suppl 1):S1-S224. doi:10.1097/NAN.0000000000000396 6 POLICIES AND PROCEDURES FOR INFUSION THERAPY: ACUTE CARE 1. General Organizational Policies Organization of Infusion and Vascular Access Services ................... 8 Competency and Competency Assessment ................................. 12 Product Evaluation, Integrity, and Defect Reporting ..................... 18 Informed Consent ......................................................................... 20 Latex Sensitivity or Allergy ............................................................ 24 Adverse and Serious Adverse Events ............................................ 26 7 Organization of Infusion and Vascular Access Services Policy Infusion therapy requires interprofessional collaboration among all clinicians that prescribe, dispense, and administer a wide variety of solutions, medications, nutrition, and blood components, as well as management and purchasing personnel. The scope of services provided by the infusion team/vascular access team (VAT) is structured to meet patient and organizational needs for safe delivery/administration of quality
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