Infusion Therapy

INFUSION THERAPY STANDARDS OF PRACTICE Developed by Lisa Gorski, MS, RN, HHCNS-BC, CRNI®, FAAN Lynn Hadaway, MEd, RN-BC, CRNI® Mary E. Hagle, PhD, RN-BC, FAAN Mary McGoldrick, MS, RN, CRNI® Marsha Orr, MS, RN Darcy Doellman, MSN, RN, CRNI®, VA-BC REVISED 2016 315 Norwood Park South, Norwood, MA 02062 www.ins1.org Purchased by [email protected], Faye Baker From: INS Digital Press (ins.tizrapublisher.com) JIN-D-15-00057.indd 1 05/01/16 11:30 PM The Art and Science of Infusion Nursing Infusion Therapy Standards of Practice Reviewers Jeanette Adams, PhD, RN, ACNS-BC, CRNI® Alicia Mares, BSN, RN, CRNI® Steve Bierman, MD Britt Meyer, MSN, RN, CRNI®, VA-BC, NE-BC Daphne Broadhurst, BScN, RN, CVAA® Crystal Miller, MA, BSN, RN, CRNI® Wes Cetnarowski, MD Diana Montez, BSN, RN Vineet Chopra, MD, MSc Tina Morgan, BSN, RN Michael Cohen, RPh, MS, ScD(hon), DPS(hon), FASHP Russ Nassof, Esq. Ann Corrigan, MS, BSN, RN, CRNI® Barb Nickel, APRN-CNS, CRNI®, CCRN Lynn Czaplewski, MS, RN, ACNS-BC, CRNI®, Shawn O’Connell, MS, RN ® AOCNS Susan Paparella, MSN, RN ® Julie DeLisle, MSN, RN, OCN Roxanne Perucca, MSN, RN, CRNI® Michelle DeVries, MPH, CIC Ann Plohal, PhD, APRN, ACNS-BC, CRNI® ® Loretta Dorn, MSN, RN, CRNI Kathy Puglise, MSN/ED, RN, CRNI® Kimberly Duff, BSN, RN Vicky Reith, MS, RN, CNS, CEN, APRN-BC ® Cheryl Dumont, PhD, RN, CRNI Claire Rickard, PhD, RN ® Beth Fabian, BA, RN, CRNI Robin Huneke Rosenberg, MA, RN-BC, CRNI®, Stephanie Fedorinchik, BSN, RN, VA-BC VA-BC Michelle Fox, BSN, RN Diane Rutkowski, BSN, RN, CRNI® Marie Frazier, MSN, RN, CRNI® Laura Rutledge, MN, RN, CRNI® Claudia Freitag, PhD Ofelia Santiago, BSN, RN, CRNI® Doreen Gendreau, MSN, MS, CNS, RN-BC, CWCN, Liz Sharpe, DNP, ARNP, NNP-BC, VA-BC DAPWCA Marvin Siegel, RN, CRNI® Lynn Gettrust, MSN, RN Marc Stranz, PharmD Connie Girgenti, BSNc, RN, VA-BC Tim Vanderveen, PharmD, MS Sheila Hale, BSN, RN, CRNI® , VA-BC Cora Vizcarra, MBA, BSN, RN, CRNI®, VA-BC ® ® Dora Hallock, MSN, RN, CRNI , OCN , CHPN Paula Foiw Washesky, MBA, RD, LDN ® Max Holder, BSN, RN, CEN, CRNI , VA-BC Steve Weber ® ® Pamela Jacobs, MHA, BSN, RN, CRNI , OCN Sharon Weinstein, MS, RN, CRNI®, CSP, FAAN, James Joseph, MPH, BSN, RN, CRNI®, VA-BC FACW Matthias Kahl Marcia Wise, RN, VA-BC Pat Kienle, RPh, MPA, FASHP Cheryl Wozniak Melissa Leone, BSN, RN Mary Zugcic, MS, RN, ACNS-BS, CRNI® Michelle Mandrack, MSN, RN Purchased by [email protected], Faye Baker From: INS Digital Press (ins.tizrapublisher.com) JIN-D-15-00057.indd 2 05/01/16 11:30 PM Journal of Infusion Nursing JANUARY/FEBRUARY 2016 Volume 39 • Number 1S Editor Editorial Reviewers Peggy Link, MSN, RN, CRNI® Mary Alexander, MA, RN, Mohammad Abdollahi, PharmD, PhD Rose Anne Lonsway, MA, BSN, CRNI® CRNI®*, CAE, FAAN Jeanette Adams, PhD, RN, Lisa P. L. Low, MPhil, BN, RHV, RN ACNS-BC, CRNI® Lauro Manalo, Jr, MSN Managing Editor Rhonda Maneval, DEd Dorothy Lohmann Melissa Adler, MSN, RN, CMSRN, OCN® Mary McGoldrick, MS, RN, CRNI® ® Editorial Offices Christopher Basnett, MSN, RN, Britt Meyer, MSN, RN, CRNI , INS CRNI®, FNP-BC VA-BC, NE-BC ® ® 315 Norwood Park South Deborah Benvenuto, MBA, BS, CRNI® Nancy Mortlock, RN, CRNI , OCN , Norwood, MA 02062 Georgene Bloomfield, RPh, MS CSRN (781) 440–9408 ® Wendy L. Boersma, BSN, RN, CRNI® Inez Nichols, MSN, RN, CRNI , Fax: (781) 440–9409 Elizabeth Ann Bonilla, MEd, BSN FNP-BC ® For advertising information: Tammy Burdeaux, RN, CRNI® Julie D. Painter, MSN, RN, OCN Nicholas Cardinale, RN, CRNI® Alvisa Palese, MSN Product Advertising Susan Paparella, MSN, RN Michelle Smith, Senior Account Pamela Clark, BSN ® ® Lorelei Papke, MSN, CEd, CRNI Manager Lynda Cook, MSN, RN, CRNI France Paquet, MScN [email protected] Nancy Corbitt, BSN, RN, OCN®, CRNI® Evridiki E. Patelarou, PhD (646) 674-6537 Ann M. 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Weinstein, MS, CRNI , Lisa Bruce, BSN, RN, CRNI , IgCN ® ® BC, AOCNS , CRNI FAAN Directors-at-Large Alene J. Keller, BSN, RN, CRNI® Judy G. Williams, BA, RN, CRNI® ® Diedre Bird, BSN, RN, CRNI Edward Korycka, CRNI®, OCN® Kathleen Wilson, MPH, BSN, RN, Max Holder, BSN, RN, CEN, ® ® Dana Kyles, BSN CRNI CRNI , VA-BC James Lacy, BSN, RN, CRNI® Ann Zonderman, JD, BSN, CRNI® Public Member Helen Larson, BSN, RN, CRNI® Mary Zugcic, MS, RN, ACNS-BC, Donald Filibeck, PharmD, MBA CRNI® INS Chief Executive Officer *CRNI is a registered trademark of the Infusion Nurses Certification Corporation. Mary Alexander, MA, RN, CRNI®, The Journal of Infusion Nursing, the official publication of the Infusion Nurses Society (INS), seeks to promote excellence in infusion CAE, FAAN 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 health care providers who participate in the delivery of infusion. Purchased by [email protected], Faye Baker From: INS Digital Press (ins.tizrapublisher.com) JIN-D-15-00057.indd 3 05/01/16 11:30 PM Journal of InfusionInfusion NursingNursing Contents Note: The “S” in page numbers denotes supplement issue and does not refer to a speciﬁ c standard. Foreword S1 SECTION THREE: III. Central Venous Access via Peripherally Inserted About the Standards of INFECTION PREVENTION Central Catheters S55 Practice Committee S3 AND CONTROL IV. Central Venous Access Preface S5 16. Hand Hygiene S38 via Nontunneled Central A Message from BD Medical S6 17. Compounding and Preparation of Vascular Access Devices (CVADs) S55 Acknowledgments S7 Parenteral Solutions and Medications S39 V. Central Venous Access via Methodology for Developing the 18. Medical Waste and Sharps Tunneled Central Vascular Standards of Practice S8 Safety S40 Access Devices (CVADs) Strength of the Body of Evidence S10 and Implanted Ports S55 19. Standard Precautions S41 VI. Peripheral Arterial Access S55 20. Transmission-Based Precautions S42 STANDARDS OF PRACTICE VII. External Jugular Vein 21. Disinfection of Durable Medical Access S56 Equipment S43 SECTION ONE: INFUSION 28. Implanted Vascular Access THERAPY PRACTICE SECTION FOUR: INFUSION Ports S58 1. Patient Care S11 EQUIPMENT 29. Hemodialysis Vascular Access Devices (VADs) S59 2. Special Patient Populations S11 22. Vascular Visualization S44 30. Umbilical Catheters S60 3. Scope of Practice S13 23. Central Vascular Access Device 31. Apheresis Catheters S62 (CVAD) Tip Location S46 4. Infusion Team S17 32. Local Anesthesia for Vascular 24. Flow-Control Devices S48 5. Competency Assessment Access Device (VAD) Placement and Validation S18 25. Blood and Fluid Warming S49 and Access S63 6. Quality Improvement S21 33. Vascular Access Site Preparation SECTION FIVE: VASCULAR and Device Placement S64 7. Evidence-Based Practice and ACCESS DEVICE (VAD) I. General S64 Research S24 SELECTION AND II. Short Peripheral and 8. Patient Education S25 PLACEMENT Midline Catheters S64 9. Informed Consent S26 26. Vascular Access Device III. Central Vascular Access (VAD) Planning S51 10. Documentation in the Device (CVAD) S65 Medical Record S28 I. Short Peripheral Catheters S51 IV. Arterial Catheters S66 II. Midline Catheters S52 SECTION SIX: VASCULAR SECTION TWO: PATIENT III. Central Vascular Access ACCESS DEVICE (VAD) AND CLINICIAN SAFETY Devices (CVADs) (Nontunneled, Tunneled, MANAGEMENT 11. Adverse and Serious Implanted Ports) S52 Adverse Events S31 34. Needleless Connectors S68 IV. Arterial Catheters S53 35. Filtration S70 12. Product Evaluation, Integrity, and Defect Reporting S32 27. Site Selection S54 36. Add-on Devices S71 37. Vascular Access Device (VAD) 13. Medication Verification S34 I. Peripheral Venous Access via Short Peripheral Catheters S54 Stabilization S72 14. Latex Sensitivity or Allergy S35 II. Peripheral Venous Access 38. Joint Stabilization S74 15. Hazardous Drugs and Waste S36 via Midline Catheters S54 39. Site Protection S75 Purchased by [email protected], Faye Baker From: INS Digital Press (ins.tizrapublisher.com) JIN-D-15-00057.indd 4 05/01/16 11:30 PM Journal of Infusion Nursing Contents Note: The “S” in page numbers denotes supplement issue and does not refer to a speciﬁ c standard.

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