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 MedicalMedical 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

Infusion Nursing
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 &
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Text printed on acid-free paper.

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