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Speaking of Standards . . .

• • • • • • • • • • • • • •

W elcome to the first column in a series addressing the 2006 Infusion Nursing Standards of
Practice. I have used the Standards to guide my practice for many years. In the 1980s, I
moved from critical care to homecare and was given a position to develop a home infusion ther-
apy program. At that time, home infusion therapy was in its infancy, and there was relatively
little literature to draw upon. I joined INS (at that time called the Intravenous Nursing Society),
obtained a copy of the Standards, and used them as the foundation for developing our organi-
zation’s policies and procedures. Little did I know that I would eventually have the exciting
opportunity to work with INS and a group of expert clinicians in revising this important docu-
ment. In this column, I will be providing a focused discussion on some of the Standards that
have generated most of the questions from nurses. I will highlight some of the research refer-
ences that were used to support the Standards and provide updated references as available.
I welcome your feedback as we launch this new feature of the Journal of Infusion Nursing.

Infusion Nursing Standards placed.1 Catheter stabilization is increasingly recognized as

of Practice
Lisa A. Gorski, MS, APRN,BC, CRNI©, FAAN
Standard 43.1: Catheter stabi-
lization shall be used to preserve
the integrity of the access device
and to prevent catheter migration
and loss of access.
Standard 43.2: Catheters shall be
stabilized using a method that
does not interfere with assessment
and monitoring of the access site
or impede vascular circulation or
delivery of the prescribed therapy.
Standard 43.3: Catheter stabilization shall be performed
using aseptic technique.
Standard 43: Catheter Stabilization
The term stabilization is used interchangeably with secure-
ment when referring to a structure, support, or foundation that
makes something less likely to fall, give way, or become dis-
an important intervention in reducing the risk for phlebitis, in-
fection, catheter migration, and catheter dislodgment. When
the catheter is stabilized, there is less movement of the
catheter in and out of the insertion site, and the catheter is less
likely to be dislodged. Studies examining catheter stabilization
have focused primarily on peripheral IV catheters and periph-
erally inserted central catheters (PICCs). One of the changes
to the 2006 Standards is that the Practice Criteria now recom-
mend the use of manufactured catheter stabilization devices
as preferred over other methods, such as sterile tapes and sur-
gical strips. INS does not endorse any particular device.
Both healthcare worker safety issues and clinical research
have prompted this change. Suturing is no longer recom-
mended due to the risk for healthcare provider needlestick
injuries.2 Sutures are also associated with increased risk for
infection. In a prospective randomized study,3 170 patients
with PICCs were randomly assigned to either sutures or to
the placement of a manufactured securement device. Sig-
nificant findings included shorter securement time and fewer
PICC-related bloodstream infections in the group using the
manufactured securement device; there was 1 needlestick
injury in the suture group. Two prospective studies cited in
the Standards4,5 compared the use of tape to a securement
device in the stabilization of peripheral IV catheters and
found significantly decreased rates for scheduled IV restarts,

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as well as an overall reduction in complications. Since the
6
publication of the Standards, Schears summarized pooled
product evaluation data on the use of 1 available secure-
ment device (StatLok, Venetec International, San Diego, CA)
with peripheral IV catheters from 83 institutions representing
over 10,000 patients. Although he acknowledges the need
for an independent, randomized trial, the data demonstrat-
ing significant reductions in complications and restarts are
compelling enough to believe that catheter stabilization de-
vices do improve outcomes in relation to peripheral IV
catheters.
The use of catheter stabilization devices represents a signif-
icant change in practice. Education emphasizing proper use
of the product, maintenance of aseptic technique, and ca-
theter stabilization during the placement procedure is ab-
solutely essential. There are several commercially available
manufactured stabilization devices. It is imperative that in-
fusion nurses read and incorporate specific manufacturer’s
Vol. 30, No. 1, January/February 2007
directions for use and frequency of replacement into orga-
nizational procedures.
R E F E R E N C E S
1. Infusion Nurses Society. Infusion Nursing Standards of Practice.
J Infus Nurs. 2006;29(1S):S1-S92.
2. Occupational Safety and Health Administration. Securing medical
catheters. OSHA Fact Sheet. Available at: http://www.osha.gov/
SLTC/bloodbornepathogens/factsheet_catheters.pdf. Accessed June
14, 2006.
3. Yamamoto AJ, Soloman JA, Soulen MC, et al. Sutureless secure-
ment device reduces complications of peripherally inserted central
venous catheters. J Vasc Interven Radiol. 2002;13(1):77-81.
4. Sheppard K, LeDesma M, Morris N, O’Connor K. A prospective
study of two intravenous catheter securement techniques in a skilled
nursing facility. J Intraven Nurs. 1999;22(3):151-156.
5. Smith B. Peripheral intravenous catheter dwell times: a comparison
of 3 securement methods for implementation of a 96-hour sched-
uled change protocol. J Infus Nurs. 2006;29(1):14-17.
6. Schears GJ. Summary of product trials for 10,164 patients: Com-
paring an Intravenous stabilizing device to tape. J Infus Nurs.
2006;29(4):225-229.
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