Every 5 years, the Infusion Nurses Society (INS) publishes the Infusion Therapy Standards of Practice. The types of infusions addressed in the Standards include IV-, SC-, intraosseous-, and intraspinal-access devices and infusions. Among the specific areas covered by the standards are infusion-therapy practice, patient and clinician safety, infection prevention and control, infusion equipment, vascular-access device (VAD) selection and placement, vascular access management, severe VAD-related complications, and other infusion devices and therapies.
Although the standards are relevant to all practice settings in which infusions are administered, a number of standards and recommendations are very relevant to the home-care setting. These include addressing the needs of special patient populations, including neonatal, pediatric, pregnant, and older adults. In particular, the standards recognize physiological and anatomical changes that can impact therapy.
The organization of infusion and vascular services, or infusion teams, which are relatively uncommon in the home-care setting, is also discussed. The availability of such teams is associated with improved outcomes, including lower rates of complications. Competencies in the safe delivery of infusion therapy and VAD insertion and management should be assessed. Quality-improvement standards address issues of surveillance, analysis, and reporting of quality indicators and adverse events; these can include blood stream infections associated with VADs, occlusion of VADs, or adverse drug events. Emphasis is placed on patient and caregiver education, as this is one of the five key areas considered essential for positive patient outcomes.
The 2021 Standards introduces the term "Aseptic Non Touch Technique (ANTT)" to standardize the competencies involved in applying a specific and comprehensively defined type of aseptic technique for use in all invasive clinical procedures and in the management of invasive medical devices. Within ANTT, there are two approaches: standard ANTT, which applies to the disinfection of surfaces and equipment prior to VAD flushing or medication administration, and surgical ANTT, which requires the use of a sterile drape or barrier for more complex procedures.
It is important for home healthcare professionals to be knowledgeable about the use of near infrared light technology, which can be used for vascular visualization to determine the successful placement of peripheral catheters. There are standards that refer to VAD planning, which involves choosing the correct VAD based on patient- and therapy-specific factors, venous site selection, implanted vascular access ports, VAD site preparation and placement, the use of needless connectors and their risk of infection, and VAD securement.
The Standards point out that pain-management strategies are underutilized among patients undergoing VAD-related procedures. They recommend the use of various strategies, ranging from behavioral interventions such as distraction (for example by using virtual reality) and relaxation to the use of local anesthetics, including vapocoolant sprays, topical transdermal agents, or jet injection of pressure-accelerated lidocaine.
A new standard included in the 2021 is on the prevention and management of catheter-associated skin injury. The appendix of the standards includes an evidence-based algorithm on the management of skin impairment.
One of the most important sections and standards for pharmacists is on infusion therapies—in particular, on infusion medications and solution administration. An addition to the Standards includes addressing the potential risk for severe allergic or anaphylactic reactions associated with the first dose of a medication. The Standards recommend that the use of first doses of medications with an "appreciable" risk of severe allergic or anaphylactic reactions should only be administered in a nonacute care setting (e.g., home care) if conditions for safe administration have been evaluated and verified. Pharmacists can assist this assessment, which includes evaluating a patient's medication history and drug- allergy history.
Pharmacists should be familiar with these infusion-therapy standards of practice. They can be proactive in educating nursing colleagues on proper infusion administration and in helping to address medication-related issues to assure optimal patient care.
The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.
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