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Disclosure
10/26/2016
Started to address lack of consistency, education and standards for the practice
of I.V. therapy
Currently affiliated chapters exist in 9 countries:
Brazil, Canada, Columbia, Germany, India, New Zealand, Philippines, Russia,
Thailand.
INS active members are in 29 additional countries:
Argentina, Australia, Bermuda, China, Dominican Republic, France, Greece,
Guam, Hong Kong, Indonesia, Ireland, Italy, Jamaica, Japan, Korea, Malaysia,
Mexico, the Netherlands, Nepal, Peru, Puerto Rico, Qatar, Saudi Arabia,
Singapore, South Africa, Taiwan, Ukraine, United Arab Emirates, the United
Kingdom
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Because clinical practice continually evolves based on on-going 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 take precedence .
Nurses continually evaluate quality and effectiveness of nursing practice and seek to optimize
outcomes
ANA Scope & Standards of Practice, 2007, p 10
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2016
What changed and what does this mean for
vascular access clinicians?
What was deleted?
What do the recommendations
ask of the clinicians?
Do I change my practice?
What does my
patient know?
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INS
10/26/2016
Definitions:
Standard of Care
www.Webster-Meriam.com/dictionary/standard
A standard of care is that nursing practice will reduce the risk of infection
while providing infusion therapy.
One standard of practice to achieve this goal is the use CHG for all
intravenous starts.
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What is
Evidence Based Practice Criteria?
Defines the practice settings, scope of practice, ethics, competencies and quality
improvement related to infusion therapy.
Defines how the nurse will utilized evidence-based practice and research to guide
policies, procedures and practice issues.
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follows
Provides
additional
Guidelines
recommendations
Established proper steps to
take
Procedures
How do I do it?
Standards
Policies
Anatomy
of a
standard
Practice Criteria=based
strength of evidence
Regulatory statement
included:
single use safety control
mechanisms
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IVERA
3M
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author
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34
37
40
37
34
40
48
3
6
41
57
41
44
64
10
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skin
Vascular
Device
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MARSI: Definition
A medical adhesive-related skin injury is an occurrence in which erythema
and/or other manifestation of cutaneous abnormality (including, but not limited
to, vesicle, bulla, erosion, or tear) persists 30 minutes or more after removal of
the adhesive.
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Acrylate Adhesive
Tape is taperight?
Silicone
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A dressing is a dressingright?
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Example of skin
barrier protection
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Apply dressing..
If blood is still present or site continues to ooze, consider using gauze
dressing until bleeding has stopped.
Apply CHG impregnated product, if ordered
Identify adhesive free areas on dressing
Apply dressing to site. Do NOT stretch dressing onto skin; rather place
dressing over skin in the middle; then drop sides.
Use gentle firm pressure after applying to skin; stroking adhesive product or
tape into place
Standard 41: Recommendation to change securement device with dressing
change found (practice criteria H)
Additional injuries
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D. Broadhurst,
Used with permission,
Adhesive Removers
Many of the products, practices to remove dressings are not evidenced based (i.e. using
hand foam) and are non-sterile.
Many removers contain acetone which is extremely flammable but do manage adhesive
sticky-ness
Water and normal saline are effective removal agents; however do not manage the
adhesive sticky-ness
Citrus based solvents contain d-limonene which disrupts skin lipids and can be a skin
irritant. The product also affects future product adhesiveness when applied over same
site.
To date, there is not an exclusive adhesive product for infusion therapy populations.
(Thayer, 2012)
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Conclusion
The 2016 Standards of Practice highlight a more thoughtful, patient centric approach to
vascular access and infusion therapies.
Questions?
References
Broadhurst, D., Moureau, N., Ullman, A. (2016). CVAD Associated Skin Impairment Tool. Author
(electronic communication dated July 15, 2016)
Kutzsche, L. (2012). Management of irritant contact dermatitis and peripherally inserted
central catheters. Clinical Journal of Oncology Nursing (16) 2: E48-58. doi:10.1188/12.CJON.E48-E55
Hadaway, L. (2016). Action Verbs in the Infusion Therapy Standards of Practice, Lynn HadawayBlog post accessed: 6/17/2016
Infusion Nurses Society (2016). Infusion Therapy Standards of Practice. Journal of Infusion
Nursing, (39): 1S
Matsumura, H., et al. (2012). A mode for quantitative evaluation of skin damage at adhesive
wound dressing removal. International Wound Journal, 291-294.
McNichol, L., Lund, C., Rosen, T., Gray, M. (2013). Medical Adhesive and Patient Safety:
Consensus statements for the assessment, prevention, and treatment of adhesive
related injuries. Journal of Wound, Ostomy and Continence Nurse Society,
July/August:1-15.
Thayer, D., (2012). Skin damage associated with intravenous therapy. Journal of Infusion Nursing
(35)6: 390-401.
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