Lisa A. Gorski

Central venous access device outcomes in a homecare agency: a 7-year study.

Homecare agencies must collect, analyze, and report patient outcomes. Despite a critical need for data related to the incidence of infections and other complications related to central venous access devices (CVADs) among patients receiving homecare, this information currently is underreported and inconsistently collected by homecare agencies. Obstacles to data collection and analysis have been noted including inadequate information systems, underdeveloped infection control programs, and the lack of a universally accepted definition of a homecare infection. This descriptive survey reports 7 years of CVAD outcomes in a large, urban homecare agency. The data collection processes and definitions used in this survey are described. The reported outcomes include a relatively low incidence of CVAD-related infections, occlusions, and other complications. Demographic data, including types of home infusion therapies provided and patient self-care outcomes, also are described.

Peripherally inserted central catheters and midline catheters for the homecare nurse.

Peripherally inserted central catheters are the most common type of catheter used for homecare patients. Midline catheters offer a less invasive, cost-effective option for vascular access in some patients. Homecare nurses play a key role in teaching patients how to live safely with and manage these devices and must possess expert knowledge of catheter placement, standards of assessment, care and management, and potential complications.

Intermittently delivered IV medication and pH: reevaluating the evidence.

The Infusion Nurses Societys Infusion Nursing Standards of Practice has treated pH as a critical factor in the decision-making process for vascular access device selection, stating that an infusate with a pH less than 5 or greater than 9 is not appropriate for short peripheral or midline catheters. Because of the Standards, drug pH is not an uncommon factor driving the decision for central vascular access. In this era of commitment to evidence-based practice, the pH recommendation requires reevaluation and a critical review of the research leading to infusate pH as a decisional factor. In this narrative literature review, historical and current research was appraised and synthesized for pH of intermittently delivered intravenous medications and the development of infusion thrombophlebitis. On the basis of this review, the authors conclude and assert that pH alone is not an evidence-based indication for central line placement.

Consensus conference on prevention of central line-associated bloodstream infections: 2009.

Health care-acquired infections are a significant cause of morbidity and mortality in all patient care settings. In 2009, a consensus conference was held to evaluate practices and recommendations for the prevention and control of one specific type of health care-acquired infections, those associated with central catheter use. The conference had 2 purposes—-to provide a tool for quality changes within health care institutions regarding central catheter infections and to empower those who are responsible for implementing policies needed to reduce the risk of these infections. The findings of the expert panel assembled for the conference are presented in this article.

Recommendations for frequency of assessment of the short peripheral catheter site.

As many organizations choose to follow the Infusion Nurses Society (INS) recommendations for peripheral intravenous (IV) site rotation based on clinical indications rather than a specific time frame, INS recognizes the critical importance of site assessment to identify any signs of complications. The risks of peripheral IV catheters are well known, including phlebitis, infiltration/extravasation, and infection. Nerve damage is also a risk both during insertion and as a result of major infiltrations/extravasations. Minimizing the complications associated with these risks demands regular assessment for signs and symptoms and prompt removal when evident. Peripheral IV sites should be assessed for redness, tenderness, swelling, drainage, and/ or the presence of paresthesias, numbness, or tingling. In addition to site-related changes, the possibility of catheter-associated bloodstream infection must also be considered in any patient with a peripheral IV catheter who has an elevated temperature, even in the absence of site redness, tenderness, swelling, or drainage. There are limited evidence-based guidelines addressing how often to assess the peripheral IV site. Much of the general nursing literature addresses the need for “frequent” assessment of the IV site, and the 2011 Infusion Nursing Standards of Practice recommends “routine” assessment for signs and symptoms of phlebitis and infiltration. In the winter of 2012, INS convened a national task force of infusion therapy experts representing the varying areas of infusion practice based on population (neonatal, pediatric, geriatric, oncology) and settings (acute care, outpatient, home care, long-term care) to examine current practices and to develop specific recommendations for the frequency of peripheral IV assessment.

Establishing research priorities for the infusion nurses society

As the leader in the infusion nursing community, the Infusion Nurses Society (INS) recognizes the critical need for research to support the specialty practice. The purpose of this project was to gain input from INS members to establish research priorities for the organization. In partnership with Wayne State University College of Nursing, INS surveyed its members by using the Delphi approach. The qualitative responses received supported a theoretical framework on which to base an agenda. Respondents identified more problem areas in their practice than in research topics needing further exploration. Four themes, all falling under the overarching domain of patient safety, were identified. By identifying research priorities, INS will be able to guide the direction for research, focus the use of limited financial resources toward the most needed research, and use research to develop and support best practices for the infusion nursing specialty.