Below we have listed some frequently asked Clinical Practice Questions received by INS and answered by the INS Nursing Network. The INS Nursing Network is a volunteer group of infusion specialists who offer practice advice and evidence-based replies to clinical infusion practice questions.
These questions will be updated periodically to reflect the types of questions the network receives, so check back often to see new questions and answers.
How often is the Infusion Nursing Standards of Practice revised?
The Infusion Nursing Standards of Practice is revised every five years. The next revision is due in 2011.
What are the INS recommendations for the frequency of access cap changes?
An access cap should be changed if the integrity is compromised or residual blood remains in the cap. The optimal frequency for cap changes is not known, but it is recommended that the cap be changed at least every seven days. Refer to the manufacturer’s guidelines and your institution’s policies and procedures.
Should a mask be worn during a central vascular access device (CVAD) dressing change? Does the patient need to wear a mask as well?
When a catheter has an extended dwell time, the catheter tip is centrally located, or the patient is immunocompromised a mask should be worn. The dressing change should coincide with catheter site care. Many nurses have the patient wear a mask as well.
What is the recommended site rotation frequency for a peripheral IV catheter?
Site rotation frequency in an adult patient is every 72 hours.
When is a drug considered a vesicant?
If a a drug or solution can potentially cause blistering, tissue sloughing, or tissue necrosis when it extravasates, it is considered a vesicant.
Should there always be an order by a physician or authorized prescriber to start a peripheral IV catheter or saline lock?
Yes, there should be a written order, and the order should be verified by the nurse before the initiation of therapy.
Where can I find classes that teach infusion therapy?
Suggestions for classes include your local INS chapter, the facility or organization for which you work, or a local college may have listings of classes offered in the area. You can also search the internet for classes.
How long can a central vascular access device (CVAD) be left in?
The optimal dwell time for a CVAD (PICC, nontunnelled, tunnelled, or implanted port) is not known. The device should be monitored for signs and symptoms of complications in an ongoing and frequent manner.
Can a blood pressure be taken in the arm where a PICC is placed?
No. The pressure exerted during a blood pressure reading can damage the lining of the vessel where the PICC is dwelling. This damage may lead to phlebitis or thrombus formation.
Are there certain medications that should not be given through a peripheral IV?
Medications and solutions that have a pH less than five or more than nine or an osmolality greater than 600 mOsm/L, continuous vesicant therapy, and parenteral nutrition should not be given through a peripheral or a midline device.
Can a peripheral IV be used to obtain blood samples?
If the expected dwell time of the device is less than 48 hours, and the device is used only for blood sampling, yes. Otherwise, blood samples should be obtained only at the time of insertion.
Can a transparent semipermeable membrane (TSM) dressing be used to stabilize a catheter?
A TSM is a dressing only, and cannot stabilize or secure a catheter. Appropriate materials are those devices specifically designed for securement, such as manufactured catheter stabilization devices, surgical strips and sterile tape.
Additional Resources
A school, hospital, or local librarian will be able to assist with a literature search and may have access to subscriptions that are unfamiliar to the nurse. A librarian can also guide you in the process of searching databases to find the evidence-based practice and research articles that can help answer your question. Here are some additional online resources:
Lippincott Williams & Wilkins’ NursingCenter.com
Created by nurses, for nurses, Lippincott’s NursingCenter.com is the premier destination site for your clinical and professional informational needs. You will have access to more than 50 leading peer-reviewed nursing journals as well as other specialty journals.
PubMed Central (PMC)
PMC is the U.S. National Institutes of Health (NIH) free digital archive of biomedical and life sciences journal literature.
Google Scholar
Google Scholar is a free Web search engine that provides a search of scholarly literature across many disciplines and sources.
Exclusive for Members
Members of INS have exclusive access not only to the Journal of Infusion Nursing archives, but also to many other archived INS publications, including the bimonthly membership newsletter, INS Newsline. Log in as a member to review the contents for each publication for help in finding the information you seek.
Still can’t find your answer?
Follow the instructions for members and nonmembers to submit your question to the INS Nursing Network.
Members: Log in to the Membership-Exclusive section using your username and password. From there, click the link to the “Membership Exclusive INS Nursing Network,” review additional Clinical Practice Questions, and follow directions for submission if you cannot find the answer to your question online.
Nonmembers: Submit your question to the INS Nursing Network through the INS Nursing Network Nonmember Submission Form. While nonmember requests are important to us, INS members will receive first priority. Priority use of the INS Nursing Network is a membership benefit. We strongly encourage nonmembers to join INS.
