The Infusion Therapy Standards of Practice¹ is a comprehensive evidence-based guide to all facets of infusion therapy in all care settings. It is revised every 3 years based on the rapidly evolving body of clinical evidence. This summary covers recommendations related to vascular access securement, vascular access post-insertion care, minimizing risk of catheter-associated skin injury, and quality improvement. 

Standard 39: Vascular Access Device Post-Insertion Care (p. S131-S135)

This standard emphasizes the routine assessment of the entire infusion system for integrity, accuracy, and identification of complications. It also highlights the need for regular assessment of Vascular Access Device (VAD) necessity and prompt removal when complications persist or treatment is no longer needed. Proper site care, including skin antisepsis and dressing changes, should be conducted at regular intervals and immediately when the site is compromised.
 

Practice Recommendations

• Change transparent semipermeable membrane (TSM) dressings at least every 7 days (except neonatal patients) or immediately if dressing integrity is dis­rupted (eg, lifted/detached on any border edge or within transparent portion of dressing; visibly soiled; presence of moisture, drainage, or blood) or evidence of compromised skin integrity under the dressing, and following manufacturer’s instruction for use. (Level III)
• Change sterile gauze dressings every 2 days or earli­er if dressing integrity is disrupted (eg, if damp, loose, or visibly soiled). (Level III)
• Consider the beneficial use of gum mastic liquid adhesive on adult patients when enhanced adhesive dressing adherence is needed (eg, diaphoresis). (Level III)
• Select the type of sterile dressing considering factors such as the type of VAD, risk of bleeding or infection, skin condition, known allergies or sensitivities, patient size, patient preference, cost, sterility, wear time, and ease of use of dressing, with the goal of selecting and applying a dressing that will have minimal dressing disruptions, as multiple dress­ing changes increase the risk of infection. (Level I)
• Use a securement method to stabilize and secure VADs, considering a bundled approach. (Level I)
• Use a dressing change kit to standardize the procedure and improve efficiency. (Level V)

Please note that these recommendations are not exhaustive and do not encompass all possible recommendations or best practices. Users are advised to refer to The Infusion Therapy Standards of Practice and facility-specific policies and procedures relevant to their care setting.

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Standard 55: Catheter Associated Skin Injury (p. S189-S195)

This standard describes recommendations for preemptive care to minimize the risk of catheter-associated skin injury (CASI). It emphasizes routine assessment of the VAD site, dressing, and securement for signs of skin injury. Additionally, it suggests implementing appropriate interventions to manage existing injuries and prevent further risk of CASI.

Practice Recommendations

• Change the VAD dressing promptly if soiled, not intact, or upon initial signs/symptoms of skin impairment. (Level III) Follow manufacturers’ instructions for use.
• Consider use of gum mastic liquid adhesive that is compatible with antiseptic and dressing products when enhanced dressing adherence is needed. (Level IV)
• Use medical adhesive remover per manufacturer instructions and adhering to Aseptic Non Touch Technique (ANTT®). Use additional precautions with dressing and securement removal for patients at high risk for skin injury. (Level III)
• Employ quality improvement measures to monitor and address incidence of CASI. Monitor current evidence to explore options. (Level IV)

Standard 36: Vascular Access Device Securement (p. S120-S123)

This standard emphasizes the importance of securing access devices to prevent complications related to dislodgement and movement at the insertion site. It specifies that the methods used for securing the VAD should not hinder the ability to regularly assess and monitor the access site or obstruct vascular circulation or the delivery of prescribed therapy.

Practice Recommendations

• Use a securement method, such as adhesive securement device (ASD), integrated securement device (ISD), subcutaneous anchor securement system (SASS), or tissue adhesive (TA), in addition to the primary dressing, to stabilize and secure VADs. Inadequate securement can cause dislodgement and complications requiring premature removal. (Level I)
• Avoid the use of sutures, as they are not an effective alternative to a securement method; sutures are associated with needlestick injury, support the growth of biofilm, and increase the risk of catheter-associated bloodstream infection (CABSI). (Level III)
• Evaluate the potential for clinical and fiscal efficacy of SASS for PICCs and CVADs, including both tunneled, cuffed and tunneled, noncuffed catheters in adult and pediatric patients. (Level III)
• Assess the integrity of VAD securement with each dressing change and change the securement device according to the manufacturers’ directions for use. Remove ASDs with each dressing change to allow for appropriate skin antisepsis and apply a new ASD. TA should be reapplied at each dressing change. A securement device designed to remain in place for the life of the VAD (eg, SASS) does not need to be removed and replaced regularly with each dressing change; however, it should be assessed during catheter care and management to ensure its integrity. (Level I)

Standard 6: Quality Improvement (p. S33-S37)

This standard focuses on implementing Quality Improvement (QI) activities to enhance safety and excellence in infusion therapy and VAD insertion and management. It emphasizes the importance of QI programs that include surveillance, aggregation, analysis, and reporting of patient quality indicators and adverse events. Clinicians are expected to take action as needed to improve practices, processes, and/or systems based on the findings of these programs.

Practice Recommendations

• Clearly define the aims of the quality improvement project and the metrics for success.
• Use audit and real-time feedback when implementing changes in practice.
• Use consistent data definitions during data collection activities to allow for meaningful comparisons. (Level V)
• Include process as well as outcome measures when planning metrics for performance evaluation. (Level II)
• Consider adopting technology for consistency and ease of use during rounding and audit activities. (Level IV)
• Consider expanding surveillance to include hospital onset bacteremia as a broad-quality metric. (Level IV)