GORSKI, Lisa A. et al. Infusion therapy standards of practice. J Infus Nurs. V.39, n. 1S, p. S1-S159, 2016.
These are exciting times in the fi eld of infusion practice. Never before has there been as much interest, technology, evidence, or cross-disciplinary collaboration in the fi eld as there is today. Whether it’s research that in-forms the safety of a particular vascular access device, guidance for when a device may be appropriate for use, or in-depth reviews of how best to prevent complications—the knowledge, data, and wisdom in our specialty are brim-ming. For infusion and vascular clinicians all over the world, there has never been a better moment to be on the front lines of patient care.
Yet, this progress does not come without a price, for with these times also comes great responsibility. For example, our patients have never been more complex in terms of their vascular access needs. Unlike times past, a dizzying array of devices, designs, and technology to meet nuanced needs (eg, power injection-capable midline catheters) or fill key niches (ultrasound-guided devices for patients with difficult access) are now available. The very health care system within which we all operate has transformed—improving in many ways, but also becoming more fractured and misaligned in others. As patients transition through the labyrinth of outpatient, hos-pital, and post-acute care settings, the imperative to do what’s right in their vascular access voyage has perhaps never been more urgent than it is today.
In this whirlwind of change, clinicians are expected to not only master the inser-tion, care, and management of vascular access devices but to also inform clinical decisions regarding device choice and venous access route. Although such opportuni-ties present a unique step forward for the field, they also introduce many new and unexpected challenges. For example, what should one do when limited evidence exists to guide clinical decision making? When available data do not support current practice, how should one approach the patient or provider so as to prevent harm? How may one learn, master, and implement the evidence to enact change in her or his facility? And relatedly, what practices are associated with improved outcomes, and which are relics of times past? In the endless quest to improve the care and qual-ity of infusion practice, knowing what we don’t know has become more important than ever before.
Highlighting how fortunate we have been to have the Infusion Therapy Standards of Practice serve as the bedrock of our field for so many years is not hyperbole. Rather, the Standards represents the best of our specialty: a tome within which excel-lence, expectations, and enigmas are not only defined but also primed and supported by available data and strength of the evidence. Whether the purpose lies in informing patient care, legal proceedings, or personal edification and growth, no document is more versatile, time-tested, or valuable in the field of infusion practice. As a review-er and contributor to this 2016 update, I am pleased to say the exulted tradition of the Standards continues. With new and improved sections on special patient popula-tions, the definition and role of infusion teams, vascular visualization technologies, and catheter tip location, the 2016 Standards incorporates and assimilates the many advances in our field within a single comprehensive document. Not only have new criteria for practice been added but substantial improvements to the key domains of infection prevention, phlebotomy, and device complications have been included. These significant enhancements reflect the growth in our field and the ever-changing expectations of the public in infusion care. The new Standards is thus not merely recommended, but required reading for any clinician interested in infusion or vascu-lar therapy.
As a physician researcher dedicated to improving the safety of patients who require vascular access and infusion-based therapies, the Standards has informed the work that I do, the questions I ask, and the clinical care I provide. Quite simply put, there is nothing else like it. This edition continues to provide us with critical answers to the many important questions, conundrums, and challenges we face today. I urge you all to read, evaluate, and adapt the recommendations within this document to your care and decision making. Your patients, practice, and society will thank you for it.
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