Review of INS Standards Part 1 of 3: Nurse Expertise and Patient/Caregiver Education

The most recent edition of the INS Infusion Therapy Standards of Practice stresses the importance of nurse expertise, nonpharmacologic interventions, and patient and family education to create better outcomes.

The Infusion Nurses Society recently released the 8th edition of the Infusion Therapy Standards of Practice (INS Standards), a publication dedicated to providing health care providers the best and most up-to-date evidence-based research available on the delivery of safe and effective IV therapy.

This publication highlights the benefits of using complementary IV therapy interventions with standardized assessment practices because they’ve been shown to increase dwell times and reduce patient harm caused by common complications.

Over the next few months, we’ll highlight some of the recommendations regarding peripheral IV catheter insertion, protection, and joint stabilization from the INS Standards.

Starting with the basic, but highly important recommendations below, this advice will help you build a strong practice that operates from the set of proven guidelines.

In part one of this three-part series, we’ll address the importance of nurse vascular access expertise, reduction of patient anxiety, and the role of patient and family education in improving outcomes.

Nurse Expertise

The INS recommends that IV catheter insertion should be performed by a member of a skilled vascular access team when available, otherwise hospitals should use the most knowledgeable PIVC clinician on staff. Utilizing these experts ensures IV catheter insertion follows the same standard of care for each patient. (Standard 4) Point of interest: I.V. House was founded by a pediatric ER nurse with expertise in IV catheter insertion.

Anxiety Relief

In order to reduce pain and anxiety associated with IV therapy procedures, the INS Standards promote the use nonpharmacologic measures. (Standard 2) This is also a highlight from a position paper* published by PediNeoSIG, the pediatric specialty group of the Association for Vascular Access (AVA). Nonpharmacologic measures should be age appropriate; some of the suggested strategies for infants include swaddling, breastfeeding, pacifiers, and rocking.

Distraction, such as bubble blowing, peekaboo, or picture books are techniques suggested for toddlers. Tablets and virtual reality headsets during IV insertion can be helpful at distracting school age patients. Relaxation, breathing exercises, and the use of a vibrating cold device were also cited as effective methods for anxiety reduction. (Standard 32)

Pediatric patient with parents and nurse in hospital
Age appropriate education allows patients to alert health care providers if something seems amiss.
Pediatric patient with parents and nurse in hospital
Parents or other family members can be taught to spot early warning signs of IV therapy complications.

Patient Caregivers

Both the INS and AVA recommend educating patients and their caregivers (parents, guardians, family members, or other surrogates) and incorporating them into the care team. Educational messages should be age appropriate and address goals of IV therapy, signs of adverse reactions to medications, and the early warning signs of IV therapy complications such as changes in color, temperature, or swelling. (Standard 2, Standard 8

As we work with hospitals across the U.S., we’re encouraged to see these practices already in place in many of them. In our next blog post we’ll take a closer look at IV insertion site selection and preparation.

*Hovda Davis MB, Doellman, D, Pitts, S. Minimum Education and Training for Pediatric and Neonatal IV Insertion for all Clinicians. Position Paper; Association for Vascular Access. 2020, December

More in this series:

Part 2, INS Standards Provide Direction on IV Insertion Site Selection & Attempts

Part 3, INS Best Practices Include IV Insertion Site Protection & Joint Stabilization