I just received my 2011 Standards of Practice and I must say I am disappointed about the wording on the use of ultrasound for PICC placement.  On page S41 it says under Practice Criteria  "D. The nurse should consider using visualization technologies that aid in vein identification and selection." I didn't expect the critieria to state you must use ultrasound, but I was hoping for a more strongly worded statement.  Our long term care pharmacies that we service for PICC placement use the Standards of Practice as their guidelines.  It is a little bit difficult to convince them that we need to use ultrasound as the standard for PICC insertion when the criteria is stated the way it is.  They want to use nurses who insert without ultrasound and my feeling is that there is just too much information out stating that this is NOT the way a PICC nurse should be practicing.

I welcome all comments.  

 

Robyn Whitlock RN, MSN, CRNI

IV Assist, Inc. 

2011 CDC guidelines will be

2011 CDC guidelines will be published in the AJIC hopefully in April. Since this is a government document, anyone can take it and do what they want with it for extraction, abstraction, condensing, etc. The Infusion Nursing Standards of Practice is copyrighted by the INS and condensing or comparing in any way would require permission from INS. I am not aware of anyone that has sought to do this and I would ***not*** recommend that it even be done. We spent an extraordinary amount of hours working on the verbiage to ensure it was accurate. Trying to condense it in any way could open the door for lots of misinterpretation. I do not believe that the document should be taken as a series of individual standards. The document should be used as a whole entitity as there are so many referrals within many standards to other sections in the document. Just my opinion, Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

INS and CDC guidelines

Kathy,

Thanks for the date on the CDC-HICPAC guidelines! At long last!  Does anyone know of any one or company that may be so kind as to be putting together a document that shows the changes in these documents?  In 2006 we were lucky enough to have that provided by a vendor and it was lovely to have a succinct document to aide us.  Unfortunately, the one from May 2010 for CDC is no longer accurate.

Lauren Blough, RN, BS, CRNI

 

Lauren Blough, RN, BS, CRNI, VA-BC
Clinical Development Manager
Biolife, LLC "Makers of StatSeal"

makes sense - great idea

makes sense - great idea about the ten commandments, that will help me to remember.  thanks.

 

No. Shall carries a greater

No. Shall carries a greater legal weight than should. All standard statements are shall - no shades of gray, no equivication. Think of the Ten Commandments, Thou shallt -----. Should is in all practice criteria statements with greater explanation and more caveats. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

OK, have a dumb question. 

OK, have a dumb question.  The verbage should vs shall.  Is should a strongly recommended practice while shall is left up to the discretion of the clinician/facility?

 

Thank you Lynn.   I did

Thank you Lynn.   I did notice the "should" instead of the shall.  This did help make it more clear!

CDC 2011

You will be happy to find thet the new CDC 2011 coming out April 1, 2011 mentions that ultrasound guided central line placement shoud be considered.

This is a first for CDC.  This will hep support the mandatory usage of ultrasound.

a PICC is a central venous catheter.

kathy kokotisRN BS MBA

We could not find any

We could not find any information about where the scale came from, or that it was tested to be reliable and valid. So we could not continue to recommend its use until it has been tested. I wrote this one and could not find any other scales in any literature that had been tested either. Some hospitals may continue to use the old one or may have another one they have created but not published. Another problem with the old scale was that it only represented signs and symptoms from infiltration, not extravasation and only for peripheral sites and not CVC sites, yet the problem occurs with both sites. I think references #7 & 8 have included a scale. Also notice that this scale is in the practice criteria with a "should" statement and not the standard statements with a "shall" verb. It may come down to how you define a "scale". If you have a list of signs and symptoms progressing from nothing to worst case, that could be considered to be a scale. So we are leaving this to each individual faclity to determine what is best for them since there is a lack of evidence for a workable scale. Hope this makes sense, Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Lynn, We are

Lynn,

We are reviewing/revising our guidelines and I guess I am confused by the statement that the "nurse should use a standardized scale for assessing and documenting infiltration/extravasation from all types of vascular access devices (VADs)", then they removed the old scale that had been in the last standards. 

What "standardized scale" are we to use for this now?  We had the old scale in our guidelines, but it sounds like we maybe shouldn't use it, especially since INS has officially removed it from their new edition.  Why did they choose to leave the statement that we should have a scale for this in the revision? 

You are correct - there is no

You are correct - there is no scale that has been validated for reliablity to grade infiltration and extravasation. We could find nothing in the literature. The old scale only included signs and symptoms for peripheral sites and not for CVC sites yet the problem occurs at both. There were also no details about extravasation vs infiltration. So this is an area where we need research to create a good scale and test it for reliability and validity. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Infiltration Scale

I just received a copy of the INS standards that were just published. I see that there is a  Phlebitis scale that should be followed. I do not see an Infiltration scale as we have seen in the past. Is that Infiltration scale no longer evidenced based? The wording in the new guidelines state "that a nurse should use a standardized scale for assessing and documenting infiltration/extravasation from all types of vascular access devices." Should we continue to use the scale as published in the previous standards?

Karen Ratz,RN St. Lukes Hospital, Cedar Rapids,IA

As far as I know you can only

As far as I know you can only get a paper copy from the web store.  If you are a member of the INS you get a copy sent with the January journal.  Theresa Reed

How to get them?

Can I buy the Standards as a pdf file on line? Will they be published in J of Inf Nurs? Or just as paper copy through the web store?

Thanks

Mats in Stockholm

2011 Standards of Practice

Lynn,

Thanks so much!  That makes me so happy!  This will really help us with our clients.

 

Chris, we tried sending articles but all our client would say is "All we use is the INS Standards of Practice."  So this will be extremely helpful.

 

Thanks again,

Robyn

Robyn Whitlock RN, MSN, CRNI

Look at page S45 PC C the

Look at page S45 PC C the standard on device placement. You were only looking at the standard on site selection. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Ultrasound

There are many published articles siting the advantages to the nurse for using ultrasound, proving higher success rates and better outcomes for the patients.  Many are posted under the downloads section of this website, and more can be found with a Google Scholar search.  Have you tried to use those articles to prove your point?  They can be very persuasive.  Good luck

Chris Cavanaugh, RN, BSN, CRNI, VA-BC