INS Standards of Practice Outline

An updated version of the Infusion Therapy Standards of Practice (8th edition) was recently published in the Journal of Infusion Nursing (Volume 44 January/February 2021). As a manufacturer of medical devices, Moog Medical is proud to support and endorse the INS Standards and recognize the important work of the Infusion Nurses Society (INS). This organization, in collaboration with the National Home Infusion Agency (NHIA) and contributing clinical professionals, oversees the needs of the patients receiving infusion therapy to ensure that the best possible care is delivered to patients through best practices.

To assist you in providing the best possible patient care, this article will review a few important infusion nursing standards (INS) updates and how they relate to Moog Medical’s CURLIN Infusion Pump products.

When using a CURLIN Infusion Pump, it is important to understand how the pump and administration sets work together to provide the patient with a safe and effective ambulatory infusion option. Flow-control devices, as outlined in the INS Standard 24.1, should be selected “based upon factors including the prescribed infusion therapy, rate control requirements, infusion-related risks, patient care setting, and available resources within the organization.”

Best practice recommendations for use of electronic infusion pumps include many safety considerations. Two of these considerations include Education and Administration Set Management.

 

Education

Standard 8: Patient Education

Patient Education is defined in the INS Standards as:

8.1 “The patient/caregiver is educated about the prescribed infusion therapy and plan of care including, but not limited to, the purpose and expected outcome(s) and/or goal(s) of treatment, expected duration of therapy, risks and benefits, infusion therapy administration, VAD options and expected care, potential complications, adverse effects associated with treatment or therapy, and how to access health care services as needed.”

8.2 “Teaching strategies and learning materials are congruent with the knowledge and skills being taught and encompass patient/caregiver learning needs, abilities, and resources.”

The importance of understanding how to use an infusion pump and teaching patients and their caregivers how to manage their infusions and equipment, is also mentioned in Section Two: “Patient and Clinician Safety” and defined in Standard 12 and Standard 24.

 

Standard 12: Product Evaluation, Integrity and Defect Reporting

12.2 “Clinician and end users attain and maintain knowledge about developments and technologies relating to VADs, infusion products, and equipment to meet evidence-based standards.”

CURLIN pump training materials, education, and resources are available, free of charge, to all of our customers, including clinicians and patients using the CURLIN pump. Clinician training and education programs have been developed to assist the clinician in attaining and maintaining knowledge about the CURLIN pump and its use. Training tools are also available to assist the clinician in providing patient teaching.

 

Standard 24: Flow-Control Devices

The INS Standards and guidelines help us understand that the importance of education is paramount. Without receiving proper education, a patient or caregiver could experience a life-threatening injury. Becoming familiar with the CURLIN pump and administration sets, by participating in CURLIN pump clinical training programs and providing proper teaching and training to patients and caregivers using the CURLIN pump, will meet these standards.

Clinicians are responsible for teaching and training the end user, to prevent injury by:

1. Inspecting equipment and reporting issues
2. Troubleshooting potential issues
3. Providing education and training for use of the product/equipment
4. Utilizing the product manufacturer for education and clinical support

Moog Medical is committed to providing outstanding educational resources related to our products and accessories. Our clinical team is available by phone, 24/7 for pump-related education, troubleshooting, and assistance. Our website provides educational resources such as: training videos, clinical programming and troubleshooting guides, and a virtual CURLIN pump tour for a simulated “hands on” experience. We also offer CURLIN pump livestream training and eLearning programs, designed to support new and existing customers. These tools will assist you with your professional education, as well as when providing patient teaching- as outlined in the INS standards.

 

Standard 13: Medication Verification

The CURLIN Infusion Pump is capable of providing additional patient safety, through the Protocol Library Safety Software (PLSS) or Drug Error Reduction Software (DERS), as mentioned in Standard 13:

“Use electronic infusion pumps that include dose error reduction systems ([DERS] ie, smart pumps) with current and relevant drug libraries, as these are associated with reduced risk for infusion-related medication errors, including error interceptions (eg, wrong rate) and reduced adverse drug events.6,45,46 (II)”

Using a PLSS drug library with the CURLIN pump reduces the risk of a medication error by allowing a specific patient’s prescription with unique identifying information, dose/rate limits (MedLimits), and advisories- including specific drug protocols, to be downloaded to the CURLIN pump for a patient’s therapy. Pharmacists and providers are able to build and manage their own drug libraries based on their patient population and each patient’s needs.

 

Administration Set Management

Standard 43: Administration Set Management

Updated safety information, related to Administration Set management, has been added in Standard 43.

Utilizing proper priming technique, filter selection, and Aseptic Non Touch Technique (ANTT) with CURLIN administration set use/management recommendations will decrease the risk for patient harm. It is important to follow the package insert instructions for use (IFU), located in each CURLIN administration set, for proper priming technique, including filter position, during priming.

Loose CURLIN administration set tubing may create a trip hazard and increase the risk of strangulation. Coil and secure the excess length of tubing to prevent an accidental trip, fall, or traumatic removal from patient. The small blue vented caps, located at the distal end of the CURLIN tubing, may pose a risk for choking.  Keep all small parts away from at-risk individuals, including children and pets. Use only approved CURLIN administration sets. Use of non-CURLIN administration sets could result in air infusion, under delivery, over delivery or free flow, that could result in patient harm.

Adherence to Standard 43, will reduce the risk for patient harm.

43.1 “Administration set changes are performed with adherence to Standard-ANTT at a frequency based upon factors such as patient condition, type, rate, and frequency of solutions administered, immediately upon suspected contamination, when the integrity of the product or system has been compromised, and when a new VAD is placed.”

43.2 “Administration sets are of a luer-lock design to ensure a secure connection, reduce manipulation, and minimize the risk of leaks, disconnections, or misconnections.”

43.I.L. “Minimize risk of strangulation or entanglement related to the use of administration sets. Research is needed to test preventative strategies such as individual risk assessment, ongoing assessment of need for continuous vs intermittent infusions, increased supervision or video surveillance, avoiding use of extension sets, coiling excess tubing, and use of accessories to stabilize flexible lines (eg, clear plastic sleeve over administration set).”

43.I.K. “Trace all catheters/administration sets/add-on devices between the patient’s access device and the solution container before connecting or reconnecting any infusion/device, at each care transition to a new setting, or service, and as part of the hand-off process.”

 

Standard 43: Set Change Frequency

A frequently asked question regarding our CURLIN administration sets is: “How long can a CURLIN administration set be used?” CURLIN administration sets and sets with filters are tested for use up to 72 hours. This testing includes delivery accuracy and set functionality.  Both of which can be affected if CURLIN sets are used longer than 72 hours.  The INS recommendation, for primary and secondary continuous infusions, not containing lipids, blood, or blood products, are outlined as follows:

43.II.A. “Replace primary and secondary continuous administration sets used to administer solutions other than lipid, blood, or blood products no more frequently than every 96 hours but at least every 7 days (unless otherwise stated in manufacturers’ directions for use), when the VAD is changed, or if the integrity of the product or system has been compromised.”

43.III.A. “Change intermittent administration sets every 24 hours.”

43.IV.A. “Replace administration sets with inline and add-on filters for PN solutions (with or without lipids) every 24 hours or with each new PN container.”

 

Standard 35: Filtration

If the CURLIN administration set includes an air-eliminating filter, refer to the administration set instructions for use (IFU) for proper filter positioning during priming. Also consider the type of therapy being delivered, medication protocol, and patient risks, when selecting an administration set with a filter. New information from ASPEN related to filter selection and use with TPN Infusions include the following information:

35.1: Parenteral Nutrition (PN) solutions are filtered using a filter appropriate to the type of solution:

G: “ASPEN published new recommendations for filtration that states: Use a 1.2-micron filter for all PN solutions including PN solutions with lipids [“total nutrient admixtures” (TNA)], dextrose-amino acid admixtures, and lipid injectable emulsions. To align with ASPEN, this new recommendation supersedes the INS Practice Recommendations for the use of 0.22-micron filtration for non-lipid solutions. Specifically, this revised guidance impacts Standard 35, Filtration, Practice Recommendation G (page S103)1 and Standard 63, Parenteral Nutrition, Practice Recommendation B1 (page S190).”

“Why is filtration of PN solutions critically important?  What are the clinical consequences of particulate matter? In-line filters were initially developed for infection control purposes, but their role in protecting patients from the harmful effects of particulate matter has emerged as their primary purpose in infusion therapy. The main consequence of particulate matter is to the lungs. Symptoms may include fever, dyspnea, cough, respiratory failure, and even sudden death. Notably, when medications are co-infused with PN, there is an even greater increase in particulate matter. In 1994, the US Food and Drug Administration (FDA) issued a safety alert regarding patient deaths related to calcium-phosphate precipitation in PN solutions that led to microvascular pulmonary emboli.5 As a result, ASPEN worked in collaboration with the FDA to develop the filtration recommendations. Filtration poses challenges such as decreased flow rates, occlusion alarms and air locks. Cost has also been cited as a barrier to consistent use. Use of only 1.2-micron filters reduces the risk of errors associated with using 2 different types of filters not only by nurses but also by home care patients receiving PN and reduces cost. ASPEN provides procedural steps for the use of filters. In addition to the Position Paper, ASPEN has created a 2-page fact sheet that includes best practices for filter use, helpful illustrations, and guidance in trouble-shooting high pressure/occlusion alarms and potentially occluded filters.6”

For more detailed information and citations, please see the fact sheet www.nutritioncare.org/uploadedFiles/Documents/Guidelines_and_Clinical_Resources/IV-Filters-For%20PN-Factsheet.pdf

 

Summary

Thank you for taking the time to review these INS Standards updates and for understanding the importance of using these standards with the CURLIN Infusion Pump and administration sets in a clinical setting. By familiarizing yourself with this information and attaining knowledge to help keep your patients safe, you have already utilized the “Education” piece of this article. If you have any questions about this article or would like additional information about the CURLIN Infusion Pump and administration sets, please reach out to us, anytime. Our goal as the manufacturer is to support you, as you become familiar with and confident using the CURLIN pump.