2018 Infectious Diseases Society of America Clinical Practice Guideline for the Management of Outpatient Parenteral Antimicrobial Therapy.

A panel of experts was convened by the Infectious Diseases Society of America (IDSA) to update the 2004 clinical practice guideline on outpatient parenteral antimicrobial therapy (OPAT) [1]. This guideline is intended to provide insight for healthcare professionals who prescribe and oversee the provision of OPAT. It considers various patient features, infusion catheter issues, monitoring questions, and antimicrobial stewardship concerns. It does not offer recommendations on the treatment of specific infections. The reader is referred to disease- or organism-specific guidelines for such support.

2018 Infectious Diseases Society of America Clinical Practice Guideline for the Management of Outpatient Parenteral Antimicrobial Therapy.

A panel of experts was convened by the Infectious Diseases Society of America to update the 2004 clinical practice guideline on outpatient parenteral antimicrobial therapy (OPAT) [1]. This guideline is intended to provide insight for healthcare professionals who prescribe and oversee the provision of OPAT. It considers various patient features, infusion catheter issues, monitoring questions, and antimicrobial stewardship concerns. It does not offer recommendations on the treatment of specific infections. The reader is referred to disease- or organism-specific guidelines for such support.

Update: The 2024 Infusion Therapy Standards of Practice.

The Infusion Therapy Standards of Practice provide evidence-based recommendations for infusion and access device related care in any healthcare setting. Developed and published by the Infusion Nurses Society, the Standards have increased the frequency of the revision process from an every 5-year cycle to a 3-year cycle due to the growing base of literature and to deliver the most updated and current practice recommendations. This article provides an overview of the development process and a brief description of selected standards. Notably, a new standard entitled Home Infusion Therapy was added in this latest edition. The Standards are an essential reference that should be available to every home care agency that provides home infusion therapy.

A Look at 2021 Infusion Therapy Standards of Practice.

The Infusion Therapy Standards of Practice provide evidence-based recommendations as published by the Infusion Nurses Society every 5 years. This article provides a brief overview of the development process and short summaries of selected standards with attention to highlighting the relevance to home care agencies and nurses. The Standards should be reviewed by any home care organization that provides home infusion therapy.

The Impact of Home Infusion Therapies on Caregivers.

OBJECTIVES: To describe the scope of home infusion therapy in cancer care, expectations related to caregiver involvement in home infusion therapy, literature addressing the impact upon caregivers, and nursing implications. DATA SOURCES: Published data on cancer care and home infusion therapy. CONCLUSION: While the administration of home infusion therapy is not uncommon practice for patients with cancer and is generally well-accepted, there is scant research focused specifically on the impact upon caregivers. IMPLICATIONS FOR NURSING PRACTICE: Caregiver support not only includes providing instruction in infusion-related tasks but also recognizing the potential impact on the caregiver's life and offering supportive interventions.

Antimicrobial Agents and Catheter Complications in Outpatient Parenteral Antimicrobial Therapy.

OBJECTIVES: Debate about whether certain antimicrobial agents traditionally considered vesicants increase the risk of catheter complications has led to uncertainty in venous catheter placement protocols. To understand whether patients requiring home-based outpatient parenteral antimicrobial therapy (OPAT) should receive peripheral catheters (e.g., midline catheters) versus central venous catheters, and to understand whether certain antimicrobial agents place home-based OPAT patients at higher risk for catheter complications, we investigated associations between antimicrobial agent(s) and catheter complications. METHODS: We performed a prospective cohort study of patients requiring home-based OPAT discharged from two urban tertiary care academic medical centers, including telephone surveys and chart abstractions. Multivariable Poisson regressions were used to evaluate: (i) associations between antimicrobial agents traditionally considered vesicants, based on pH or osmolarity, and catheter complication rates, and (ii) associations between antimicrobial agent and rates of catheter complications. RESULTS: Vesicant antimicrobials defined using pH or osmolarity criteria were not associated with an increased rate of catheter complications (adjusted incidence rate ratio [aIRR]: 1.63, 95% confidence interval [CI]: 0.89-2.96). Vancomycin was associated with an increased rate of catheter complications, as was daptomycin (aIRR: 2.32 [95% CI: 1.20-4.46] and 4.45 [95% CI: 1.02-19.41], respectively). Staphylococcus aureus infections were also associated with an increased rate of catheter complications (aIRR: 2.13, 95% CI: 1.09-4.19), as were midline catheters (aIRR: 9.44, 95% CI: 2.12-41.97). CONCLUSIONS: Our study supports recent guidance identifying vancomycin as a vesicant, among a subset of antimicrobial agents, and removal of pH criteria for identification of vesicants.

The 2016 Infusion Therapy Standards of Practice.

Approximately every 5 years, the Infusion Nurses Society publishes evidence-based practice standards. This article provides an overview of the process used in standards development, describes the format of the standards, and provides a short summary of selected standards as applied to home care. The Standards are an important document that should be available to every home care organization that provides home infusion therapy.

Development of an Evidence-Based List of Noncytotoxic Vesicant Medications and Solutions.

Infiltration of a vesicant medication, defined as extravasation, may result in significant patient injuries. The first step in preventing extravasation is the identification and recognition of vesicant medications and solutions. Because there is no list of noncytotoxic vesicants as established by a professional organization, the Infusion Nurses Society, as the global authority in infusion nursing, identified the need to address this gap. A task force was formed for the purpose of creating an evidence-based list of noncytotoxic vesicant medications and solutions.

Integrating standards into practice. Revised standards for home care infusion: what has changed?

In 2006, the latest revision of the Infusion Nursing Standards of Practice was published by the Infusion Nurses Society. The Standards define the scope of practice and educational requirements for nurses who practice in infusion therapy in all healthcare settings. This article provides a description of the Standards, including a discussion of 12 Standards to illustrate their application in home care.

Implementing Home Health Standards in Clinical Practice.

In 1986, the American Nurses Association (ANA) published the first Standards of Home Health Practice. Revised in 1992 and expanded in 1999 to become Home Health Nursing: Scope and Standards of Practice, it was revised in 2008 and again in 2014. In the 2014 edition, there are 6 standards of home healthcare nursing practice and 10 standards of professional performance for home healthcare nursing. The focus of this article is to describe the home healthcare standards and to provide guidance for implementation in clinical practice. It is strongly encouraged that home healthcare administrators, educators, and staff obtain a copy of the standards and fully read this essential home healthcare resource.

Intermittently delivered IV medication and pH: reevaluating the evidence.

The Infusion Nurses Society's Infusion Nursing Standards of Practice has treated pH as a critical factor in the decision-making process for vascular access device selection, stating that an infusate with a pH less than 5 or greater than 9 is not appropriate for short peripheral or midline catheters. Because of the Standards, drug pH is not an uncommon factor driving the decision for central vascular access. In this era of commitment to evidence-based practice, the pH recommendation requires reevaluation and a critical review of the research leading to infusate pH as a decisional factor. In this narrative literature review, historical and current research was appraised and synthesized for pH of intermittently delivered intravenous medications and the development of infusion thrombophlebitis. On the basis of this review, the authors conclude and assert that pH alone is not an evidence-based indication for central line placement.

Central venous access device outcomes in a homecare agency: a 7-year study.

Homecare agencies must collect, analyze, and report patient outcomes. Despite a critical need for data related to the incidence of infections and other complications related to central venous access devices (CVADs) among patients receiving homecare, this information currently is underreported and inconsistently collected by homecare agencies. Obstacles to data collection and analysis have been noted including inadequate information systems, underdeveloped infection control programs, and the lack of a universally accepted definition of a homecare infection. This descriptive survey reports 7 years of CVAD outcomes in a large, urban homecare agency. The data collection processes and definitions used in this survey are described. The reported outcomes include a relatively low incidence of CVAD-related infections, occlusions, and other complications. Demographic data, including types of home infusion therapies provided and patient self-care outcomes, also are described.

Peripherally inserted central catheters and midline catheters for the homecare nurse.

Peripherally inserted central catheters are the most common type of catheter used for homecare patients. Midline catheters offer a less invasive, cost-effective option for vascular access in some patients. Homecare nurses play a key role in teaching patients how to live safely with and manage these devices and must possess expert knowledge of catheter placement, standards of assessment, care and management, and potential complications.

A disease management program for heart failure: collaboration between a home care agency and a care management organization.

This article describes a collaborative approach to manage patients with heart failure between a home care agency and a care management agency. The resulting disease management program used a combination of home visits and phone contact. Care management plans emphasized patient education on increasing adherence to medical and diet regimens, and recognizing early symptoms of exacerbation that could lead to rehospitalization. Clinician activities and patient outcomes are described.

Central venous access device occlusions: part 1: thrombotic causes and treatment.

Many home care patients have central venous access devices to administer a variety of infusion therapies. Catheter occlusion is a potential complication. This month, catheter occlusion due to thrombotic causes is addressed. In many cases, thrombotic occlusions can be treated, sparing patients trauma and the expense of replacing the catheter. Thrombolytic drug therapy using the drug alteplase can be performed in the home setting to "declot" central venous access devices. Next month, occlusion due to nonthrombotic causes will be described.

Central venous access device occlusions: part 2: nonthrombotic causes and treatment.

Home care nurses commonly care for patients with central venous access devices (CVAD) for administration of a variety of infusion therapies. Catheter occlusion is a potential complication. In the February 2002 issue of the etiology and treatment of thrombotic occlusions were described. This month, the focus is on nonthrombotic causes of CVAD occlusion.

Effective teaching of home IV therapy.

In order to be successful teachers of home IV therapy, nurses need to have good technical and general nursing skills and also be familiar with the principles of adult development and learning.