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DJD
2016 INS Standards

I received an e-mail about errors in the 2016 standards and that a new copy of the standards will be sent. Does anyone know if there were more than the two errors we were notified about? I scanned through the standards and see that osmolality was increase to 900 for central access. I could contact INS to see what content was changed rather than searching and comparing 2011 and 2016 standards.

Lynn, I thought you could possibly comment on this.

Thanks,

Dave

lynncrni
 900 mOsm per liter is

 900 mOsm per liter is correct. The 2 errors were in the printing process, not the actual considertion of the content. In one formula, 100 was used instead of 1000. In one other location 5% was used instead of 0.5%. The information was correct when it was sent from INS to the publisher. Lynn

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

pallik
I've not received the 2016

I've not received the 2016 Standards as yet. Are they no longer part of our membership? I've tried calling and am waiting for an email response from them

lynncrni
 Have you received your Jan

 Have you received your Jan-Feb issue of the JIN? They were packaged and mailed together. After they were mailed out, a couple of printing errors were found, so they are now being reprinted and will be mailed again to all INS members. Lynn

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

RTerryJonesRN C...
RTerryJonesRN CRNI VA-BC's picture
2016 INS SOP

Lynn,
Was the language on the "Empowered Observer" and a checklist with CVAD insertion omitted?

R. Terry Jones, RN, CRNI, VA-BC

Memorial Hermann Northeast Hospital

Humble, Texas

lynncrni
 Not omitted at all. See page

 Not omitted at all. See page S65. Standard 33 Lynn

 

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

RTerryJonesRN C...
RTerryJonesRN CRNI VA-BC's picture
Empowered Observer

Thank you Lynn, I like the way it is worded also.

R. Terry Jones, RN, CRNI, VA-BC

Memorial Hermann Northeast Hospital

Humble, Texas

Toni T.
Ointment

I could not find the use of petroleum based ointment with CVAD removal in the new guidelines.  Was that removed as a standard?

lynncrni
 Standard 50 Air Embolism

 Standard 50 Air Embolism

Lynn

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

pH changes in the new standards book

Lyn, INS "used" to say that pH should be between 5 and 9 to safely go into a short term peripheral IV catheter. What standard not speaks to extremes in pH?

lynncrni
 #26 VAD Planning Lynn  

 #26 VAD Planning

Lynn

 

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Butttttt...

Standard 26 does NOT even mention the pH. Do the standards review the pH "extremes" anywhere? Or, should the 900 Osmolarity be the consideration. I know that I've read research where the pH findings in 2011 standards were erroneous.

lynncrni
 The pH parameters of 5 to 9

 The pH parameters of 5 to 9 were removed based on a thorough literature review published by Gorski - #7 on the reference list for Standard 26. 

Osmolarity was increased to 900, based on included references. One of those references is from ASPEN, an organization that also recommends 900 mOsm for parenteral nutrition. 

Lynn

 

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Wendy Erickson RN
I did not receive an email

I did not receive an email about errors. How do I find out what the errors were? I did receive the second copy of the standards but did not understand that it was because of errors.

Wendy Erickson RN
Eau Claire WI

lynncrni
 A page in the front explains

 A page in the front explains the 2 errors. 

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

jeffrn
Picc replacement

Has anyone ever heard of a standard or practice where a patient already has a properly functioning double lumen Picc being used for hydration and ABX therapy and a new order was written starting the patient on TPN and the attending is demanding that the old Picc be removed and a new one inserted over the wire because when TPN is initiated it must always be initiated with a new PICC. This MD can't provide any inhouse documentation or written policies to support his point and I don't see any need to pull a perfectly functioning Picc just because TPN has been started on a Picc that is only one month old ? 

lynncrni
 This physician will never

 This physician will never find any studies or other evidence supporting the need for a "virgin" line for any PN formula. This concept is out there but it is not evidence-based practice. I think these people are confusing a "virgin" catheter with a dedicated catheter or lumen. Dedicated lumen meaning that PN is the only solution infusing through the lumen. A dedicated lumen is preferred for 2 reasons - compatibility between the PN components and any medication given through the lumen and the increased manipulation increasing the risk of BSI. It might be possible that an existing catheter has intraluminal biofilm and the glucose in PN would provide more nutrients for it to grow and increase the risk of BSI, but I have never seen any standards, guidelines, or recommendations or even any studies supporting the need for a virgin line for PN. Dedicated lumens are preferred though. In this case you would need to put the fluids and medications through one lumen and the PN through another. Lynn

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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