Explore Nufactor’s updated standards for PIVs, ports, and central lines to support optimal patient care.
By Marianna Herrera - CNE - March 26, 2025

Home infusion therapy requires a high level of knowledge and proficiency in intravenous (IV) skills, including the insertion, management, and monitoring of peripheral IV lines , as well as expertise in central line accessing and management. Strong competency in both peripheral and central access devices is imperative in ensuring patient safety and optimal outcomes.

Nufactor’s peripheral intravenous (PIV) access standards

• Three (3) initial attempts. After 3 failed attempts, assess patient. If viable veins available, discuss the option of continuing further attempts with patient. If patient is agreeable, contact Nufactor pharmacy at 1-800-323-6832 for approval.
  • Implement appropriate interventions to optimize venous access such as warm compress, additional oral hydration, run arm under warm running water, gravity pooling of blood in arm, etc.
  • Advise Nufactor of patient’s willingness to continue. Nufactor will obtain verbal confirmation from patient to continue with additional peripheral access attempts.
• Single day courses - d/c PIV access after infusion
• Multiple day courses
  • PIV maybe left in place overnight or patient can choose to be accessed daily.
  • PIV can be left in place for up to five (5) days if no erythema or edema present.
  • Ensure patient has enough supplies to accommodate scenario.
  • PIV in forearms will last longer than more flexible/mobile areas.
  • After infusion is complete, clear line of infusate with NS and heparinize with heparin 10 units/mL. Nufactor standard orders for the volume of heparin vary by patient weight. D/C PIV on last day of infusion
  • Secure PIV in place with mesh sleeve or self-adhesive tape (available upon request), if PIV access left overnight.
  • Discuss and teach patient what to do in case of an accidental PIV removal.
  • Discuss, teach and monitor patient for signs/symptoms of infection/infiltration.

Nufactor’s implanted port access standards

• Three (3) initial attempts. After 3 failed attempts, assess patient. If viable veins available, discuss the option of inserting a PIV and administering medication peripherally. If patient is agreeable, after successful start of infusion, contact Nufactor pharmacy at 1-800-323-6832 to discuss options for port care/revision.
• According to the latest INS standards, patency may be evaluated through alternative signs, including ongoing clinical response to an infusing medication, lack of resistance to flushing, site evaluation, and patient symptom report. This assessment can assist in determining patency, especially when limited or no blood return is present. If patient verbalizes smelling, tasting or feeling the flush, this can essentially indicate patency and proper placement of line.
• Single day courses - de-access port after clearing line of infusate with NS and lock with heparin, if needed. Nufactor standard orders for the volume of NS and volume and strength of heparin vary by patient weight.
• Multiple day courses
  • Port can be stay accessed overnight or patient can choose to be accessed daily.
  • Port can stay accessed for up to seven (7) days if no erythema or edema present.
  • Ensure patient has enough supplies to accommodate scenario.
  • After each infusion is complete, clear line from infusate with NS and lock with heparin, if needed. Nufactor standard orders for the volume of NS and volume and strength of heparin vary by patient weight.
  • Transparent semipermeable membrane (TSM) dressing required to be changed:
    • If sterile gauze used under TSM for comfort or needle stabilization, change after 48 hours for infection control.
    • If TSM is not clean, dry and intact.
  • De-access port on last day after clearing line from infusate with NS and lock with heparin, if needed. Nufactor standard orders for the volume of NS and volume and strength of heparin vary by patient weight.
  • Discuss and teach patient what to do in case of an accidental de-access.
  • Discuss, teach and monitor patient for signs/symptoms of infection/infiltration.

Nufactor’s standards on midlines and peripherally inserted central catheters (PICC)

• Not typical/common practice for chronic/long-term condition home infusion.
• Change dressing weekly.
• After each infusion is complete, clear line from infusate with NS and lock with heparin, if needed. Nufactor standard orders for the volume of NS and volume and strength of heparin vary by patient weight.
• Discuss and teach patient what to do in case of an accidental de-access.
• Discuss, teach and monitor patient for signs/symptoms of infection/infiltration.

Specialty pharmacies do not all have one size fits all standards of practice (SOP). Having parameters allow nurses to be successful in autonomous positions. Nufactor’s clinical nurse educators contact every field nurse prior to providing services to any patient to review the most current SOPs. Nufactor’s SOPs are created by following recommendations from IgNS and INS standards and regularly updates them to ensure patients receives the best standard of care.

References

• Immunoglobulin National Society. (2024). Immunoglobulin therapy standards of practice (3.2 ed.).
• Nickel, B., Gorski, L., Kleidon, T., Kyes, A., Devries, M., Keogh, S., Meyer, B., Sarver, M. J., Crickman, R., Ong, J., Clare, S., & Hagle, M. E. (2024). Infusion therapy standards of practice (9th ed.). Infusion Nurses Society.