Developed by the Infusion Nurses Society (INS), the Infusion Therapy Standards of Practice emphasize routine IV site surveillance to ensure early detection and management of complications such as infiltration, extravasation, phlebitis, infection, and device malfunction. These standards rightly underscore the importance of regular and systematic assessment of the vascular access device (VAD) and infusion system.
However, while comprehensive, the INS guidelines are fundamentally reactive in nature—focusing on identifying signs of injury after they begin to develop, rather than using available technology to prevent harm in the first place.
For example, the Standards recommend visual inspection and palpation of IV sites and note that assessment frequency should be tailored to the patient population and therapy. But these manual checks are subjective, intermittent, and often insufficient—particularly in high-risk environments like pediatric, oncology, or critical care units. Clinicians are also taught to rely on indicators such as blood return and the ability to flush a line. But these are not definitive signs of a healthy IV. In fact, an infiltrated line may still offer both—a dangerous false sense of security that can delay necessary intervention.
These overarching INS recommendations can be extremely difficult to maintain in the current clinical environment, with high patient ratios, more experienced nurses retiring, consistent short staffing, decreases in supplies, and increases in patient complexity.
The INS acknowledges the use of near-infrared (nIR) technology for insertion in patients with difficult access. However, there is no mention of leveraging continuous monitoring technology to proactively track IV health after insertion, despite its proven ability to reduce harm. This is where ivWatch steps in.
ivWatch provides real-time, continuous monitoring of IV sites, detecting infiltration at volumes as low as 0.2 mL with 99% sensitivity in >10 mL. It acts as a “second set of eyes,” alerting clinicians the moment infiltration begins—long before it becomes visibly apparent to the naked eye and ultimately can cause tissue damage.
This proactive approach is especially crucial in vulnerable patients that cannot communicate discomfort or have fragile veins and patients receiving expensive or vesicant drugs (high or low pH drugs) that can cause harm to tissue immediately. IV extravasation injuries evolve over time and can progress rapidly creating necrotic tissue or permanent staining, which can lead to more severe adverse events.
In the UK, the National Infusion and Vascular Access Society (NIVAS) has already taken steps toward proactive prevention. Their national toolkit for infiltration and extravasation safety includes the designation of extravasation leads and the integration of continuous monitoring technology like ivWatch. Clinical evaluation at NHS Frimley Health Foundation Trust found:
· Extravasation incidents were twice as frequent as previously estimated
· 100% of extravasation injuries were prevented following ivWatch implementation
· Improved diagnosis accuracy and reduced misclassification of vascular injuries.
In a recent interview Nurse Consultant Andrew Barton noted:
“ivWatch has given the staff massive confidence around infusion therapy, but also the patients coming into the unit now. I can’t ask for more than for patients to feel safe during their infusion therapy—and that’s because of ivWatch.”
The INS Standards provide a solid foundation for infusion care, however with modern technology available, clinicians have the opportunity—and responsibility—to go further.
Let’s shift from a “wait and see” model to one rooted in early detection and prevention. Learn more about how ivWatch can help protect your most vulnerable patients, reduce complications, and raise the standard for infusion safety.