History of Infusion Therapy

Sharon M. Weinstein

EARLY HISTORY AND METHODOLOGY

Almost 400 years have passed since the discovery of blood circulation. William Harvey’s 1628 research stimulated increased experimentation, and he found that the heart is both a muscle and a pump.

Renaissance Period

In 1656, Sir Christopher Wren, the famed architect of St. Paul’s Cathedral in London, injected opium intravenously into dogs. Wren, known as the father of modern intravenous (IV) therapy, used a quill and bladder. In 1662, Johann Majors made the first successful injection of unpurified compounds into human beings, although death resulted from infection at the injection site.

In 1665, an animal near death from loss of blood was saved by the infusion of blood from another animal. In 1667, a 15-year-old Parisian boy was the first human to receive a transfusion successfully; lamb’s blood was administered directly into the boy’s circulation by Jean Baptiste Denis, physician to Louis XIV (Cosnett, 1989). The enthusiasm aroused by this success led to promiscuous transfusions of blood from animals to humans with fatal results, and in 1687, by an edict of church and parliament, animal-to-human transfusions
were prohibited in Europe. Nearly 150 years passed before serious attempts were again made to inject blood into people.

The 19th Century

James Blundell, an English obstetrician, revived the idea of blood transfusion. In 1834, saving the lives of many women threatened by hemorrhage during childbirth, he proved that animal blood was unfit to inject into humans and that only human blood was safe. Nevertheless, there were safety concerns, and complications persisted, with infections developing in donors and recipients. With the discovery of the principles of antisepsis by Pasteur and Lister, another obstacle was overcome, although reactions and deaths continued.

The first recorded attempt to prevent coagulation during transfusion was in 1821 by Jean Louis Prévost, a French physician who, with Jean B. A. Dumas, used defibrinated blood in animal transfusions (Cosnett, 1989).

In the middle to late 19th century, increased knowledge of bacteriology, pharmacology, and pathology led to new approaches. Ignaz Semmelweis, a Viennese obstetrician, was the first to correlate the effect of hand washing on prevention of infection. Semmelweis is credited with a 90% reduction of maternal deaths between 1846 and 1848. Meanwhile, chemist Louis Pasteur was proving that bacteria were living microorganisms, although his ideas were challenged by many researchers and practitioners.

In 1889, William Halsted of the Johns Hopkins Hospital, in cooperation with Goodyear Rubber Company, introduced the use of surgical gloves in the operating theater. Ten years later, the use of rubber gloves was widely accepted as a means of protecting patients and physicians (Sutcliff, 1992).

In 1896, the H. Wulfing Luer Company of France developed the Luer connection, allowing the head of a hypodermic needle to be easily attached and detached from a glass syringe. This connection, which is composed of tapering male and female components, is still used today to attach various pieces in an IV line. These interlocking pieces allow practitioners to change IV bags, add additional drip lines, and attach the IV tubing to the needle with minimal discomfort to the patient.

French physiologist Claude Bernard is credited with experimental injection of sugar solutions into dogs. The precursor to modern nutritional support, Bernard’s experiments were followed by the subcutaneous injection of fat, milk, and camphor by Menzel and Perco in Vienna. Work in nutritional support remained at a standstill for many years.

Twentieth-Century Advances

In the 20th century, IV therapy advanced rapidly. Blood transfusions and parenteral fluids, which bypass the intestines, were administered, and parenteral nutrition became possible as well. Moreover, nurses became skilled in both administering and monitoring infusions.

TRANSFUSION THERAPY

In 1900, Karl Landsteiner proved that not all human blood is alike when he identified four main classifications. In 1914, sodium citrate was found to prevent blood from clotting (Cosnett, 1989), and since then, rapid advances have been made (Table 1-1).

TABLE 1-1 TWENTIETH- AND TWENTY-FIRST-CENTURY PROGRESS IN INFUSION THERAPY

Year	Significant Advancement
1900	Karl Landsteiner discovered three of four main blood groups
1914	Sodium citrate was first used to preserve blood Hydrolyzed protein and fats were administered to animals
1925	Dextrose was used as an infusate
1935	Marriot and Kekwick introduced slow-drip method of transfusion
1937	Rose identified amino acids essential for growth
1940	Disposable plastic administration sets were developed
1945	Flexible intravenous (IV) cutdown catheter was introduced
1950	Rochester needle was introduced
1960	Peripherally inserted catheter lines were introduced in intensive care areas
1963-1965	First success with hyperalimentation at the University of Pennsylvania
1964	First disposable intravenous catheter introduced by Deseret
1970	Centers for Disease Control (CDC) guidelines for IV therapy were published First edition of Plumer’s Principles and Practice of Intravenous Therapy was published
1972	Access with implanted ports was introduced
1972	The American Association of IV Nurses was organized by Ada Plumer, Marguerite Knight, and colleagues
1973	The professional society name was changed to reflect a more inclusive audience—National Intravenous Therapy Association (NITA) Broviac tunneled catheter was introduced
1976	Fat emulsions were used for nutritional support
1980	NITA Standards of Practice was published NITA National Office opened IV Nurse Day was recognized by U.S. House of Representatives
1981	CDC Guidelines were revised and published
1982	Implantable ports were used for long-term access First IV teaching program in People’s Republic of China
1983	Home blood transfusion initiated Osteoport was developed
1984	Core Curriculum for Intravenous Nursing was published
1985	Intravenous Nurses Certification Corporation offered its first credentialing examination (CRNI)
1986	Use of patient-controlled analgesia increased
1987	Development by the Centers for Disease Control and Prevention (CDC) of “standard precautions”
1987	NITA changed its name to the Intravenous Nurses Society (INS)
1990	Safe Medical Device Act and Food and Drug Administration Device Reporting regulations published INS Revised Standards of Practice published
1992	U.S. Food and Drug Administration issued alert concerning needlestick injuries
1995	Occupational Safety and Health guidelines for handling cytotoxic drugs published
1996	LPNI examination offered to LPN/LVNs by INS CDC Guidelines revised and published
1998	INS celebrated its 25th Anniversary (Houston, TX)
1999	Journal of Intravenous Nursing offered CE/recertification units
2000	Core Curriculum for Intravenous Nursing, 2nd edition, published Revised Standards of Practice published INS Policies and Procedures Manual published CRNI Exam Preparation Guide & Practice Questions published First public member added to the INS board of directors
2001	The organization’s name again changed to the Infusion Nurses Society reflecting the expansive role of the infusion nursing specialist
2002	Publication of the CDC Guidelines for the Prevention of Intravascular Catheter-Related Infections supporting the use of trained personnel
2003	Core Curriculum for Infusion Nursing, 3rd edition, published Infusion Nurses Society celebrates its 30th year
2004	Infusion Nurses Society Standards for Adult Patients published
2005	Revised Infusion Nurses Standards of Practice published
2006	Plumer’s Principles and Practice of Intravenous Therapy, 8th edition, published
2006	Revised Infusion Nurses Standards of Practice published
2006	Initiation of central line bundling recommendations by the Institute for Healthcare Improvement
2011	Policies and Procedures for Infusion Nursing, 4th edition, published by the Infusion Nurses Society
2011	Revised Infusion Nurses Standards of Practice published
2012	Policies and Procedures for Infusion Nursing of the Older Adult published by the Infusion Nurses Society
2013	Infusion Nurses Society celebrates its 40th year where it began
2014	Plumer’s Principles and Practice of Infusion Therapy, 9th edition, published with a name change to reflect current practice and a co-author