Table 4 Clinical practices around SIVAD that can be provided to patients by nurses as outlined in the clinical nursing practice guideline

1. Engage in standardized and comprehensive discussion on the risks of self-injection of non-prescribed substances into vascular access devices (SIVAD)

2. Primarily discourage SIVAD and encourage use of alternate injection techniques (e.g. venipuncture, muscular injection)

3. Complete a standardized documentation template (located in the hospital electronic medical record) that an informed discussion took place

4. If the patient decides to engage in SIVAD despite risks and alternate route suggestions, offer education on safer sterile injection techniques and provide sterile supplies, including saline flushes and alcohol swabs

5. Facilitate nursing communication about SIVAD activities to other providers, including Addiction Medicine and Infectious Disease clinicians, so that ongoing medical indication for the VAD can be assessed, and substance use disorder, withdrawal and cravings can be assessed and treatment optimized