Competency and Competency Validation in Vascular Access

Establishes the standards, framework, and requirements for initial and ongoing competency assessment and validation for all clinicians performing vascular access and infusion therapy procedures, including educational delivery methods, simulation requirements, insertion training protocols, and program evaluation metrics.

policies•Jan 2026•Education

Competency and Competency Validation in Vascular Access Policy

1. Policy Statement

It is the policy of this organization that all clinicians who perform, assist with, or manage vascular access devices and infusion therapy shall demonstrate documented competency prior to practicing independently and shall maintain that competency through ongoing validation driven by clinical data, regulatory requirements, and technological change.1234 No clinician shall perform a vascular access procedure independently without documented evidence of initial competency validation on file. Competency is measured by demonstrated performance, not by a specific number of procedures performed or years of experience.567

2. Purpose

This policy exists to:

  • Protect patients and the public by ensuring that all clinicians performing high-risk, invasive vascular access procedures have been objectively assessed and validated as competent before practicing independently.
  • Establish the framework for both initial competency assessment (during orientation, role transitions, and practice expansion) and ongoing competency validation (driven by clinical data, sentinel events, and regulatory requirements).
  • Define the required educational delivery methodology, including a blended learning approach incorporating didactic instruction, observation, simulation, and supervised clinical performance.
  • Mandate specific safety requirements for vascular access device insertion training, including the absolute prohibition of invasive practice on live human volunteers.
  • Ensure that competency programs address health equity through the use of diverse anatomical training models and culturally competent care education.
  • Define the metrics by which the competency program itself is evaluated for effectiveness.

3. Scope

This policy applies to:

  • All employees, contracted staff, agency personnel, students, and trainees who perform any vascular access or infusion therapy task within the organization, including but not limited to: peripheral IV insertion, PICC insertion, CVAD management, blood specimen collection from vascular access devices, infusion pump programming, medication administration via vascular access, dressing changes, catheter flushing and locking, and vascular access site assessment.
  • The Clinical Education Department, Vascular Access Specialist Team leadership, unit-based educators, preceptors, and all personnel who serve as competency evaluators.
  • All clinical settings within the organization.

4. Policy Requirements

4.1 Foundational Standards and Accountability

4.1.1 Mandatory Pre-Practice Validation. Competency shall be verified, documented, and on file before any clinician performs a vascular access task independently. No exception exists for seniority, prior experience at another institution, or self-assessment of proficiency. Clinicians transferring from another organization must complete the organization’s validation process, although prior experience and certifications may inform the pace and depth of the assessment.8910111213

4.1.2 Personal Professional Responsibility. Each clinician bears personal accountability for maintaining their skills within their legal scope of practice and specific clinical environment. Clinicians shall self-identify when they have not performed a specific procedure for an extended period or when they feel their competency has degraded, and shall proactively seek re-training and re-validation.

4.1.3 Interprofessional Program Design. Competency assessment programs shall be designed collaboratively with input from multiple disciplines, including Vascular Access Specialists, Infection Prevention, Pharmacy, Physician Champions, and Clinical Education, to reflect the team-based nature of modern vascular access care.1415

4.2 Initial Competency Assessment

4.2.1 Initial competency assessment is mandatory during the following circumstances:

New Employee Orientation. All newly hired clinical personnel whose role includes vascular access tasks—whether new graduates or experienced clinicians—shall complete the organization’s initial vascular access competency program during orientation and before practicing independently.161718

Role Transitions. When a clinician transitions to a new role, unit, or specialty that requires vascular access skills not previously validated (e.g., moving from a medical-surgical unit to critical care, or from general nursing to a vascular access specialist position), a focused initial competency assessment for the new skills shall be completed.

Practice Expansion. When the clinical scope of a role is expanded to include new vascular access procedures (e.g., an RN beginning to insert PICCs, or a team beginning to administer hazardous medications via vascular access), all affected clinicians shall complete initial competency assessment for the expanded skill set before practicing independently.

System or Product Changes. When new institutional policies, procedures, or specialized medical products are introduced that materially change the way a vascular access task is performed (e.g., a new infusion pump platform, a new catheter product line, or a new antiseptic protocol), affected clinicians shall complete competency validation for the change.

4.2.2 The initial competency assessment shall include, at minimum: a written or electronic knowledge assessment, direct observation of the procedure or skill by a qualified evaluator, and successful demonstration of the skill meeting the organization’s minimum performance criteria.

4.3 Ongoing Competency Validation

4.3.1 Annual Validation. All clinicians performing vascular access tasks shall undergo ongoing competency validation at minimum annually. The specific skills selected for annual validation shall be determined by a data-driven needs assessment rather than a fixed, rotating checklist.192021

4.3.2 Data-Driven Focus. The Clinical Education Department, in collaboration with the VAGC and Quality Department, shall conduct an annual needs assessment to identify which competencies require focused validation. This assessment shall consider: analysis of clinical outcome data (complication rates, adverse events, near-misses), sentinel event investigation findings, patient satisfaction data, staff self-assessment surveys, regulatory and accreditation requirements, and new evidence or guideline publications.

4.3.3 Root Cause Analysis of Practice Gaps. When a competency gap is identified (through data analysis, direct observation, or event investigation), the organization shall conduct a structured assessment to determine whether the gap represents a knowledge deficit, a skill deficit, a process or system failure, or a motivational or behavioral issue. Interventions shall be targeted to the root cause.

4.3.4 Low-Frequency/High-Risk Skills. Procedures that are performed infrequently but carry significant patient risk (e.g., managing catheter embolism, responding to air embolism, managing extravasation of vesicant medications, troubleshooting rare catheter complications) shall require validation more frequently than annually, at minimum every six (6) months, using simulation-based methods.222324

4.4 Educational Delivery: The Four Phases of Mastery

4.4.1 The organization shall employ a blended learning approach organized into four sequential phases of mastery:

Phase 1 — Knowledge Acquisition. Building the theoretical and cognitive foundation through instructor-led sessions, e-learning modules, self-directed study materials, and peer-reviewed literature review. All educational materials shall be reviewed at minimum annually for currency and accuracy.2526272821429303132

Phase 2 — Observation. Structured observation of the procedure performed by an expert clinician in a real clinical or simulated environment. Observation may also be accomplished through expert-narrated video demonstrations. The learner shall have the opportunity to ask questions and discuss clinical reasoning during this phase.113334

Phase 3 — Simulation. Development and refinement of psychomotor skills using anatomical models, task trainers, and standardized simulation scenarios. Simulation allows for repetitive practice, error identification, and feedback without patient risk. All simulation exercises shall use validated, standardized checklists for performance evaluation.3522362337383940414243444546472448495051525354

Phase 4 — Clinical Performance. Performance of the skill on actual patients under the direct supervision of a qualified clinical evaluator. The evaluator shall use a standardized, objective competency validation tool to document the learner’s performance. The learner shall not transition to independent practice until the evaluator confirms that all critical performance elements have been met.455713

4.4.2 Mastery Learning Standard. If a learner’s performance falls below the organization’s minimum performance criteria during any phase, the learner shall not advance to the next phase. The learner shall repeat the deficient phase, receive targeted remediation, and be re-evaluated until a “mastery” rating is achieved. There is no limit on the number of repetitions; however, if a learner fails to achieve mastery after a defined number of attempts (specified by the Clinical Education Department), the learner’s eligibility for the procedure shall be reviewed by the Clinical Education Director and the VAGC.5649575859

4.5 Vascular Access Device Insertion Training

4.5.1 Competency in VAD insertion shall be measured exclusively by demonstrated performance quality, not by a specific number of procedures completed or years of experience.60616263586454

4.5.2 Non-Invasive Practice. Clinicians in training shall practice tourniquet application, vein identification by palpation, and the use of visualization technologies (ultrasound, near-infrared) on live volunteers. These non-invasive activities are permissible because they do not breach the skin.252627281565

4.5.3 Critical Safety Prohibition. Invasive procedures—including venipuncture, catheter insertion, blood specimen collection, and any procedure that breaches the skin—shall NEVER be performed on live human volunteers for training purposes. All invasive skill development shall occur exclusively on validated anatomical models, simulation task trainers, or cadaveric specimens (where permitted and with proper ethical oversight).126652

4.5.4 Supervised Clinical Transition. Following successful simulation performance, the learner’s first invasive procedures on patients shall be performed under the direct, bedside supervision of a qualified evaluator who has the authority and ability to intervene immediately if patient safety is at risk.675051

4.6 Specialized Considerations

4.6.1 Role Differentiation. The competency program shall clearly distinguish between the competencies required for general nursing vascular access tasks (e.g., PIV insertion, site assessment, medication administration) and the specialized competencies required for Vascular Access Specialist Team roles (e.g., ultrasound-guided insertion, PICC insertion, catheter clearance, complex troubleshooting).25262728606869 Each role shall have a distinct competency matrix.6552170

4.6.2 Contracted and Agency Clinicians. All agency, contract, travel, and per-diem clinicians shall meet the same competency standards as permanent staff. Before performing any vascular access task, contracted clinicians shall provide documented proof of current licensure, current competency validation for the specific tasks they will perform (from their agency or a recognized validation body), and any required certifications. If the contracted clinician cannot provide documentation meeting organizational standards, the organization shall conduct its own competency assessment before authorizing independent practice.7172

4.6.3 Health Equity in Training. Competency programs shall incorporate anatomical simulation models with various skin tones to ensure that clinicians are trained to accurately assess vascular access sites, identify complications (e.g., erythema, ecchymosis, infiltration), and visualize veins across the full spectrum of patient skin pigmentation. Educational materials shall address cultural humility and communication strategies for diverse patient populations.73

4.7 Program Evaluation

4.7.1 The effectiveness of the vascular access competency program shall be evaluated using the following five-level framework:

Level 1 — Learner Satisfaction. Post-training evaluations completed by the learner assessing the quality, relevance, and delivery of the educational experience.

Level 2 — Knowledge Gain. Pre- and post-training assessment scores demonstrating measurable improvement in cognitive knowledge.

Level 3 — Behavioral Change. Direct observation data and audit results demonstrating that training has translated into improved clinical practice at the bedside.

Level 4 — Patient Indicators. Analysis of clinical outcomes demonstrating that competency programs have contributed to measurable reductions in vascular access complications and infections.

Level 5 — Return on Investment. Financial analysis demonstrating the cost-effectiveness of the competency program, including cost-avoidance from reduced complications, reduced length of stay, and reduced liability exposure.

4.7.2 The Clinical Education Department shall report program evaluation results to the VAGC and organizational leadership at minimum annually.

5. Compliance

5.1 Monitoring. Compliance shall be monitored through annual audit of competency validation documentation for all clinicians performing vascular access tasks (target: 100% current validation on file), tracking of competency completion rates during orientation for new hires, monitoring of agency/contract clinician documentation compliance, review of simulation participation logs, and correlation of competency program participation with clinical outcome trends.

5.2 Enforcement. A clinician found to be performing a vascular access task without current documented competency shall be immediately removed from that clinical activity pending completion of the validation process. Willful falsification of competency documentation shall result in disciplinary action up to and including termination and may be reported to the applicable licensing board.

6. Exceptions

6.1 In a declared institutional emergency (e.g., mass casualty event, pandemic surge), the Chief Nursing Officer may authorize temporary competency waivers for specific low-risk vascular access tasks, provided that: the clinician holds a valid license, the clinician receives an abbreviated just-in-time training, and direct supervision by a validated clinician is maintained. Waivers shall be documented and shall expire upon resolution of the emergency or within thirty (30) days, whichever occurs first.

6.2 No exception shall be granted for the prohibition on invasive practice on live human volunteers.

  • SOP-VA-070: Initial Vascular Access Competency Assessment Procedure
  • SOP-VA-071: Ongoing Competency Validation Procedure
  • SOP-VA-072: Simulation-Based Training for Low-Frequency/High-Risk Skills
  • SOP-VA-073: Agency and Contract Clinician Competency Verification Procedure
  • POL-002: Scope of Practice and Professional Boundaries in Infusion Therapy
  • POL-001: Foundations of Clinical Practice and Specialized Population Management
  • Vascular Access Competency Validation Tool (by role)
  • Vascular Access Competency Matrix (General Nursing vs. VAST)
  • Simulation Scenario Library
  • Joint Commission Human Resources Standards (HR.01.05.03, HR.01.06.01)
  • Organizational Orientation and Onboarding Policy
  • Organizational Agency/Contract Staff Policy

8. Revision History

VersionDateAuthor(s)Description of Change
1.02026-02-01D. Woo, M. Stern, I.M. WrightInitial policy creation and approval
———Scheduled review date: 2027-02-01

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Teams can standardize this procedure with version control and compliance tracking.

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