ASF Standards · Ambulatory Clinic · Standard 10

Standard 10 — Longevity & IV Therapy

4 criteria · 3 non-negotiable · 1 core · Version 3.0

Criteria in this standard

10.1 — IV Line Insertion and Site Care Follow Recognised Infusion Standards
10.2 — Hormone and Peptide Products Are Sourced From Licensed, Regulated Suppliers Only
10.3 — Physician Oversight of Hormone and Peptide Protocols Is Genuine, Not Nominal
10.4 — Baseline Screening Happens Before Any Protocol Begins, Not After

10.1

IV Line Insertion and Site Care Follow Recognised Infusion Standards

Non-Negotiable

IV line insertion, site selection, and ongoing site care follow a recognised, evidence-based infusion therapy standard — aseptic technique, appropriate site selection, and defined site monitoring — not informal practice varying by whoever happens to be inserting the line.

In plain terms: IV drips and infusions are put in and looked after according to a recognised infusion standard — clean technique, the right vein, the site checked — not by whoever has done it before.

Facility category	Crisis	Transition	Small	Standard
Applicability	N/A	Full	Full	Full

Why this matters

A cannula placed without aseptic technique introduces bacteria directly into the bloodstream. A cannula in the wrong site — antecubital fossa in an ambulant patient, a vein that has been used repeatedly — fails and infiltrates. A site not monitored develops phlebitis nobody notices until the arm is red and swollen. Infusion therapy in wellness and longevity clinics is often delivered by staff whose training was informal and whose technique has drifted. The Infusion Nurses Society standards or an equivalent national standard define what good practice is; the clinic's job is to adopt one, train to it, and check compliance.

What good looks like

Insertion technique is consistent and follows a recognised standard.
Site selection is based on defined criteria, not convenience alone.
Site monitoring happens on a defined schedule with a real response process.

Common failure modes

Insertion technique varies significantly by individual staff member.
Site selection has no defined criteria beyond ease of access.
No defined monitoring schedule exists, or findings don't trigger any response.

Worked example

In practice

A longevity clinic delivering 30 IV infusions a day from four reclining chairs.

BeforeCannulation was done by nurses and one non-nurse 'infusion specialist.' Technique varied. Skin was wiped with alcohol and cannulated immediately, without allowing to dry. Sites were not scored or monitored. Two patients had developed phlebitis in the previous month; one had a bloodstream infection requiring hospital admission.

ActionThe INS Infusion Therapy Standards of Practice were adopted. Only registered nurses cannulate. A competency assessment was completed for each. The technique was standardised: hand hygiene, chlorhexidine-alcohol skin prep with 30-second dry time, sterile dressing, site labelled with date. A visual infusion phlebitis score is recorded every 30 minutes during infusion and at removal. Monthly audit of ten infusions.

AfterThe Monitor observed three cannulations following the standard, reviewed competency records for all nurses, and reviewed the phlebitis audit (0 events in eight weeks). Verified.

If you are starting from zero — do this first

Watch three cannulations. Is skin prep allowed to dry? Is a sterile dressing applied?
Adopt a recognised infusion standard and train every cannulator to it.
Assess competency and record it.
Score every site at intervals and at removal.

The most common mistake: Wiping the skin and cannulating immediately — the antiseptic works only when it has dried.

Self-assessment questions

1. Does IV insertion follow a recognised aseptic technique standard, applied consistently by every staff member who inserts lines? — A recognised standard, applied consistently — not technique that varies by individual.
Evidence: IV insertion protocol document

2. Is the insertion site selected and assessed against defined criteria, not simply whichever vein is easiest to access? — Site selection based on vessel health and treatment need, not convenience alone.
Evidence: N/A — tested directly

3. Is the IV site monitored on a defined schedule for signs of complication, with a specific response if found? — A defined monitoring schedule and response, not informal checking.
Evidence: Site monitoring record

Common reasons for a PARTIAL answer

Technique is consistent for straightforward insertions but varies more for difficult access cases. — Difficult access is exactly where technique consistency matters most for reducing complications.
Monitoring happens but isn't documented, relying on staff memory. — Undocumented monitoring is difficult to distinguish from monitoring that didn't happen.
A response process exists for infection signs but not for infiltration or phlebitis specifically.

Implementation plan

When	What
Week 1	Review current insertion and site care practice against the recognised standard.
Week 2	Standardise technique and site selection criteria across all staff who insert lines.
Week 3	Establish a defined, documented site monitoring schedule.
Ongoing	Audit monitoring documentation and technique consistency periodically.

How the Monitor verifies this

Method	What	Detail
OBSERVE	Insertion technique observation	Observes an actual IV insertion for aseptic technique and site selection practice.
DOCUMENT	Monitoring schedule review	Reviews the defined site monitoring schedule and recent monitoring records.
ASK	Complication response interview	Asks staff what happens when site monitoring identifies a possible complication.

Supervisor tips

Observe an actual insertion if timing allows, not just a description of policy. — Real practice sometimes diverges meaningfully from stated policy.
Ask about a specific difficult-access case and how it was handled. — This reveals whether the standard genuinely holds under real, harder conditions.

Evidence base

[53] Gorski LA, Hadaway L, Hagle ME, Broadhurst D, Clare S, Kleidon T, et al. Infusion Therapy Standards of Practice, 8th Edition. J Infus Nurs. 2021;44(suppl 1):S1-S224.

Train your team: AMB-10 · Longevity & IV Therapy on GMJ Academy →

This course teaches practical implementation of this standard. Free to enroll. ASF certificate on completion.

10.2

Hormone and Peptide Products Are Sourced From Licensed, Regulated Suppliers Only

Non-Negotiable

Every hormone, peptide, or compounded product used is sourced exclusively from a licensed, regulated compounding or manufacturing facility recognized by the relevant national medicines regulatory authority — never from research-use-only vendors, overseas suppliers, or any source without verifiable regulatory standing, regardless of cost or convenience.

In plain terms: Every hormone, peptide, or compounded product comes only from a pharmacy or manufacturer licensed by the national medicines regulator — never from a supplement website or a 'research chemicals' supplier.

Facility category	Crisis	Transition	Small	Standard
Applicability	N/A	Full	Full	Full

Why this matters

Peptides sold as 'research chemicals' are unregulated: their content, purity, sterility, and dose are unverified. Growth hormone and testosterone from grey-market sources are frequently counterfeit or contaminated. Compounded hormones from an unlicensed compounder may be sub-potent, super-potent, or non-sterile. Injecting these into patients is injecting an unknown. The only acceptable source is one the national regulator licenses: a registered pharmacy, a licensed compounding pharmacy, or a manufacturer with marketing authorisation. Every product must carry a batch number that can be traced to that source.

What good looks like

Every product is sourced from a specifically named, licensed, verifiable supplier.
Research-use-only and overseas sourcing are genuinely excluded.
Certificates of analysis are retained and available for review.

Common failure modes

Sourcing cannot be verified, or "we have a supplier" is the only answer given.
Research-use-only products are used under a different clinical framing.
No certificates of analysis or equivalent verification exist.

Worked example

In practice

A longevity clinic offering peptide and hormone protocols.

BeforePeptides were purchased from an online supplier selling 'for research purposes only.' Testosterone came from a pharmacy in another country without verification of its licence. Batch numbers were not recorded. A patient developed a sterile abscess at an injection site; the product could not be traced.

ActionThe clinic wrote a sourcing policy: only products from suppliers holding a current licence from the national medicines regulator, verified annually against the regulator's register; only compounded products from a licensed compounding pharmacy with a certificate of analysis per batch; batch numbers recorded in every patient record. All research-chemical stock was destroyed. Protocols requiring unavailable licensed products were discontinued.

AfterThe Monitor sampled eight products in stock and traced each to a licensed supplier with a current licence. Reviewed 15 patient records with batch numbers. Verified.

If you are starting from zero — do this first

List every hormone and peptide product you use and its supplier.
Check each supplier's licence on the national regulator's website.
Destroy anything marked 'research use only' or from an unlicensed source.
Record batch numbers in patient records from today.

The most common mistake: Buying peptides labelled 'not for human use' and using them on humans — the label is not a formality.

Self-assessment questions

1. Is every hormone or peptide product sourced from a licensed, regulated compounding or manufacturing facility, verifiable by name? — A specific, named, licensed source — not "we have a supplier."
Evidence: Supplier licensing verification

2. Are research-use-only or overseas-sourced products genuinely excluded, not used under a different label? — Genuine exclusion, not the same product relabelled or described differently.
Evidence: N/A — tested directly

3. Does documentation retain certificates of analysis or equivalent verification for products used? — Real, retained verification, not assumed from the supplier's reputation alone.
Evidence: Certificate of analysis records

Common reasons for a PARTIAL answer

Primary hormone products are properly sourced, but a newer peptide offering was added without the same verification. — Sourcing verification needs to apply to every product offered, not only the established ones.
A licensed source is used but certificates of analysis aren't consistently retained. — A legitimate source doesn't eliminate the value of retaining the actual verification documentation.
Staff know the practice sources responsibly in general but can't name the specific supplier.

Implementation plan

When	What
Week 1	Audit every hormone and peptide product currently offered against supplier licensing status.
Week 2	Discontinue or replace any product without a verifiable, licensed source.
Week 3	Establish retained certificate-of-analysis documentation for all products.
Ongoing	Verify supplier licensing status periodically, not only at first sourcing.

How the Monitor verifies this

Method	What	Detail
DOCUMENT	Supplier licensing verification	Reviews documentation confirming every supplier's specific, current regulatory licensing status.
DOCUMENT	Certificate of analysis review	Reviews retained certificates of analysis or equivalent verification records.
ASK	Sourcing awareness interview	Asks staff to name the specific licensed source for a product currently in use.

Supervisor tips

Ask staff to name the specific supplier for a product currently in use, not describe sourcing generally. — Specificity is the real test of whether sourcing is genuinely verified versus assumed.
Ask directly whether any product offered is sourced as "research use only." — A direct, specific question often surfaces what a general policy question won't.

Evidence base

[54] Unregulated peptide and hormone sourcing, including research-use-only vendors and overseas suppliers, is documented to carry real risks of incorrect product identity, contamination, and dosing error, with licensed, regulated compounding and manufacturing facilities recognized by the relevant national medicines regulatory authority representing the only verifiable, regulated sourcing channel.

Train your team: AMB-10 · Longevity & IV Therapy on GMJ Academy →

This course teaches practical implementation of this standard. Free to enroll. ASF certificate on completion.

10.3

Physician Oversight of Hormone and Peptide Protocols Is Genuine, Not Nominal

Non-Negotiable

A licensed physician genuinely evaluates and prescribes each patient's specific hormone or peptide protocol, based on that patient's actual results and history — not a standardised protocol applied uniformly with a physician's name attached after the fact.

In plain terms: A doctor genuinely designs each patient's hormone or peptide protocol from that patient's own blood results and history — not a standard package applied to everyone who pays.

Facility category	Crisis	Transition	Small	Standard
Applicability	N/A	Full	Full	Full

Why this matters

Testosterone therapy for a man with normal testosterone is not treatment; it is harm — raised haematocrit, suppressed fertility, cardiovascular risk. Growth hormone for a person without deficiency is the same. A 'longevity protocol' sold as a package, with the same drugs at the same doses regardless of the patient's results, is a product, not medicine. Genuine oversight means: the doctor reviews the baseline results, decides whether treatment is indicated at all, sets the dose for this patient, and reviews monitoring results to adjust. Every decision is documented. The patient is not a customer buying a package; they are a patient receiving a prescription.

What good looks like

Physician evaluation is genuinely individual, reflected in real, patient-specific documentation.
Protocols are adjusted based on this patient's own monitoring results.
The physician describes specific, real clinical reasoning for individual cases.

Common failure modes

A standardised protocol is applied to all patients with a physician's name attached.
Protocols never change regardless of individual monitoring results.
The physician cannot describe specific reasoning beyond a general standard approach.

Worked example

In practice

A longevity clinic offering three tiered 'optimisation packages.'

BeforePatients chose a package from a menu. The medical director signed prescriptions for the package contents without reviewing individual results. A patient with a haematocrit of 54% was prescribed testosterone; another with no growth hormone deficiency received GH. The doctor's involvement was a signature.

ActionThe package model was discontinued. Every patient now has a doctor consultation reviewing baseline results; a written treatment decision (treat, do not treat, or refer) with reasoning; individually specified doses; and a monitoring schedule. The doctor sees monitoring results and documents adjustments. Patients with normal results are told treatment is not indicated.

AfterThe Monitor reviewed 20 patient records: each showed a documented doctor decision referencing that patient's results, individualised dosing, and monitoring reviews with adjustments. Three records showed treatment declined. Verified.

If you are starting from zero — do this first

Pull ten patient records: does the doctor's note reference this patient's specific results?
Look at your treatment menu. If everyone on a package gets the same drugs at the same doses, that is the gap.
Require a documented, individualised doctor decision before every protocol.
Decline treatment for patients without an indication — and document it.

The most common mistake: Having a doctor sign prescriptions for a package the patient has already bought — the decision was made by the sales process.

Self-assessment questions

1. Does a licensed physician genuinely evaluate each patient individually before prescribing a hormone or peptide protocol? — A real, individual clinical evaluation, not a standard protocol applied to everyone.
Evidence: Individual evaluation record

2. Is the protocol adjusted based on this specific patient's actual monitoring results, not applied uniformly regardless of results? — Genuine responsiveness to this patient's data.
Evidence: Protocol adjustment record

3. Can the physician describe their specific reasoning for a particular patient's protocol? — Real, individual clinical reasoning, not a general description of the standard approach.
Evidence: N/A — tested directly

Common reasons for a PARTIAL answer

Initial evaluation is genuinely individual but follow-up adjustments become more standardised over time. — Ongoing responsiveness to patient data matters as much as the initial evaluation.
Monitoring results are collected but don't consistently change the protocol when they should. — Data collected but not acted on doesn't provide the protection genuine oversight is meant to offer.
The physician is involved for complex cases but less so for routine ones.

Implementation plan

When	What
Week 1	Review a sample of patient protocols for genuine individual evaluation versus standardisation.
Week 2	Establish a consistent process for adjusting protocols based on individual monitoring results.
Week 3	Brief the physician on documenting specific, individual clinical reasoning.
Ongoing	Audit protocol individualisation periodically.

How the Monitor verifies this

Method	What	Detail
DOCUMENT	Individual evaluation review	Reviews records for evidence of genuine, individual patient evaluation before prescribing.
DOCUMENT	Protocol adjustment review	Reviews whether protocols are adjusted based on individual patient monitoring results.
ASK	Physician reasoning interview	Asks the physician to describe their specific reasoning for a particular patient's protocol.

Supervisor tips

Compare two different patients' protocols and documented reasoning. — Genuinely different content reveals real individualisation; near-identical text reveals a standardised template.
Ask the physician to explain a specific protocol decision in detail. — Real clinical reasoning is specific and detailed; a formality reveals itself in vague or general answers.

Evidence base

[55] Physician-supervised prescribing, based on individual patient evaluation and monitoring rather than standardised protocols, is identified as the defining distinction between legitimate hormone and peptide therapy and unregulated wellness-market practice.

Train your team: AMB-10 · Longevity & IV Therapy on GMJ Academy →

This course teaches practical implementation of this standard. Free to enroll. ASF certificate on completion.

10.4

Baseline Screening Happens Before Any Protocol Begins, Not After

Core

Every patient undergoes genuine baseline laboratory and clinical screening before a hormone or peptide protocol begins, with monitoring continuing at defined intervals — not a protocol started based on symptoms alone, with testing added only if a problem later emerges.

In plain terms: Baseline bloods and a clinical assessment happen before any hormone or peptide protocol starts, and monitoring bloods continue at set intervals — not started on a questionnaire and never re-checked.

Facility category	Crisis	Transition	Small	Standard
Applicability	N/A	Full	Full	Full

Why this matters

You cannot know whether a patient needs testosterone without measuring it — twice, in the morning. You cannot safely give it without knowing their haematocrit, PSA, and liver function first. You cannot continue it without re-checking those at three months and then regularly. Protocols started on symptoms alone, or on a questionnaire, or on a single afternoon blood test, are protocols started on inadequate evidence. Protocols continued without monitoring are protocols that will eventually cause polycythaemia, prostate disease, or liver damage that nobody sees coming.

What good looks like

Baseline screening is genuinely completed before every protocol begins.
Monitoring continues at defined, followed intervals throughout.
A real example exists of monitoring results changing a protocol decision.

Common failure modes

Protocols begin based on symptoms or patient request, without baseline screening.
No defined ongoing monitoring schedule exists beyond the initial visit.
Monitoring results are collected but never lead to any protocol change.

Worked example

In practice

A longevity clinic that started hormone protocols after an online questionnaire.

BeforePatients completed a symptom questionnaire; if they scored above a threshold, treatment was offered. Some had a single blood test at any time of day. Monitoring was 'when the patient came back.' The Coordinator found patients on testosterone for over a year with no repeat bloods.

ActionA pre-treatment protocol was written: two morning testosterone levels on separate days, plus haematocrit, PSA, lipids, liver function, and a clinical examination before any androgen; equivalent panels for other protocols. Monitoring at 3 months, then every 6 months, with defined action thresholds (e.g. haematocrit >54% → stop and review). Patients who miss monitoring have their prescription paused.

AfterThe Monitor reviewed 20 records: all had complete baselines before starting; all on treatment over 3 months had monitoring results with documented review. Two showed dose reduction after monitoring. Verified.

If you are starting from zero — do this first

Pull ten hormone patient records: what bloods were done before starting? What time of day?
Write a baseline panel per protocol and require it before any prescription.
Set monitoring intervals with action thresholds.
Pause prescriptions for anyone who misses monitoring.

The most common mistake: Starting testosterone on a single afternoon blood test — afternoon levels are lower and a single test is unreliable.

Self-assessment questions

1. Does every patient undergo genuine baseline screening before any protocol begins, not after starting? — Testing before the first dose, not added only if a concern later arises.
Evidence: Baseline screening record

2. Is monitoring continued at defined intervals throughout the protocol, not only at baseline? — A specific, followed monitoring schedule, not a one-time check.
Evidence: Ongoing monitoring schedule

3. Are monitoring results actually reviewed and acted on, not just filed? — Genuine review that can change the protocol, not passive data collection.
Evidence: N/A — tested directly

Common reasons for a PARTIAL answer

Baseline screening happens but the specific panel doesn't match what the protocol actually requires. — Generic baseline testing may miss the specific markers relevant to this particular protocol.
Monitoring intervals are followed initially but lapse as treatment continues. — Ongoing risk doesn't diminish just because a protocol has been running without incident so far.
Results are reviewed by staff but not consistently by the prescribing physician.

Implementation plan

When	What
Week 1	Review current screening practice against genuine pre-protocol baseline testing.
Week 2	Establish the specific baseline panel appropriate to each protocol offered.
Week 3	Establish a defined ongoing monitoring interval and physician review process.
Ongoing	Audit monitoring adherence and evidence of results genuinely influencing protocol decisions.

How the Monitor verifies this

Method	What	Detail
DOCUMENT	Baseline screening review	Reviews patient records for genuine baseline screening completed before protocol start.
DOCUMENT	Ongoing monitoring schedule review	Reviews the defined monitoring interval and adherence to it.
ASK	Result review interview	Asks staff for a real example where a monitoring result changed a protocol decision.

Supervisor tips

Ask for a real example where a monitoring result changed what was done. — A real example reveals whether monitoring is genuine practice or a formality.
Check whether monitoring intervals are still being followed for patients further along in treatment. — This is where monitoring discipline most commonly erodes over time.

Evidence base

[56] Baseline laboratory assessment followed by monitoring at defined intervals — for growth hormone secretagogues, typically IGF-1 at baseline, six weeks, and every three to six months thereafter — is identified as a standard safety practice distinct from symptom-triggered testing alone.

Train your team: AMB-10 · Longevity & IV Therapy on GMJ Academy →

This course teaches practical implementation of this standard. Free to enroll. ASF certificate on completion.

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