Looking for RNs to take a SURVEY!

If you are a registered nurse currently working with/delegating/supervising “unlicensed healthcare personnel” (UHCP) also known as “unlicensed assistive personnel” (UAP), would you be interested in answering a short survey related to the use of unlicensed healthcare personnel in the provision of infusion therapy?

The survey is open to US registered nurses from all healthcare settings who work with, delegate/and/or supervise UHCP. The survey results will be integrated in a project for the Infusion Nurses Society.

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(Click sign ^^ above to take the survey)

If you have any questions, please use the comment section of this post. Your comment will reach me first and will not be posted publicly. I will reply as soon as possible.

Thank you so much! Your help and willingness is greatly appreciated!

 

 

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Q&A: BP cuff for vein distention

Q: I am a new RN and was always told that I can use a BP cuff to distend the veins for IV starts instead of a tourniquet. Can you tell me how high should I pump the cuff?

A:  BP cuff is one method that can be used for vein distention while assessing veins for venipuncture and during the actual venipuncture. There are various views on what the inflation pressure is best for this purpose  and the consensus opinion appears to indicate  just below diastolic pressure.  Here’s what the following infusion nursing/infusion therapy textbooks indicate:

1. Alexander et al:  Infusion nursing an evidence based approach 3rd edition 2009 states: You can inflate the cuff and release to just below the diastolic pressure.

2. Philips & Gorski Manual of IV Therapeutics 6th edition 2014:  You can apply the BP cuff on the patient’s arm, then slightly pump the cuff to about 30mmHg  The authors added this nursing fast fact: when using a blood pressure cuff, care must be exercised not to start the IV too close to the cuff, which causes excessive back pressure.

3.  Weinstein & Hagle Plumer’s Principles and Practice of Infusion Therapy 9th edition 2014. The patient’s blood pressure cuff may be used to distend the vein; inflate the cuff and then release it until the pressure drops to just below the diastolic pressure.

As an infusion nurse, I’ve only used a BP cuff in lieu of a tourniquet a few times when starting an IV.  I’ve found that inflating and releasing to about 30-40mm Hg provided sufficient distention without increased discomfort to the patient.

Good luck and thank you for your question.

hand-held-aneroid-sphygmomanometers-67891-133555

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Filed under Certified Nurses, Continuing nursing education, Cora Vizcarra, In office infusions, Infection Control and Prevention, Infusion Nurse Chat, Infusion Nursing, Infusion Nursing Standards of Practice, Infusion Therapy Resources and References, InfusionNurse, IV, IV start, IVchat, Nursing, Nursing blogs, Patient Education, Patient Safety, State Board Of Nursing, Toruniquets

Happy 4th of July!

Always proud and grateful to live in this country! Have a safe and wonderful 4th of July!!

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Q&A: When is a single use syringe considered used?

Q:  You will think I am a complete idiot but please explain when is a single use syringe considered used? I need to explain to my practice manager why I can’t re-use a syringe while reconstituting a powdered medication for injection. My practice manager is complaining that I am using too many syringes and needles which are not reimbursed by insurance. Thank you.

A:  You are correct, syringes should not be re-used; those are designed to be single use only. When the syringe is taken out of the sterile  packaging and the plunger is pulled  to withdraw the medication, then pushed completely in to expel the syringe content,  the internal barrel of the syringe is considered contaminated and must be discarded appropriately.  Any microorganisms, which might be placed onto the sides  (ribs) of a syringe plunger by finger contact while withdrawing the plunger, can be transferred to the inside of the barrel and enter the fluid pathway if the plunger is drawn in and out several times.  A syringe must only  be used once to draw up medication, and must not be used again even to draw up the same medication, from the same vial, for the same patient.

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Syringe parts – photo from Concept in Sterile Preparation and Aseptic Technique

If you observe a nurse withdrawing fluid from a vial with a syringe, take note of where that person’s fingers are on the plunger of the syringe. Many have their fingers/palm wrapped around “ribs” of the plunger, with or without gloves, as they are pulling the fluid into the syringe. Once the syringe is full, then the plunger (where fingers were wrapped) now is pushed into the barrel of the syringe until empty. Imagine this scenario over and over when the same syringe is used over and over. I believe no nurse will “deliberately” harm a patient, unfortunately, there are nurses who should know better but fall into this poor practice for one reason or another. I  have witnessed some nurses “unknowingly” re-use a syringe and become embarrassed once the poor practice is brought to their attention.

It seems like you work  in a office or ambulatory setting, if that is the case, please refer to the CDC Guide for Infection Prevention for Outpatient settings. Click here for more information on infection control prevention.

I would also refer you to the CDC One and Only” campaign to raise awareness among patients and healthcare providers about safe injection practices. The campaign aims to eradicate outbreaks resulting from unsafe injection practices.  For more information on this campaign, go to their website  – http://www.oneandonlycampaign.org.

Thank you for your question and hope this will help you explain to your manager that patient safety comes first!

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References:

1. Perz JF, Thompson ND, Schaefer MK, Patel PR. US outbreak investigations highlight the need  for safe injection practices and basic infection control. Clin Liver Dis. Feb 2010;14(1):137-151; x.

2. Perceval A. Consequence of syringe-plunger contamination. Med J Aust. May 17 1980;1(10):487-489.

3. Huey WY, Newton DW, Augustine SC, Vejraska BD, Mitrano FP. Microbial contamination potential of sterile disposable plastic syringes. Am J Hosp Pharm. Jan 1985;42(1):102-105.

4. Olivier LC, Kendoff D, Wolfhard U, Nast-Kolb D, Nazif Yazici M, Esche H. Modified syringe design prevents plunger-related contamination–results of contamination and flow-rate tests. J Hosp Infect. Feb 2003;53(2):140-143.

 

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Why do nurses use the same alcohol swab over and over?

I know, this may come as a surprise to all of you, but the truth is, I have seen many nurses (even those highly trained and specialized) both in hospitals and outpatient settings, use the same alcohol swab over and over.

Imagine this scenario where a nurse is ready to withdraw medication from several vials. The nurse rips open a swab, then removes the swab from the package using the thumb and forefinger, literally touching the entire surface and both sides of the swab, then proceeds to disinfect the top of one vial. Then using the same swab, the nurse proceeds to disinfect the top of the next vial, and repeats the same until all vials are disinfected, still using the same swab. The swab is then laid on the work surface, and if additional disinfection of the vial is required, the nurse picks up the same swab and proceeds to use it again. The same observation is true when disinfecting Y-sites, connection hubs or needleless connectors attached to vascular access devices. Rip open an alcohol swab, pick up with thumb/forefinger, disinfect hub, then either lay swab on surface or disinfect another hub with same swab. Why do nurses re-use alcohol swabs?

When brought to their attention and nurses are asked – why are you re-using the alcohol swab? Often, I get a blank stare or I get this..“what do you mean”look, and I don’t get an answer. Sometimes I get this answer, “its alcohol, dummy!” or “it’s still wet”. I think back to my nursing school training and I tried to recall what my Fundamentals instructor told us about how to use alcohol swabs. I honestly don’t remember what we were told, whether or not to reuse, or use till dry…..maybe I skipped school that day.

I can’t find evidence based research about re-using alcohol swabs. The fact is that an alcohol swab (aka alcohol prep pad) contains 70% Isopropyl Alcohol and is sterile while in the package. When removed, we need to take great care not to contaminate it with our fingers before we even use it for disinfection. Discard after one use, even if the alcohol swab is still dripping wet. When disinfecting several vials, use one alcohol swab per vial; don’t share alcohol swabs between the vials. I am aware that there are non-sterile alcohol prep pads available in the market, often used by diabetic patients for insulin injections. If selected to be used for disinfection, discard after use. Alcohol swabs are inexpensive and always available. Let’s put this in perspective, if you are the patient, do you want your nurse re-using alcohol swabs on you?

So next time you are getting ready to open an alcohol swab, will you remember hold the swab properly and not to re-use?

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INS Exhibit Hall 2014 – Part 2 New PIV Technology

Don’t you just hate it when you stick a perfectly good vein  and end up going through the vein? Can you tell when the tip of the needle and the tip of the catheter have entered the vein to know when to advance the catheter into the vein?

As I always do, here’s my disclaimer – there were many different products represented there and as the owner of this blog, I reserve the right to point out the ones that caught my attention. For disclosure purposes, I was not paid to write this post and have no relationship whatsoever with these companies, nor am I endorsing the products. This is my blog, my opinions and not of the Infusion Nurses Society and is just FYI.

At the INS Exhibit Hall, there were two products that I thought were great in potentially increasing PIV insertion on the first attempt.

1. AccuCath Intravenous Catheter from Vascular Pathways:

The AccuCath™ Intravenous Catheter is a REVOLUTION in peripheral catheter technology. Its AccuTip™ nitinol guidewire creates a pathway within the vessel that deploys the catheter atraumatically. The AccuCath™ device is expected to lower complication rates and increase dwell times while enhancing patient satisfaction and healthcare worker safety.

  • Designed to increase first attempt success
  • Atraumatic delivery designed to reduce complication rates
  • Expected to extend average catheter dwell times
  • Greater patient and clinician satisfaction

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You know how nurses like to test out new widgets, right? I’m no exception.  I saw the product demonstration video and was VERY disappointed I was not able to actually use the product in a simulation insertion. Why? They were not offering anyone to try their product!!!!!

I viewed their eposter entitled: Randomized Controlled Comparison of Accucath vs Conventioanl Peripheral IV authored by Bette K. Idemoto, PhD, RN, ACNS-BC, CCRN and James R. Rowbottome, MD. This poster demonstrated the effectiveness of this new IV catheter showing first successful attempt at 89% vs 43% with conventional PIV. The study randomized 248 patients.

For more information, visit their website – http://vascularpathways.com/accucath-iv-catheter

 

2. SurFlash® Safety I.V. Catheter by Terumo / CareFusion

As the only safety IV catheter with a double-flash feature that verifies both needle and catheter placement, SurFlash® improves first-stick success. SurFlash® catheters reduce needlestick injuries, blood exposure, and cost (because of fewer wasted catheters). With its new pressure rating, proprietary safety valve and bevel-up indicator, SurFlash® has it all!

Surflash

It was a great experience learning about this product and you know what the best part is? I got to try this product in a dummy IV arm!!! It doesnt feel any different than inserting a conventional PIV but it offers the first stick success, smooth skin insertion and protection from blood exposure after the venipuncture.

They also had an eposter entitled: Peripheral IV Cannulation: Technology and Technique Driving Best Practices by Mark Hunter RN, CRNI, VA-BC and Nancy Trick RN, CRNI. It described the use of evidence based technique and technologies designed to reduce infusion related risks of peripheral IV therapy.

Here’s a video from their website:  Surflash Video

For more information, visit their website – Click here

 

 

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Exhibit Hall Experience INS 2014

At every INS Annual Meeting, the exhibit hall is the one of the highlights of the week.  I am very grateful to all the vendors who were there whether they had something new to show or not because their products contribute greatly to patient care and safety. Their willingness to educate nurses is always appreciated.

As I always do, here’s my disclaimer –  there were many different products represented there and  as the owner of this blog, I reserve the right to point out the ones that caught my attention. For disclosure purposes, I was not paid to write this post  and have no relationship whatsoever with these companies, nor am I endorsing the products. This is my blog, my opinions and not of the Infusion Nurses Society and is just FYI.

 For this post, I would like to feature one of those products that was “born out of necessity” and caught my attention:

Kevin’s Cover, an adjustable PICC/IV shower sleeve designed by Kevin’s mom after Kevin’s PICC line caught on a doorknob and had to be replaced in the emergency room. It is a breatheable, waterproof version available in 7 sizes for kids and adults and features a hook and loop closure that allows for a gentle, adjustable fit. The neoprene wrap at each end ensures a watertight seal so patients have full use of their hands.

Another great idea to protect PICC lines and here’s an interesting review from an infection control perspective. Click here

Check out their You Tube Video

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Photo taken by @infusionnurse

This is Kevin who needed a PICC line and as a result his mother designed Kevin’s covers out of necessity to protect his PICC line. For more information, you can contact  them at hamptonhousemedical@gmail.com. Although they have a website, http://www.kevinscovers.com, I was unable to connect to that web address during this post.

Stay tuned for more featured products next few blog posts.

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