Category Archives: Infusion Nursing Standards of Practice

What? Seriously?

I’ve had conversations with several RN colleagues that left me saying, are you serious? I hesitated writing about this but I thought I’d share so we can all learn and avoid doing the same.

1. Whatever happened to those “multi-use” syringes? That’s crazy that I can’t reuse syringes when I’m just drawing up medication for injections and not using it on patients. 

  • Ok, I know what you’re thinking but this conversation came up during our discussion of the “One and Only Campaign” on safe injection practices. ONE NEEDLE, ONE SYRINGE, ONE TIME! If you are not familiar with this campaign. please click here  and read about it.
  • This RN looked at me like I had 10 heads.  I pointed to the icon on the syringe label. Have you looked at your syringe labels lately?


  • Bottom line: Unless you are using glass syringes, which should be cleaned and sterilized after each use, before the next use, there is no such thing as “multi-use” syringe! The syringes in the US are disposable and as the label indicates, do not reuse! ONE NEEDLE, ONE SYRINGE, ONE TIME!
  • In case you are wondering, when is a syringe considered used? Check this post out – click here

2. An RN preparing to give a weight based medication to a patient states: I don’t weigh the patient each time they come, only in the beginning of their treatment. Why should I weigh them again, they can tell me if their weight has changed.

  • What? seriously? I’m sure all of you reading this are shaking your heads much like I did. So tell me, is this a case of lack of knowledge or just plain laziness? You be the judge.
  • Bottom line: one vital piece of patient-specific information, the patient weight, is especially important because it is often used to calculate the appropriate dose of a medication (e.g., mg/kg, mcg/kg, mg/m2). A prescribed medication dose can differ significantly from the appropriate dose as a result of missing or inaccurate patient weights.

3. An RN started a PIV without gloves. RN stated, I have never worn gloves when starting IV’s and I am very careful not to touch blood.

  • This scenario happening in 2014?? How long has it been since Blood borne pathogen and Needlestick Safety and Prevention Act became a federal law? It was the year 2000 and came into effect in 2001.
  • When asked why the RN wasn’t using gloves, the response was, never have and never will. (oy!)
  • Employer was made aware and stated, yeah, we know. Sad but true, they don’t seem to be concerned.
  • Bottom line: The law applies to all employers who have an employee(s) with occupational exposure (i.e., reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of the employee’s duties). These employers must implement the requirements set forth in the standard.

It was heart breaking to have these conversations with my nursing colleagues who are actively practicing nursing and providing patient care. Why are there nurses who think and act this way when there are standards of practice  and federal mandates that give us guidance? We have a responsibility to follow best practice/standards of practice to protect ourselves, the public and the patients we serve.  It’s always a convenient excuse to say that one didn’t know such standards or law exist. Let’s not forget, a person who is unaware of a law ( or in some cases, standards of practice)  may not escape liability for violating that law  merely because he or she was unaware of its content.


Filed under CDC Guidelines, Certified Nurses, Infection Control and Prevention, Infusion Nurse Chat, Infusion Nursing, Infusion Nursing Standards of Practice, InfusionNurse, IV, IVchat, Nursing, Nursing blogs

NIOSH 2014 List of Antineoplastic & Other Hazardous Drugs in Healthcare Settings

This is an updated version of  the National Institute of Occupational Safety and Health (NIOSH) hazardous drugs list. So what’s new in this current update?

The text for the update to the 2014 list was updated and expanded to reflect the complexity of safe handling issues that have arisen over the past few years.  This was driven, in part, by the growing number of oral antineoplastic drugs and the addition of oral non-antineoplastic drugs.  The list was reformatted and some drugs have been deleted.

(a) Based on feedback from multiple sources, it was determined that the universal approach as described in the 2004 Alert on Hazardous Drugs for handling hazardous drugs was no longer feasible.

 (b) The list of hazardous drugs was separated into three categories: (Table 1) Antineoplastic drugs; (Table 2) Non-antineoplastic drugs; (Table 3) Drugs with adverse reproductive effects only; and (Table 4) Deleted drugs.

  (c)  It was noted that the majority of the antineoplastic drugs may have adverse reproductive effects and the drugs in the non-antineoplastic category that had adverse reproductive effects as a secondary reason for their listing was noted.

  (d) New drug listings for 2014 are indicated by red font and drugs in the non-antineoplastic category that also have adverse reproductive effects are indicated by blue font.

 (e) Also added is a matrix of common activities related to hazardous drug handling and recommendations for the use of personal protective equipment and ventilated engineering controls for each activity (Table 5).


Hazardous drugs include those used for cancer chemotherapy, antiviral drugs, hormones, some bioengineered drugs, and other miscellaneous drugs.  The NIOSH cautions that the list may not be all inclusive and recommend that each organization should create its own list of drugs considered to be hazardous. This perhaps explains why sometimes I notice a drug not on the hazardous list is considered hazardous by one organization but not by another.  In my experience, many oncology infusion centers follow the precautions recommended for hazardous drugs for all drugs they administer regardless of classification in a effort to standardize handling practices.

When a  drug is hazardous, various precautions should be applied when handling the drug.  Click here for the full publication of the 2014 NIOSH Hazardous Drug List.

NIOSH 2014


Many thanks to Barbara MacKenzie and Thomas H. Connor for the  information and updates.

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FIVE Year Blog Anniversary Gift

To celebrate the “FIVE” year blog anniversary and to thank you for your continued support, I am giving away “FIVE” free registrations to  a web seminar on September 18, 2014 entitled:  A Closer Look at Peripheral IVs

Intravenous therapy via a peripheral IV (PIV) catheter is one of the common IV procedures performed by nurses in hospitals and other healthcare settings, including long-term care, outpatient, and home care.  PIVs are used for medication administration and/or infusion of IV solutions.  Because PIV placement is such a common and simple nursing procedure, nurses may underestimate the risks and the consequences of complications such as phlebitis, infiltration/extravasation, infection, and nerve damage.  In this presentation, the importance of appropriate PIV site selection, techniques to reduce complications, and the importance of monitoring the PIV site will be addressed.

Here’s how to participate:

1. You must reside in the United States and available to attend on Sept 18, 2014 1-2pm ET

2. Send a comment to this post.  The comments must be in response to this particular post in order to be considered an entry. Comments (entry) must include your first and last name, a valid email address, and  the phrase – “Fabulous 5 giveaway”

3. This free offer is valid only for the webinar on Sept 18, 2014. Offer does not apply to any other events.

4. Five entries will be selected. You will be notified by email if you’re one of the five winners. No substitution will be allowed.

5. Offer ends on September 12, 2014 12noon ET.






Filed under CRNI, Infusion Nurse Chat, Infusion Nursing, Infusion Nursing Standards of Practice, InfusionNurse, IV, IV start, IVchat, Medical bloggers, Nursing, Nursing blogs

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.


(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.


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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

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.

syringe parts

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  –

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



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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