One of these things is not like the others…

Sounds familiar? Growing up, it’s my favorite Sesame Street segment. At several recent meetings with physician groups and administrators who were getting ready to open up an infusion center, it became very obvious they were confused about the following.

1. An infusion nurse (aka IV nurse) is not the same as a phlebotomist.

  • An infusion nurse inserts an IV catheter into A vein to “infuse” solutions or medications (Infusion therapy). On occasion, an infusion nurse may draw blood from the IV catheter immediately after insertion then leaves the IV catheter dwelling in the veins so a patient can  receive IV solutions or IV medications .
  • A phlebotomist  performs a blood drawing procedure called “phlebotomy” where only the tip of a needle is inserted into a vein to draw out blood, then the needle is removed when all blood tubes have been collected.

2.  An infusion nurse is:

  • One who has acquired knowledge and skill in the specialty practice of infusion nursing. The infusion nurse is accountable for practicing within the defined scope of practice for the RN and is committed to providing safe, quality infusion nursing care. The infusion nurse’s practice is based upon the following:
    • Knowledge of anatomy and physiology
    • Specific knowledge and understanding of the vascular system and its relationship with other body systems and infusion treatment modalities
    • Participation in the establishment of the patient’s ongoing plan of care
    • Skills necessary for the administration of infusion therapies
    • Knowledge of state-of-the-art technologies associated with infusion therapies
    • Knowledge of psychosocial aspects of care, including a sensitivity to the patient’s wholeness, uniqueness, and significant social relationships, along with knowledge of community and economic resources
    • Interaction and collaboration with members of the healthcare team and participation in clinical decision-making processes
  • Phlebotomists are medical professionals who draw blood from patients for various lab tests and procedures. A high school graduate or college student could take a course at a local technical or vocational school and learn phlebotomy. Many professionals who plan to become a nurse or a doctor often start out by working in a medical office or hospital as a phlebotomist. Because phlebotomy entails a fairly short training period, and because phlebotomist jobs are relatively easy to find and obtain, phlebotomy is a great way for someone to try out the medical profession.
Many physician offices have medical assistants or phlebotomists on staff so when planning to offer infusion therapy services in their offices, they think they can leverage and save money by utilizing these unlicensed medical personnel.

There shouldn’t be any confusion about this….

“Phlebotomists do phlebotomy but are not infusion nurses and should not administer infusion therapies”
“Infusion nurses can administer infusion therapies, perform venipuncture and occasionally perform phlebotomy but are not phlebotomists”
One of these things just doesn’t belong,  can you tell which thing is not like the others…. by the time I finish my song?

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Filed under Certified Nurses, Continuing nursing education, Cora Vizcarra, Infusion Nurse Chat, Infusion Nursing, Infusion Nursing Standards of Practice, InfusionNurse, IV, IV start, IVchat, Medical bloggers, Monoclonal Antibodies, Nursing, Nursing blogs, Patient Education, State Board Of Nursing, Venipuncture

In case you missed it…

Just a few interesting articles…

1.  ”Poppy Pocket” – a safe and discreet way for patients to manage their infusion pumps. What a great idea! How many times have our patients complained of having to carry their pumps and nowhere to put it? This was designed by a daughter of a patient who battled cancer and had to carry around a portable infusion pump.   For more information about this product, go to their webiste - Poppy Pocket.

2. Improved Vein Dilation Technique: Gentle touch vs. flicking veins. A nurse presented an abstract”A Scientific Explanation for Why There are So Many IV, Blood Draw and Injection of Contrast Failures,” at the World Congress  of the World Association of Societies of Pathology and Laboratory Medicine.  According to the author, Gail Stotler RN, at least four out of 10 sticks to a vein fail, and not just once based on her documented reserach. By her calculations, she estimated that in 2008 there were 174 million vein access failures divided among the IV, the blood draw and the injection of contrast. She simply uses gentle touch for vein dilatation; even though some previous research cited in other sources mentions heat, she adamantly does not advocate heat. For more information, visit their website

3. How Long Should Peripherally Inserted Central Catheterization Be Delayed in the Context of Recently Documented Bloodstream Infection?  This article was published in the  Journal of Vascular and Interventional Radiology (JVIR). Journal of Vascular and Interventional Radiology – January 2012 (Vol. 23, Issue 1, Pages 123-125, DOI: 10.1016/j.jvir.2011.09.024)

The risk of relapsing bacteremia was assessed retrospectively among a cohort of 348 patients who underwent peripherally inserted central catheter (PICC) insertion within 6 weeks of a documented bacteremia. The overall risk of relapsing bacteremia was low (three of 348; 0.9%) when PICC insertion was performed in the context of a recent bloodstream infection. The relapse risk was higher when PICCs were inserted within 2 days (two of 31; 6.5%) versus at least 3 days (one of 317; 0.3%) after documentation of bacteremia (P = .02).

4. The case of Amanda Trujillo. Amanda Trujillo is an RN from Arizona who lost her job at a local hospital after she provided education to a patient who was about to receive a liver transplant.   In case you haven’t heard or read, I would encourage to and here’s where you can begin.  http://vdutton.posterous.com/94287821  There are several nurse bloggers who have written about her case and here’s a page where you can catch up on the latest on Facebook.  http://www.facebook.com/NurseUpforAmandaTrujillo

Whether you want to support Amanda or not, I would encourage you to read about her case.  As nurses and infusion nurses, one of our responsibilities is to “educate patients”  and healthcare reforms are focusing more on patient education. This case demonstrates what can happen to someone who is simply doing their job…this could have been you!

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Filed under Board Certified Nurses, Certified Nurses, Cora Vizcarra, CRNI, Infusion Nurse Chat, Infusion Nursing, Infusion Nursing Standards of Practice, Infusion Pumps, Infusion Therapy Resources and References, InfusionNurse, IV, IV start, Medical bloggers, Nursing, Nursing blogs, Patient Education, State Board Of Nursing, Toruniquets, Venipuncture

I got a blood return…but

…it burns when you flush my port! In case you missed it…

“The Case of the Painful Port”  a very interesting article published by ONS Connect and  shared by a twitter colleague @ONSmark.  Read article here…

  • This case is a very good reminder for us nurses to stop and listen to what our patients are saying. Often, when we are busy with our work, we think we are listening to our patients but we don’t  really “hear” what they are saying and/or don’t take action.
  • When assessing for patency of a vascular access – checking for positive  blood return is a good sign that the device is in the right place and functional. Positive blood return means a free flowing blood return easily obtained on aspiration, and the color of whole blood. 
  • Aside from a positive blood return, we should also assess for other symptoms such as swelling, redness or pain and comments from patients. As was the case described in this article, had the nurse not taken the extra step  when the patient complained of “burning sensation” after flushing with saline, the outcome would have been worse  especially with Doxorubicin, a known vesicant. (A vesicant is a chemical that causes extensive tissue damage and blistering if it escapes from the vein.)
  • Kudos to the nurse for reporting to the physician and to the physician who took action and ordered a dye study. There were times in my career when I had the same scenario and reported it to the physician – only to be told to “flush ” gently the patient won’t feel the burn!  In another case, another physician told me to go ahead and use the device since I got a positive blood return!! No,  I didn’t give in and insisted on an x-ray or better yet, a dye study.
  • This case had a good outcome but what if the nurse didn’t do anything and started administering the chemotherapy? That patient would have continued to feel the ‘burning” sensation and now a vesicant has leaked into the tissue. You know what would have happened – “extravasation”.  Taking the time and the appropriate steps prevented extravasation in this patient. Prevention is still the best medicine!

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Filed under Cancer, Certified Nurses, Continuing nursing education, Cora Vizcarra, CRNI, Extravasation, Flushing Catheters, Infiltration, Infusion Nurse Chat, Infusion Nursing, Infusion Nursing Standards of Practice, Infusion Therapy Resources and References, InfusionNurse, IV, IVchat, Medical bloggers, Medication Administration, Medication Safety, Nursing, Nursing blogs, Patient Education, State Board Of Nursing, Venipuncture

Celebrate I.V. Nurse Day…

In 1980, the professional practice of infusion nursing was formally recognized when the United States House of Representatives declared January 25 as IV Nurse Day. This recognition was the beginning of what the infusion specialty has become. Specialization marks the advancement of nursing practice. It signifies that nursing has moved from a global approach to a focus on defined areas within the practice that require specialized knowledge and skills.

As we celebrate this day, I want to wish each infusion nurse Happy IV Nurse Day. Whatever you do and wherever you are, on this special day, take the time to celebrate the numerous accomplishments that make us proud to be infusion nurses.

To celebrate this special day, we are offering a FREE webinar on January 24, 2012 entitled “Are You There Yet? Integrating Infusion Nursing Standards into your Practice”. Register now and earn 1.o contact hours in nursing. To register,  Click on this link – http://t.co/179YqxxZ

 

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My IV infiltrated….

and I am wondering if what seeped into my arm will yield any medicinal benefit or if it’s like not getting anything at all? This was a question posted by a reader of this blog.

Thanks for posting this interesting question.  While I could have readily given an answer based on my experience, I wanted to see if there were any written articles about “fluid reabsorption from an infiltrated IV” before posting a reply. There were several on the topic of IV infiltration, however, no specific publication on this. Here are my thoughts.

  • We define infiltration as the inadvertent administration of nonvesicant drugs or fluids into the subcutaneous tissue. The subcutaneous tissue is not a large reservoir for fluid hence when fluid/solution escapes into this area, localized swelling will result.
  • As the reader posted, the medication that infiltrated was Solu-medrol, which is a non-vesicant solution – in the event this medication infiltrates, it it will not cause tissue necrosis.
  •  The absorption of fluid or medication in the subcutaneous tissue is known to be slow thus many medications are given intravenously. In the event of an  IV infiltration, the reabsorption of the infiltrated fluid/mediation will be slow and given the small volume,  it is doubtful that any benefit will be gained from the medication.
  • While infiltration is one of the common complications of IV therapy, it can be prevented and managed if it occurs.

Here are few thoughts to consider.

1. Location, location, location:  When selecting an IV site, avoid areas of flexion  – this includes the wrist, hand, and antecubital fossa.  Be mindful of any punctures to veins above the area you are about to stick. If patient had a recent blood draw from the antecubital fossa, use the opposite arm to find a suitable site.  Oh, btw, infiltration/extravasation can also happen in patient’s with central venous access.

2. Bigger is not better: Use the smallest gauge IV catheter to administer the prescribed therapy.  Good flow rates are possible even with a small gauge catheter. Using an IV catheter too large for the vein will obstruct blood flow and might cause thrombosis distal to the IV site.

3. Know your medications:  Medications and solutions with an osmolarity greater than 600 mosmol/L  and pH lower than 5 or higher than 9 should not be infused via a peripheral IV. Know the adverse events, if any for each medication. If in doubt, always ask our friendly pharmacists!!

4. Secure your IV device: Use a stabilization device to anchor and avoid movement of the catheter. When using a dressing, avoid obscuring the IV site to allow you to observe the site.

5. Check  IV patency and assess site: Key to early recognition of complications. Refer to your organization’s policy on frequency of IV site checks.  Infusion pumps will not tell you if an IV site in infiltrating. Always aspirate for positive blood return prior to use, but remember, checking for blood return or back flow of blood is good for patency but not a reliable method for assessing infiltration at IV site. If infusion continues to run when you apply digital pressure 3 inches above peripheral IV site in front of catheter tip – suspect infiltration

6. Policy/procedure for infiltration/extravasation: Do you know if your organization has one ? Have you even read it? What are you expected to do when infiltration/extravasation happens?  Is there a rating scale to document the severity of the problem? Are you expected to complete an “incident report”? Can you photograph the site?

7. Hot or cold: Which do you use? What does your policy state about compress? Do you need an doctor’s order for this?

8. Antidote: Is there one for the medication you administered? Obtain physician’s orders for the appropriate antidote. How is it given?

9. Document, document, document!! I know, you’ve heard this before….if it’s not documented, you didn’t do it! Keep this in mind, you will not remember what happened in the past, so hopefully, your documentation can defend you.

10. Don’t forget the patient/family: Keep them informed and provide information regarding treatment and management.

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Filed under Certified Nurses, Cora Vizcarra, Infiltration, Infusion by gravity drip, Infusion Nurse Chat, Infusion Nursing, Infusion Nursing Standards of Practice, Infusion Therapy Resources and References, InfusionNurse, IV, IV start, IVchat, Medical bloggers, Medication Administration, Nursing, Nursing blogs, State Board Of Nursing, Venipuncture

FYI….Free!

Register to attend a FREE webinar on January 24, 2012 and receive 1.0 contact hours in nursing.

Topic: Are you there yet? Integrating Infusion Nursing Standards into Your Practice

The Infusion Nursing Standards of Practice are applicable to nurses providing infusion therapy across all healthcare settings. Whether you care for patients with vascular access requiring infusion therapies in hospitals, outpatient centers, infusion centers, physicians’ offices, skilled nursing facilities or at home, the standards apply to your practice. Unfortunately, many nurses and healthcare settings are unaware of the standards and/or think it doesn’t apply to them. This web seminar will explore the important recommendations for infusion therapy; discuss ways to integrate standards into your policies, and how the standards can protect you and your patients.

Objectives:

  1. Identify at least 3 key evidence based standards of practice from the 2011 Infusion Nursing Standards of Practice.
  2. Discuss strategies for integration and implementation of the standards in your clinical setting.
  3. Discuss the legal implications of the standards to protect you, your practice and improve patient care.

Faculty: Lisa Gorski, MS, HHCNS-BC, CRNI®, FAAN  Clinical Nurse Specialist Wheaton Franciscan Home Health and Hospice, Milwaukee, WI

 Register NOW! : Click on this link to register for free- http://t.co/179YqxxZ

 Don’t miss out on this educational opportunity and receive 1.o contact hours in nursing.

NOTE: This webinar is sponsored by MCV & Associates Healthcare Inc. – who is my employer. Although the topic is about the Infusion Nursing Standards of Practice – this webinar is not in anyway associated with the Infusion Nurses Society.

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Filed under Board Certified Nurses, Certified Nurses, Continuing nursing education, Cora Vizcarra, CRNI, Infection Control and Prevention, Infusion Nurse Chat, Infusion Nursing, Infusion Nursing Standards of Practice, Infusion Therapy Resources and References, InfusionNurse, IV, IVchat, Medical bloggers, Nursing, Nursing blogs, Patient Education, State Board Of Nursing

It’s a silly kinda day…

You know one of those days when you’re trying to read and catch up on scholarly nursing articles and…then you see things like these:

1. No, I’m not making fun of anything or anybody but these two got my attention…

2. Then there’s this…

3. And flowcharts like this… borrowed from the engineers…

5. Finally this…..

Too early in the year to be slacking off on this blog, but I just couldn’t resist sharing these. I promise next blog post will be….more informative!

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Filed under Cora Vizcarra, Infusion Nurse Chat, Infusion Nursing, InfusionNurse, IV, Medical bloggers, Nursing, Nursing blogs