T H E O F F I C I A L M E M B E R S H I P N E W S P U B L I C AT I O N O F I N F U S I O N N U R S E S S O C I E T Y
A Perfect Fit A professor adopts the INS FIT program into her infusion nursing classes
Clinical Corner: On Vascular Access Devices
Meet the INS 2021 Innovation Award Winner
A Hospital Chaplain During the Pandemic VOLUME 4
INFUSION NURSES SOCIETY
Hizentra is an Ig* therapy that provides proven PI protection and CIDP relapse prevention, with the convenience of self-administration, so you can focus on everyday living.
Important Safety Information Hizentra®, Immune Globulin Subcutaneous (Human), 20% Liquid, is a prescription medicine used to treat: • Primary immune deficiency (PI) in patients 2 years and older • Chronic inflammatory demyelinating polyneuropathy (CIDP) in adults WARNING: Thrombosis (blood clots) can occur with immune globulin products, including Hizentra. Risk factors can include: advanced age, prolonged immobilization, a history of blood clotting or hyperviscosity (blood thickness), use of estrogens, installed vascular catheters, and cardiovascular risk factors. If you are at high risk of blood clots, your doctor will prescribe Hizentra at the minimum dose and infusion rate practicable and will monitor for signs of clotting events and hyperviscosity. Always drink sufficient fluids before infusing Hizentra. See your doctor for a full explanation, and the full prescribing information for complete boxed warning.
Treatment with Hizentra might not be possible if your doctor determines you have hyperprolinemia (too much proline in the blood), or are IgA-deficient with antibodies to IgA and a history of hypersensitivity. Tell your doctor if you have previously had a severe allergic reaction (including anaphylaxis) to the administration of human immune globulin. Tell your doctor right away or go to the emergency room if you have hives, trouble breathing, wheezing, dizziness, or fainting. These could be signs of a bad allergic reaction. Inform your doctor of any medications you are taking, as well as any medical conditions you may have had, especially if you have a history of diseases related to the heart or blood vessels, or have been immobile for some time. Inform your physician if you are pregnant or nursing, or plan to become pregnant. Infuse Hizentra under your skin only; do not inject into a blood vessel. Self-administer Hizentra only after having been taught to do so by your doctor or other healthcare professional, and having received dosing instructions for treating your condition.
Please see Brief Summary of full Prescribing Information on reverse.
Discover the latest innovation in Ig for people with PI or CIDP
Simplify your infusions with the first and only Ig prefilled syringes Simple, convenient, and ready to use so you can get back to everyday living
No more vial transfers! Prefilled syringes may reduce steps and effort, depending on dose
May simplify the setup and transfer of Hizentra for those who have difficulty drawing from vials
Hizentra prefilled syringes are transferred to a pump syringe using a syringe-to-syringe transfer device
Ask your doctor about prefilled syringes and visit HizentraPFS.com to learn more.
Immediately report to your physician any of the following symptoms, which could be signs of serious adverse reactions to Hizentra: • Reduced urination, sudden weight gain, or swelling in your legs (possible signs of a kidney problem). • Pain and/or swelling or discoloration of an arm or leg, unexplained shortness of breath, chest pain or discomfort that worsens on deep breathing, unexplained rapid pulse, or numbness/weakness on one side of the body (possible signs of a blood clot). • Bad headache with nausea; vomiting; stiff neck; fever; and sensitivity to light (possible signs of meningitis). • Brown or red urine; rapid heart rate; yellowing of the skin or eyes; chest pains or breathing trouble; fever over 100°F (possible symptoms of other conditions that require prompt treatment). Hizentra is made from human blood. The risk of transmission of infectious agents, including viruses and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent and its variant (vCJD), cannot be completely eliminated.
The most common side effects in the clinical trials for Hizentra include redness, swelling, itching, and/or bruising at the infusion site; headache; chest, joint or back pain; diarrhea; tiredness; cough; rash; itching; fever, nausea, and vomiting. These are not the only side effects possible. Tell your doctor about any side effect that bothers you or does not go away. Before receiving any vaccine, tell immunizing physician if you have had recent therapy with Hizentra, as effectiveness of the vaccine could be compromised. Please see full prescribing information for Hizentra, including boxed warning and the patient product information. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. You can also report side effects to CSL Behring’s Pharmacovigilance Department at 1-866-915-6958.
Only Hizentra offers the freedom and flexibility of self-administration with prefilled syringes for both PI and CIDP “I used to struggle with drawing Hizentra out of vials, and often I would need to have my husband help me. Now, with prefilled syringes, I can prepare the infusion myself, giving me a greater sense of independence.” —Lynne, Hizentra Patient & Voice2Voice® Advocate* *Voice2Voice advocates are not healthcare professionals or medical experts. For medical questions, please contact your physician. Voice2Voice advocates are compensated by CSL Behring LLC for their time and/or expenses.
Hizentra Connect brings together all our Ig patient support resources under one roof. Get the guidance and support you need with a single phone call today.
Call 1-877-355-4447, Mon–Fri, 8 AM–8 PM ET or learn more at HizentraConnect.com
HIZENTRA®, Immune Globulin Subcutaneous (Human), 20% Liquid Initial US Approval: 2010 BRIEF SUMMARY OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use HIZENTRA safely and effectively. Please see full prescribing information for HIZENTRA, which has a section with information directed speciﬁcally to patients. What is HIZENTRA? HIZENTRA is a prescription medicine used to treat primary immune deﬁciency (PI) and chronic inﬂammatory demyelinating polyneuropathy (CIDP). Infuse HIZENTRA only after you have been trained by your doctor or healthcare professional. HIZENTRA is to be infused under your skin only. DO NOT inject HIZENTRA into a blood vessel (vein or artery). Who should NOT take HIZENTRA? Do not take HIZENTRA if you have too much proline in your blood (called “hyperprolinemia”) or if you have had reactions to polysorbate 80. Tell your doctor if you have had a serious reaction to other immune globulin medicines or have been told that you have a deﬁciency of the immunoglobulin called IgA. Tell your doctor if you have a history of heart or blood vessel disease or blood clots, have thick blood, or have been immobile for some time. These things may increase your risk of having a blood clot after using HIZENTRA. Also tell your doctor what drugs you are using, as some drugs, such as those that contain the hormone estrogen (for example, birth control pills), may increase your risk of developing a blood clot. What are possible side effects of HIZENTRA? The most common side effects with HIZENTRA are: • Redness, swelling, itching, and/or bruising at the infusion site • Headache/migraine • Nausea and/or vomiting • Pain (including pain in the chest, back, joints, arms, legs) • Fatigue • Diarrhea • Stomach ache/bloating • Cough, cold or ﬂu symptoms • Rash (including hives)
• Itching • Fever and/or chills • Shortness of breath • Dizziness • Fall • Runny or stuffy nose Tell your doctor right away or go to the emergency room if you have hives, trouble breathing, wheezing, dizziness, or fainting. These could be signs of a bad allergic reaction. Tell your doctor right away if you have any of the following symptoms. They could be signs of a serious problem. • Reduced urination, sudden weight gain, or swelling in your legs. These could be signs of a kidney problem. • Pain and/or swelling of an arm or leg with warmth over the affected area, discoloration of an arm or leg, unexplained shortness of breath, chest pain or discomfort that worsens on deep breathing, unexplained rapid pulse, or numbness or weakness on one side of the body. These could be signs of a blood clot. • Bad headache with nausea, vomiting, stiff neck, fever, and sensitivity to light. These could be signs of a brain swelling called meningitis. • Brown or red urine, fast heart rate, yellow skin or eyes. These could be signs of a blood problem. • Chest pains or trouble breathing. • Fever over 100ºF. This could be a sign of an infection. Tell your doctor about any side effects that concern you. You can ask your doctor to give you more information that is available to healthcare professionals. Please see full prescribing information, including full boxed warning and FDAapproved patient product information. For more information, visit Hizentra.com. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. You can also report side effects to CSL Behring’s Pharmacovigilance Department at 1-866-915-6958.
Based on April 2021 version. Hizentra is manufactured by CSL Behring AG and distributed by CSL Behring LLC. Hizentra® is a registered trademark of CSL Behring AG. Biotherapies for Life® is a registered trademark of CSL Behring LLC. Hizentra ConnectSM is a service mark of CSL Behring LLC. Voice2Voice® is a registered trademark of CSL Behring GmbH. ©2021 CSL Behring LLC 1020 First Avenue, PO Box 61501, King of Prussia, PA 19406-0901 USA www.CSLBehring.com www.Hizentra.com HIZ-0141-MAY21
J u n e
4 - 7
INS BOARD OF DIRECTORS 2021-2022 PRESIDENT
Sue Weaver, PhD, RN, CRNI®, NEA-BC PRESIDENT-ELECT
Max Holder, MSN, RN, CRNI®, NE-BC SECRETARY/TREASURER
Joan Couden, BSN, RN, CRNI®
INSIDER T H E O F F I C I A L M E M B E R S H I P N E W S P U B L I C AT I O N
OF INFUSION NURSES SOCIETY
Angelia Sims, MSN, RN, CRNI®, OCN® DIRECTORS-AT LARGE
Nancy Bowles, MHA, RN, OCN®, CRNI®, NEA-BE, CPC-A Angela Skelton, BSN, RN, CRNI®
INSider encourages the submission of articles, press releases, and other materials for editorial consideration, which are subject to editing and/or
condensation. Such submissions do
John S. Garrett, MD, FACEP
not guarantee publication. If you are
CHIEF EXECUTIVE OFFICER
Mary Alexander, MA, RN, CRNI®, CAE, FAAN
interested in contributing to INSider, please contact the INS Publications Department. Photos become the property of INSider; return requests must be in writing. INSider is an official bimonthly publication of the Infusion Nurses Society.
I N S S TA F F Chief Executive Officer: Mary Alexander, MA, RN, CRNI®, CAE, FAAN Executive Vice President: Chris Hunt Director of Operations and Member Services: Maria Connors, CAE Clinical Education & Publications Manager: Dawn Berndt, DNP, RN, CRNI® Managing Editor: Leslie Nikou Editorial Production Coordinator: Rachel King Director of Clinical Education: Marlene Steinheiser, PhD, RN, CRNI®
INFUSION NURSES SOCIETY
Senior Member Services & Conference Coordinator: Jill Cavanaugh Meetings Manager: Meghan Trupiano, CMP Marketing Project Manager: Whitney Wilkins Hall Certification Manager: Adrienne Segundo, IOM Certification Administrator: Bill Taylor
©2021 Infusion Nurses Society, Inc. All rights reserved. For information contact: INS Publications Department One Edgewater Drive, Suite 209
Senior Certification & Member Services Associate: Maureen Fertitta
Norwood, MA 02062
Member Services Associate: Susan Richberg
Bookkeeper: Cheryl Sylvia
6 8 10 12 21 14 16 18 20 22 26 28 30
In this Issue President’s Message: A Healthy Work Environment Susan H. Weaver, PhD, RN, CRNI®, NEA-BC
Speaking Opportunities at the INS 2022 Annual Meeting and Exhibition Creating an Infusion Nursing Course Using the INS FIT Program Rosemarie R. Van Patten, PhD, RN
Clinical Corner: On Vascular Access Devices Lynn Hadaway, M.Ed, RN-BC, CRNI®
INS 2021 Innovation Award Winner Christopher Grimes, RN, BSN, CRNI®
A Hospital Chaplain During the Pandemic Rebecca Doverspike, MDiv, MFA
Pandemic Poems: The Neighbors Rachel King, MFA
CRNI® Connection: Your CRNI® Credential: What’s Behind It?
Member Spotlight: Our members share their experiences with the infusion community
Welcome New INS Members: Domestic and International
INSide Scoop: A closer look at what’s going on within INS
End of Year Review The INS Team
P R E S I D E N T ’ S
M E S S A G E
A Healthy Work Environment
Infusion nurses work in all types of quality. Research also demonstrates that environments, but in any setting, a healthy unhealthy work environments cause medical work environment is imperative to the health errors, ineffective delivery of care, conflict, and safety of all. A healthy work environment stress among health workers, dissatisfied staff, (HWE) is defined by the American Nurses low staff retention, and poor patient outcomes. Association as a work environment that is “safe, In my presidential address, I discussed the empowering, and satisfying” and by J. Disch in standards of skilled communication and true The Nursing Profession as “a work setting in collaboration. Let’s look at the other standards which policies, procedures, and systems are as they relate to infusion nurses. designed so that employees are able to meet organizational objectives and achieve personal Through effective decision-making, nurses Susan H. Weaver satisfaction in their work.” The American provide input on policies and procedures, Association of Critical-Care Nurses (AACN) PhD, RN, CRNI®, NEA-BC equipment and supplies, and decisions about identified six standards for establishing and patient care. Shared governance, a nursing sustaining healthy work environments: skilled management model that gives staff nurses communication, true collaboration, effective decisioncontrol over their professional practice, provides a making, appropriate staffing, meaningful recognition, and mechanism for nurses to provide input into policies and authentic leadership. practice. For one example at INS, nurses participated in Research demonstrates that HWEs impact nurse job satisfaction, retention, job performance, and patient care 6
revising and updating the 2021 Infusion Therapy Standards of Practice (the Standards). Now with the release of the
Standards, are you participating in revising and updating policies and procedures at your organization? Utilizing these new standards benefits organizations, nurses, and most importantly patients.
And feel free to share with me what you have done to improve your work environment (firstname.lastname@example.org).
The appropriate staffing standard recognizes the importance of having a sufficient number of competent nurses to care for patients. In a qualitative study I and my colleagues conducted exploring clinical nurses and nurse managers perception of the HWE, we asked “If you ruled the world, what would you change about your current staffing processes or staffing levels?” The common theme in the responses from the clinical nurses and nurse managers was that patient acuity and complexity matters. It can be helpful to think about staffing in relation to patient acuity, the competency of the nursing staff, and the physical work environment. For those who work at infusion centers, as revealed in an integrative literature review, more research is needed on outpatient acuity systems in infusion centers.
Meaningful recognition—providing recognition to nurses— has been linked to decreased burnout and increased compassion and satisfaction. Recognition of nurses can be accomplished through formal recognition programs such as The Daisy Award or organization-specific awards such as nurse excellence or nurses’ week awards. Expressing gratitude to a colleague is also meaningful recognition. At my organization, we utilize Wambi™, a gamified system that allows us to send Wambis to colleagues in appreciation for a special something they did that made an impact, or just let them know we are grateful to have them on our team. As infusion nurses, we can recognize colleagues on IV Nurse Day, held annually on January 25th; nominate a colleague for an award in the INS Awards and Recognition Program; and/or recognize nurses who have their CRNI® on March 19th each year for Certified Nurses Day™. Also, simply saying “thank you” is appreciated, as Erin Sevilla stated in the May/June 2020 INSider: “One night, as we were all leaving the hospital, there was a crowd of people all holding signs that said, ‘Thank You.’” Lastly, the authentic leadership standard recognizes that all nurses are leaders, whether in formal or informal leadership positions, and all should foster the healthy work environment at their workplace. Authentic leaders are genuine, trustworthy, reliable, and believable. To understand authentic leadership, watch this video from Delta Airlines Leadership Meeting: https://www.youtube.com/watch?v=JG69mNpafbo As infusion nurses, I think we can relate to the shrimper in this video who seemed to have purpose and passion for his job, and valued teamwork and doing the right thing when no one was looking. Just as the shrimper saw potential in this young man, I hope we see the potential in new infusion nurses.
Enjoy the holidays!
Sue Weaver recently co-authored two articles: "Exploration of the Meaning of Healthy Work Environment for Nurses" in the August 2021 issue of Nurse Leader and "Night Nurses and Exercise" in the American Nurse Journal, Volume 16, Number 9.
References American Association of Critical-Care Nurses (AACN). AACN standards for establishing and sustaining healthy work environments: a journey to excellence. Am J Crit Care 2005;14(3):187-197. American Association of Critical-Care Nurses (AACN). AACN Standards for Establishing and Sustaining Healthy Work Environment: A Journey to Excellence. 2nd Edition. 2016. https://www.aacn.org/nursingexcellence/standards/aacn-standards-for-establishing-and-sustaininghealthy-work-environments American Nurses Association (ANA). Healthy Work Environment. 2021. https://www.nursingworld.org/practice-policy/work-environment/ American Nurses Credentialing Center. Certified Nurses Day. https://www.nursingworld.org/education-events/certified-nurses-day/. Published date unknown. Barnes, B., Barnes, M., Sweeney, C. Putting the “meaning” in meaningful recognition of nurses: the DAISY award. J Nurs Adm. 2016; 46(10), 508-512. Disch, J. (2001). Creating healthy work environments for nursing practice. In: N. L. Chaska, ed. The Nursing Profession: Tomorrow and Beyond. SAGE Publishing; 2011: 735-750. https://www-doiorg.proxy.libraries.rutgers.edu/10.4135/9781452232720.n61 Erickson, J.I. Overview and summary: promoting healthy work environments: a shared responsibility. Online J Issues of Nurs. 2010;15(1). http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ ANAPeriodicals/OJIN/TableofContents/Vol152010/No1Jan2010/Over view-and-Summary-Promoting-Healthy-Work-Environments.html Fesler, S. M., Toms, R. Infusion center outpatient acuity: an integrative review of the literature. J Pediatr Nurs. 2020;55:184-191. https://doi.org/10.1016/j.pedn.2020.08.018 Hess R. Shared governance: innovation or imitation? Nurs Econ. 1994;12(1): 28-34. Johansen, M., de Cordova, P., Weaver, S. Exploration of the meaning of healthy work environment for nurses. Nurse Lead. 2021;19(4): 383-389. Kelly, L., Lefton, C. Effect of meaningful recognition on critical care nurses’ compassion fatigue. Am J Crit Care 2017;26(6): 438-444. Wei, H., Sewell, K., Woody, G., Rose, M. The state of the science of nurse work environments in the United States: A systematic review. Int J of Nurs Sci. 2018;5(3): 287-300. Weaver, S. Presidential address. J Infus Nurs. 2021;44(4): 196-197.
For more on authentic leadership, try this self-assessment.
Speaking Opportunities at the INS 2022 Annual Meeting and Exhibition INS invites health care clinicians and non-clinicians, INS members and non-members to submit an abstract for INS 2022. Those who are selected will have the opportunity to reach an international audience; bolster their curriculum vitae by speaking at a conference developed by THE organization that sets the standards for infusion therapy practice; and submit a manuscript to the Journal of Infusion Nursing. INS assesses for educational gaps in clinical practice and strives to close those gaps with interactive, engaging, high-quality educational sessions. The Annual Meeting is one of the venues where INS provides professional development programs that will improve the delivery of health care and the practice of infusion nursing. Interact with colleagues, share experiences, and learn from other experts as you contribute your expertise to INS 2022. Consider submitting an abstract on an infusion therapy–related topic.
INS 2022 will take place June 4-7 at the Rosen Shingle Creek Hotel in sunny Orlando, Florida! The luxury hotel has countless amenities and will provide attendees and speakers with easy access to everything Orlando has to offer. INS provides 1 complimentary guest room night for all speakers, and if they want to extend their stay, the hotel is offering a discounted room rate of $179 per night plus tax. INS also assists speakers with travel expenses.
I N S
2 0 2 2
O R L A N D O ,
F L O R I D A
J U N E
2 0 2 2
Are you interested in speaking at a national conference? Infusion Nurses Society (INS) is recognized as the global authority in infusion therapy and is dedicated to exceeding the public’s expectations of excellence by setting the standard for infusion care. INS is also dedicated to providing professional development opportunities and quality education, and to advancing best practice through evidence-based practice and research. We are accepting abstract submissions for 50-minute podium presentations. Content must be evidence-based and reflect the current state of the science or be based upon research-driven results contributing to the science. Presentations must be free of commercial bias and adhere to the criteria set by the California Board of Nursing for awarding contact hours.
2022 Annual Meeting abstract submissions are due by November 3, 2021 Virtual and/or webinar abstract submissions are continually accepted separate from this call
Session proposals/abstracts on the following infusion therapy–related topics may be submitted: • Vascular access device (VAD) technology – Products (eg, infusion control devices, dressings, vein visualization) – Use and management – Complications • Infection prevention • Patient education • Special populations — for example: – Pediatrics – Older adults – Pregnancy • Alternative care settings, including but not limited to: – Home care – Outpatient infusion centers – Skilled nursing facilities • Disease states
• Infusion therapies – Fluid and electrolyte balance – Pharmacology – Transfusion therapy – Parenteral nutrition – Antineoplastic and biologic therapy – Pain management • Quality improvement and patient safety • Nursing professional development • Clinician health and wellness • Current affairs, social science, and global concerns • Emerging evidence • Health care ethics • Professional liability and legal considerations • Diversity, equity, and inclusion
Apply Now: http://ins1.org/call-for-abstracts Guidelines: To be eligible, your abstract must be your original work; subsequent presentation of this content is acceptable, provided you have an original title with a different view, perspective, or focus.
Important Dates and Information:
To submit your abstract, please be prepared to enter the following information: – Name and credentials—current employer, job title, and CV/resume – Paid consultant roles (title and company) – Proposed topic (including): 1. Original title 2. Session description/abstract 3. Brief session introduction for program agenda 4. Learning objectives 5. Content outline 6. References – Speaking experience
February 11, 2022: Presentation date to be determined by the INS Education Department
November 3, 2021: Abstract submissions close January 4, 2022: Selected speakers will be notified
Organizing Committee: Marlene Steinheiser, PhD, RN, CRNI® INS Director of Clinical Education Dawn Berndt, DNP, RN, CRNI® INS Clinical Education and Publications Manager
Contact INS (email@example.com) with any questions
C O V E R
S T O R Y
Creating an Infusion Nursing Course using the INS FIT Program by Rosemarie R. Van Patten, PhD, RN
Nursing students are always asking why they do not learn how to draw blood and start short peripheral intravenous catheters (PIVCs) while in nursing school. It has been my goal to help nursing students have this opportunity prior to entering the working world. Increased knowledge regarding the safe practices of infusion therapy will support new nurses in the awareness of the proper procedures as they learn how to minimize possible complications while practicing safely. When starting as a professor at Siena College, Loudonville, New York, I was hopeful that this might be a possibility, and in Spring 2021, it was. I developed a 2-credit nursing elective entitled NURS 340 Holistic Approach to Infusion Nursing and Phlebotomy. This was a dream come true for me and for nursing students attending the Baldwin Nursing Program. 10
When developing this course, I reviewed the Infusion Nursing Society website and reached out to Marlene Steinheiser, Director of Clinical Education, Infusion Nurses Society, to inquire about any information that would be helpful. She introduced me to the 8 modules of Fundamentals of Infusion Therapy (FIT). I was very interested to see what this program entailed. When I accessed the modules, I really liked the content within the modules—topics, videos, questions to assess student learning—and I thought FIT would work well in the course. I adapted Lisa Gorski’s textbook, Manual of I.V. Therapeutics: Evidence-Based Practices for Infusion Therapy, to use for the infusion course as well.
The course followed the 12-chapter format of the Gorski textbook. I incorporated the FIT modules — Module 1: Safe Infusion Therapy Practice; Module 2: Vascular Access Device and Site Selection; Module 3: Proper Use of Short Peripheral Catheter; Module 4: Device Care and Management; Module 5: Administration of Fluids and Medication; Module 6: Proper Device Removal; Module 7: Assessment and Management of Complications; Module 8: Final Challenge—into assignments the week each topic was covered. We would review the material during class time and when practicing skills. In order to complete the course, students were evaluated on the discussion board/online activities, which included the FIT modules, case studies, articles and videos with responses to questions, infusion medication worksheet, four quizzes, a health education paper assignment (with poster or brochure), 3 skills demonstrations (blood draw, short peripheral intravenous catheters [PIVCs] insertion, central line dressing change), and a mind map presentation. Some of the student feedback and comments related to the FIT modules within the course were as follows: “I really liked the videos that were included in the FIT modules.” “It was very helpful to put these skills into real-life scenarios. The videos were very helpful to see how the skills are performed. Highly recommend for future classes.” “Helpful hands-on videos that explain all the knowledge we learned in class with detail. The two complement each other very well.” “These are skills that are integral to the nursing profession. I believe that this course should be included in the nursing curriculum.” In reply to the question, What did you like the most in this class?, one student stated, “The INS modules and their videos and scenarios.” The students and I agree that this course, including the FIT modules, is much needed and should be a part of the nursing curriculum. However, the students and I also both thought that the course should be a 3-credit required course so that they would have more time to practice the skills. The time during class was short, an hour and a half to cover both content and practice skills. We always felt rushed to practice prior to skill evaluations. Nevertheless, on the overall response to the course, one student wrote, “This class really helped me understand and gave me the knowledge and confidence I need to go into my nursing practice.” Students checked anywhere from poor to fair to good— just one student checked good—for the question of prior knowledge related to the infusion therapy topic. The
students felt they had minimal knowledge of infusion nursing prior to taking this class. After taking the class and using the FIT modules, they strongly feel that the course with the FIT modules should continue to be offered not only as an elective, but as a required part of the curriculum. Some of the comments students shared are as follows: “I learned a lot of skills including IV insertion, blood draws, and central line dressings. I learned how to provide safe care.” “I would say that I had a decent understanding but nowhere near the understanding I have now.” “I now know the best evidence-based practices to use and I look forward to doing this in my future practice.” “INS and the modules and activities really increased my knowledge.” “There are no infusion or phlebotomy materials in the nursing program. This course helped me strengthen my knowledge about the subject.” I am hopeful that the course will be offered every spring term and become a required 3-credit course, instead of the current 2-credit elective. When I teach the course again in spring 2022, I will continue to use the FIT modules as part of the course. This has been a wonderful experience for the students and me. A great aspect of the FIT modules is that the students will always have access to them and will be able to refer to them at any time on their own. They will be kept up-to-date with the current changes in standards and procedures related to infusion therapy. I strongly recommend the FIT modules for any and all future infusion therapy classes that are developed and offered.
Rosemarie R. VanPatten, PhD, RN, Caritas Coach©, is an assistant professor of nursing at Siena College’s Baldwin Nursing Program. She has been working at Siena College in Loudonville, New York since September 2019 and has been teaching nursing for the last 15 years. She has a strong infusion therapy background, working several years on the IV team, med-surg, and post-anesthesia care unit (PACU) with 30 plus years at Ellis Medicine in Schenectady, New York. She also has years of experience working in community/public health nursing, and has also served in the Air National Guard as a flight nurse. She recently completed Jean Watson’s Caritas Coach Education Program (CCEP©) and teaches using the Caring Science curriculum within the Baldwin Nursing Program. Dr. Van Patten has taught NURS 310 Health Assessment and Promotion Across the Lifespan and currently teaches NURS 410 Population and Public Health Nursing Perspectives, NURS 315 Holistic Pharmacology for Nursing Practice, NURS 305 Research for Nursing Practice, and NURS 340 Holistic Approach to Infusion Nursing.
C L I N I C A L
C O R N E R
On Vascular Access Devices Find out more on the INS Clinical Community Discussion Board! All answers by Lynn Hadaway, M.Ed, RN-BC, CRNI® Q: How long is the safe recommended time period for administration of vasopressors (Levo infusion through peripheral IV)? Is it 24 hours or 48 hours? A: Research has not established such a limit. Even 1 hour could be too much if the site is in a joint and not adequately secured. So the decision is much more than just a length of time. Catheter size, vein size, insertion technique, site selection, and joint and catheter stabilization influence the length of time before a complication will be seen.
Q: I am looking for evidence-based practice on how often Cathflo should be instilled for ports or PICCs with no blood return. Weekly? Monthly? I have a patient who has been coming daily for 6 weeks for antibiotic therapy who has had Cathflo administered twice already (2 weeks apart): there is positive blood return for several days then stops, always flushes easily, now see a third order for instilling. Pharmacy had no answer. I was unable to find an answer on the included Cathflo leaflet. A: As far as I know there is no maximum number or frequency. This need is because the instillation procedure is not reaching the full fibrin sheath. It is only allowing the TPA to reach the fibrin/thrombus directly at the tip of the catheter. The fibrin extends far beyond that point up the length of the catheter and is regrowing between treatments. You can try a low dose infusion of TPA—2-3 mg in 50 mL infused over 3 hours through each lumen. Otherwise, this regrowth will continue.
Q: I am the nurse manager for four outpatient clinics. One clinic is the outpatient infusion clinic. This week there has been some debate between the midlevel providers and the infusion clinic RN staff on whether or not chemo and blood can be administered simultaneously via two different PIVs. Looking for any guidance or research on the topic. Thanks. A: Blood is transfused frequently in ER and ICU with other meds infusing. As long as each are infusing through a separate VAD, compatibility is not the issue. In my opinion, the greatest issue would be to determine the cause of a hypersensitivity infusion reaction if one should occur. Patients receiving both blood and chemo need to have an assessment for the risk of any reaction prior to beginning the infusion. I think it could be quite confusing as to the cause of a reaction if the chemo and blood could be a potential cause. Please read the INS SOP on antineoplastic agents and blood transfusion.
Q: We want to know if you indicate any literature for the construction of the protocol for washing intravenous lines... I refer to the preparation [of an] intravenous line at the end of each medication, so that there are no underdoses in the administration of drugs. A: Look at the volume of fluid left in the set when the infusion is complete. How much does the entire set being used hold? If using an electronic infusion pump, that volume could be up to 50% of the total volume of the dose. In that case, it is best to use normal saline as the primary line and piggyback medications into this saline line. When the drug is finished, the saline infuses to flush the whole dose into the bloodstream. If you are infusing by gravity, the volume left is probably around 5% or less and would not make any clinical difference. 12
Q: We are receiving a patient with a Bard PowerLine. I practice in a hospice setting where we mainly deal with PICCs and ports. I remember the Hickman and Broviac catheters that were long-term access, but can't find anything on the Bard site that states how long they last. Someone at the hospital said 2 weeks, but this is suspect. The Bard website says short- or long-term use, but that isn’t too clear. Anybody have experience with this catheter? A: There is no maximum or optimal dwell time for ANY VAD of any kind. Number of days or weeks has not been established for any type of catheter. Valid reasons for removal for all are 1) therapy is complete and the VAD is no longer part of the plan of care, and 2) an unresolved complication. As long as it is free of any complication and yielding a blood return [and] flushes easily it is functional and should remain in place until therapy is completed. Catheter manufacturers do not provide this information.
Q: What are the recommendations for removal/replacement of PIVs inserted in the “field” (road side, ambulance, etc.) versus PIVs inserted in other facilities (hospitals, clinics, etc.)? Thanks! A: The SOP states to “label catheters inserted under suboptimal aseptic conditions in any health care setting (eg, “emergent”). Remove and insert a new catheter as soon as possible, within 24 to 48 hours.” There are no statements about any VADs, peripheral or central, that have been inserted in another facility.
Q: Can INS or someone possibly guide me to recommendations/research regarding the best type of device to infuse blood products through. Have others experienced any problems transfusing blood products through PICC or midline catheters? A: A short PIVC is the best choice. Midline catheters, PICCs, and other CVADs will slow down the transfusion due to the length of the catheter. Length adds resistance [and] the packed RBCs are already highly viscous anyway. See INS Standard of Practice 64. Blood Administration SOP and list of associated references for Blood Administration—though it does not state this information in the same manner. Length adding resistance is not discussed in the SOP. SOP says a CVAD is acceptable but the fact that longer catheters will slow the rate of infusion is a simple matter of physics for flow.
Q: I am wondering if anyone is declotting midlines with Cathflo? There are only a couple of studies that looked at this practice but in general it appears to have been found to be safe and effective. We are concerned with midlines being discontinued when they occlude and necessitating another procedure. I understand that the manufacturer does not have the product labeled for this purpose but it is hard to see how alteplase would work any differently on a clot in a midline than it would in a PICC. Arguably the smaller priming volume would allow a smaller dose and reduce any potential systemic effects. I would welcome any input about your facility’s approach to this issue. Thanks. A: The couple of studies you have found is all there is. This is considered an off-label use and your practice committees need to examine this issue. There would be a great deal of difference between a PICC and a midline regarding thrombosis. Vein thrombosis is the most common complication with midlines. Many studies report signs such as leaking but do not diagnose this as thrombosis. In a midline tip location, this can be completely occlusive, unlike the larger diameter of the SVC where the PICC tip is located. You might try using a thrombolytic agent when there is a lack of blood return, but if there are any other signs and symptoms, I would remove the midline.
Q: Following removal of a PICC, what is patient education on the type of dressing and for how long? Lots of policies and patient education materials in my search have been prior to 2021. A: Same as any other CVAD. There are anecdotal reports that air embolism has happened with a PICC removal, although no one has published this yet. There can be a skin-to-vein tract bridging to a complete fibrin sheath and air can be pulled in. Many PICCs are inserted at the level of the heart in the upper extremity, making it possible for air to enter. So [tell the patient to lie] flat for about 30 minutes [and apply] an air occlusive petroleum ointment-based dressing for at least 24 hours or until the hole has healed.
INS 2021 Innovation Award Winner Christopher Grimes, RN, BSN, CRNI , ®
Infusion Nurse Coordinator, MedStar Georgetown University Hospital
Christopher Grimes, has been a nurse (RN, BSN) for over 6 years. He began in the PICU/CICU at St. Christopher’s Hospital for Children in Philadelphia, earning his CCRN certification after 2 years and serving as an innovative leader for both the unit-based and hospital-based leadership committee, as well as the NDNQI data collection and performance improvement committees. After increasing patient safety, data collection efficiencies, and implementing a new treatment system, he transitioned into a PICU/CICU/NICU travel nurse assignment with Children’s National Medical Center in Washington, DC, then later became a travel nurse for infusion therapy at MedStar Georgetown University Hospital (MGUH) infusion clinic. He loved the opportunity it presented; he signed on full-time with aspirations to impact the patient population, nursing staff, and overall delivery of care for the infusion clinic, all while obtaining CRNI® certification. Chris recently grew into a newly created nurse coordinator position at the MGUH infusion clinic, to lead his team of nurses in providing the highest
quality care possible. He coordinates educational in-service sessions with health care specialists and pharmaceutical representatives for his nursing staff to ensure staff have recent, relevant, and important information in providing patient care. He worked with the IT team to switch handwritten questionnaires to an iPad application which is auto-populated to patients’ electronic medical record, and he is currently working with a multidisciplinary team to introduce medication scanning to bring even higher quality and efficiencies in patient safety and care delivery. Outside of work, Chris serves as president on the board of the INS local Northern Virginia chapter. He enjoys spending free time with family and friends, at the beach, and traveling. Chris is abundantly thankful for all the love and support provided by his partner, family, friends, colleagues, and patients who have helped sculpt him into the nurse he is today. Chris is excited for what the future holds: growth, opportunity, and fulfillment stemming from his deep passion for a career of serving those in need.
What does innovation mean to you? Innovation to me means to take your current process and transform it into a seamless, cutting-edge, and hassle-free workflow. This can be achieved by working hand in hand with your colleagues, manager, and administration to gather all members’ ideas. First, identify the issues; then, brainstorm ideas of how to improve the process; next, execute the plan to create a new innovative workflow. It’s fun and rewarding, and the patients and staff see the benefits at the end of this process.
What was your innovation and how did you go about implementing your innovation? I have created a few new workflows and innovations that we have adapted to use at our infusion clinic. I have streamlined the patient pre-infusion process along with my team members and helped create pre-infusion screening questionnaires that are accessed through the iPad (eliminating paper forms). These pre-infusion questionnaires input directly into the patient chart and are reviewed by the infusion nurse before administering IV medication to the patient.
What evolved to make you come up with the innovation idea? We were wasting so much paper and I am always pushing for more eco-friendly ways to provide care at our clinic. I reached out to our Tonic IT team to partner with them and create a new innovative pre-infusion questionnaire. The process works incredibly well and our patients have really enjoyed this change in our clinic. I look forward to continuing this path toward more innovative ideas as we next work with our IT team to bring medication scanning to life in our outpatient clinic setting.
How did your innovative idea impact your patients, colleagues, and/or employer? The patients all seemed very receptive to the changes. We not only moved our pre-infusion screening questionnaires to the iPads but were also able to email out pre-infusion COVID screening questionnaires to patients’ individual emails. I have heard so much praise from my patients in regard to our new workflow, and the infusion nurses have also expressed gratitude. I am excited to continue improving the care we offer. How do you plan on evaluating the effectiveness of the innovative idea you implemented? I am in the process of creating patient satisfaction surveys to compare their overall satisfaction pre-pandemic to during the pandemic in accordance with our clinic processes. I look forward to hearing feedback from patients and to see in what areas we can improve. Patient satisfaction is something I always strive for; I aim to provide the best, holistic, individualized care for all of our patients.
Was there an outdated practice in your institution that you’ve updated? I have updated a few things in our clinic over the 2 plus years I have worked here. I have minimized the paperwork and documentation for our infusion team. Also, we are in the process of working with our IT team on eliminating the old practice of paper orders and implementing live electronic ordering through MedConnect. I am also working with our IT team to implement medication scanning at our outpatient clinic which will improve patient safety and accuracy in care provided.
List one infusion-related workflow that you developed or changed in response to the COVID-19 pandemic. Our infusion clinic has been offering individual rooms for our infusion patients. Because of the pandemic, our immunocompromised patients were terrified to come into public and leave their homes out of fear of exposure. We have great screening protocols in place, detailed cleaning regimens, and clear communication among our staff and patients with regard to plan of care, vaccine access, and infusion safety. We are so proud of this!
A Hospital Chaplain During the Pandemic
During COVID, patients do not always wear masks for a variety of reasons, and while at first nerve-wracking until adaptation, the hospital also felt an intimate place, to see a full face. Eihei Dogen, a 12th century Buddhist and a founding teacher of Soto Zen, wrote, “Mountains belong to those who love them” (I think of this as a feeling of belonging rather than ownership.) Sometimes when I meet an old face, it looks like a moving mountain. Recently I met one of these 81-year-old mountains who shared with me a near-death experience he’d had. He was afraid he sounded “crazy,” afraid he was wasting my time despite my assurances that I was there to listen. As he spoke about having been dead for several rounds of resuscitation, he described tunnels of grey light and a moment of feeling “so peaceful, but not like at-home
by Rebecca Doverspike
peaceful, like something out of this world.” As he continued trying to describe it, he gave up, and said, “I don’t have words for it. It was beyond.” This is where I think the place of prayer and poetry derives from—the place beyond words, a place of wordlessness. And this is where I begin in trying to describe being a chaplain during the pandemic—a place of wordlessness that honors exhaustion the way the Inuit have handfuls of words for snow. From the early days, working in the hospital and returning home with worry about bringing something to my roommate, the isolation of less personal connections to derive joy while the work intensified, to now, I feel worn with decision-fatigue. Still hearing about COVID every day can feel erosive. It’s as if an acute situation has become chronic: how do we live in this changed world? While the pandemic has been pictured in linear graphs and numbers, at the hospital it has felt more like an ocean, where the “waves” have felt indistinguishable and not separate, except by thin psychological lines that feel each shift and re-negotiation of boundaries. When the Delta variant hit after a post-vaccinated summer where a true lull seemed to occur, I heard many stories from staff about their experiences with COVID—it touched upon the beginnings of darkness, fear, uncertainty, and loss. One woman told me she was out for three weeks, too sick to sit in her backyard, and returned to find two dear friends, other employees, had died. In the hospital, you can feel where the pandemic has touched which hallways most; to some, certain rooms will always be certain names, certain stories. As a chaplain, I collect
stories; I consider the day a pilgrimage—holy sites, ruins, complex geological histories, each life a living sacred document in time. I have seen waves of those I work with—bravery, resilience, anger, hope, anger again, that the illness and what could protect against it has been politicized while guiding yet another family to say goodbye to their loved one with faces pressed up against glass to an isolation room, the sounds of sea-like grief and wails rendering masks thin and fragile compared to the tears. There is also a renewed need to take care of one another
I have had to learn with more urgency what brings me joy, to sustain this work. One discovery is necessity of forest and sea—breathing in the company of non-human life, thinking in wider spaces—and, particular relationships that feel essential to my heart. What brings strength to your heart from which to give? Where is the light you want to grow toward? Place yourself there and turn your face like a sunflower toward it with every ounce of still being alive, for a time, as we pass through; “joy is not meant to be a crumb” (Mary Oliver).
on this side of time as we’ve cared for those who have transitioned to the other side of time. A ministry of presence has been challenged by PPE and distance— I remember the first time I allowed myself to hold a patient’s hand again, to pray. Hospital hallways and rooms hold the energy of these stories: separation, fear, loss, grief, pain, and resilience of what remains. We are tired, and we continue to learn to love, every day. I remember a patient who I visited several times a week, his room dark, his cough making it impossible for him to wear a mask (but since he’d tested negative for COVID upon admission, it was fine, I told myself). He told me memories from his childhood, birds he’d felt akin to. He told me old bits of wisdom he’d lost track of in his life but that had found him again. The movement of his reflections sounded to me like he might be dying. A couple days later, he tested positive for COVID and was transferred to the ICU and intubated. A few days later, he died. I held his sister's anger that he had contracted COVID in the hospital. I told her beneath the fear there had been peace. She broke down over the phone, in the Dollar Store, when she told me about the same birds in their grandfather’s garden and I said he’d remembered
Post-Pandemic Amid Pandemic I climb the stairs to the tenth floor of the hospital just to pretend it’s a mountain All day long wilderness to wilderness The forest hallways Like they could hold the whole sky, Heart halved open, palms together as if mending were possible. “I know there are a lot of people but keep me In your prayers” Each encounter an imprint in oil paint, the kind you move your finger across to feel texture-- here a raised yellow (a kind of sun), there a dipped blue (every lake); my heart too a museum of sorrows: my prayer: that you not be encased in glass, that any second of unexpected joy set you free. What is your anchor? Maybe there is nothing the earliest recollection of sunlight won’t heal.
them, too. Strangely, I did not get sick from that encounter nor the others I would be exposed to (I think I had a version of the virus before it became public), though it has been a different kind of sea to wonder how to be together when we need one another most amid the danger of sharing breath.
Rebecca works as an Interfaith Chaplain at St. Elizabeth’s in Boston where she draws from Zen Buddhist practice. She finds patients’ wisdom often reminds her of sitting Zazen—moments where isolated self-narrative drops away and access to generosity from being part of the fabric of the universe rather than a separate “self” feels close at hand. Rebecca holds an MDiv from Harvard Divinity School, completed a Chaplain Residency at MGH, and an MFA in creative nonfiction from WVU. Her chapbook, Every Present Thing a Ghost was published in 2019 by Slapering Hol Press. More of her work can be found in Ruminate, Leveler, Valley Voices, Midwest Review, 5x5 Literary Magazine, Peripheries, and elsewhere.
The Neighbors by Rachel King
One Neighbor My neighbor across the street died from COVID.
Right now, his extended family members are over there digging up his rose bushes. Every morning and every evening he was outside trimming. Every morning and every evening he said hello to me. I know, from his wide-open windows, that he kept his house’s interior sparsely furnished. And he told me that he once took a trip with his sister to Italy. He isn’t really mine to mourn. But the roses, wilted and untrimmed, mourn him. I hope his family replants the bushes near his grave.
Yesterday, extended family members of my dead neighbor across the street moved his belongings, a U-Haul in the driveway, just like the people down the street with pit bulls. Someone driving down 115th probably thought two families were moving-not one family and the belongings of a dead man. A Middle Eastern family just moved in next door. Every morning, the two little girls say hello to me as they ride their bikes, up and down, up and down the street. They smile, and smile, and smile some more. It’s summer. “It’s summer!” one tells me. “I love bikes, and I love the heat.”
Rachel King is the editorial production coordinator at the Infusion Nurses Society. She is also a fiction writer and poet. Her short stories have been published in over a dozen magazines and anthologies, and her debut novel People Along the Sand, which will be released on November 9, is available for order wherever you buy books online and at any local bookstore. These two poems first appeared on Erin Pringle’s blog WhatSheMight.
View these webinars and more on-demand: www.learningcenter.ins1.org/webinars Artificial Nutrition and Hydration: Ethical, Scientific, and Legal Perspectives
Supportive Care Therapies: Complexities Made Simple
Incorporating the INS Infusion Therapy Standards of Practice into Patient Care
Listen to these podcasts and more on-demand: www.learningcenter.ins1.org/podcasts Innovative Dressing for Ultrasound-Guided Peripheral Intravenous Catheter Insertion
Data That Save Lives: Improving Patient Safety with Smart Infusion Pumps
Smileyscope: Pain Management with Venipuncture and Vascular Access Procedures
Your CRNI Credential: What’s Behind It? ®
We have a never-ending cycle of certifications in January, March, and September. Each of you worked or are working extremely hard to earn this credential—and rightly so. Let’s look at what makes the CRNI® credential important and what’s behind it.
Let’s begin with dual accreditation: The CRNI® program is dually accredited by the National Commission for Certifying Agencies (NCCA) and the Accreditation Board for Specialty Nursing Certification (ABSNC). These two bodies have put their stamp of approval on the CRNI® certification program—which means a lot. When we say it means a lot, do you in fact fully understand what that means? Dually accredited by NCCA and ABSNC, INCC continues to be the leading credentialing program in the field of infusion nursing. Holding accreditation by ABSNC is extremely valuable because of its rigorous peer review process that is monitored on an annual basis and has a full reaccreditation application every fifth year. This process allows nursing certification organizations like INCC to obtain accreditation by demonstrating compliance with the highest quality standards available in the industry. Programs are evaluated on the demonstration of a valid and reliable process for development, implementation, maintenance, and governance. Compliance with these standards for accreditation includes: • Review of the scope of the CRNI® program • Organizational structure, resources, and responsibilities to stakeholders • Oversight of certification program activities • Management of program records, documents, and materials • Quality assurance and program evaluation • Development, delivery, and maintenance of education/training • Development and evaluation of assessments Accreditation by both NCCA and ABSNC makes the CRNI® certification program distinct. What else is behind the CRNI® credential? Let’s move on to the INS website: There, you’re just a click away from infusion resources, such as Educational Programing and The Learning Center, which includes a substantial amount of CRNI® recertification-approved learning. Medical professionals created these resources to help those wanting to learn more about the discipline and for those studying to earn their CRNI® credential. From past issues of the INSider to free webinars and podcasts, you can find it on the INS website. And the INS and INCC exceptional staff is available to send you your latest order of materials, to help you register for that webinar, and to do whatever else is necessary to ensure your experience is top-notch.
All this information is extensive, but what’s really behind it? Take a look in the mirror, take a step back, and look: You’re what’s behind the CRNI®. You, the RN working in the emergency room. You, the RN working in the pulmonary. You, the RN working in pediatrics. You, the RN working in geriatrics. You, the RN working in oncology. You, the RN working in home infusion. This is just sample of where our infusion nursing professionals practice. Stay tuned for new developments in the field of infusion nursing and the new tools and resources INS and INCC will have available to you. November/December 2021
INS Member Spotlight Jennifer Roger RN Infusion Nurse, InfuseAble Care What led you into the nursing profession? When I gave birth to my first son at the tender age of 18 (35 years ago), the labor and delivery nurse was so kind and understanding that I decided I wanted to do the same! At that time, unwed mothers were not as accepted as they are today and were judged by many. She did not judge me! What made you decide to specialize in infusion therapy? After working as a labor and delivery nurse for 15 years, I was diagnosed with stage 3 breast cancer and thought both my life and career as a nurse were over. Following 2 plus years of cancer treatment, I was ready to return to the field! Sitting through months and months of chemotherapy in an infusion center really opened my eyes and I found myself having an intense desire to help these patients along their individual paths in this adventure, as I now knew the feeling of having a port and sitting in an infusion chair for hours on end. How has INS Membership benefited you in your journey? I reference material often for ambulatory infusion protocol. I also find peace and comfort in knowing the resources I need are available to me at any time. Has there been a mentor, colleague, or INS member who has helped along the way? I have worked with other nurses who maintain membership and who are CRNI® certified. They are available to consult when needed. Do you have stories from your practice that you would like to share with the infusion community? One of my daily antibiotic patients recently gave me the most touching compliment of my nursing career. She was afraid of medical procedures, was not a candidate for a PICC, and needed 2 weeks of ABX therapy. I was able to maintain 3 peripheral IVs to last her throughout her treatment. She was so thankful that she experienced a painless course of daily visits, she told me, “I want you to know that because I knew you would be here, I was able to sleep at night. I was so worried about this. I honestly would have been up all night worrying and having anxiety. I couldn’t have done this without you.” Seeing her emotion, feeling her hug me goodbye, and knowing I made that difference that all of us want to make, meant the world to me.
INS is honored to share our members’ stories with the infusion nursing community. Each nursing journey is unique and we can learn so much from each other. We will continue to share stories from our members who care for patients in a variety of care settings. We are proud of you all and commend you for your hard work, passion, and dedication to patient care.
Lynn Deutsch MSN, RN, CRNI , VA-BC ®
Vascular Access Nurse, Ascension Seton Associate Professor of Nursing, Austin Community College What led you into the nursing profession? I have wanted to be a nurse since I was 5 years old. I gave my first shot to my grandfather into his buttock with my grandmother’s hat pin when he was taking a nap! As a young adult, I had children, so I thought I could do that job, bringing mothers their babies. I went to college after I had three children. Way before computers. But I never have worked a day in women’s health! What made you decide to specialize in infusion therapy? I loved starting IVs and specializing in infusion knowledge early in my career. I was the go-to person to start all the difficult IVs on my shift. Other floors were always calling me to come start IVs. I started to work in home infusion in the mid-eighties to help supplement my income after becoming a single parent. I fell in love with teaching patients how to give their own parenteral medications. I worked in home infusion, placing PICCs and midlines in patient homes. I even did a few blood transfusions in the home. I eventually went back into the hospital after changes in the Medicare coverage no longer paid for home infusions. I was lucky to get a position on a hospital infusion therapy team in 2000. I have been a vascular access nurse for 20 years now. There is so much more than just placing lines in patients. You must know all about the infusates that prevent harm to patients. How has INS Membership benefited you in your journey? I have been a member for over 20 years. I passed my CRNI® test in 1997. I did not have a BSN at the time, and it helped me get positions in vascular access and home infusion. Attending conferences and networking have added to my knowledge base as an expert. The CRNI® credential validates your expertise. The Journal of Infusion Nursing and the Infusion Therapy Standards of Practice are great benefits of belonging to INS, along with reduced rates for conferences and CEUs. Has there been a mentor, colleague, or INS member who has helped along the way? Yes. I had a wonderful mentor who was a CRNI® and helped support me getting my BSN when I was living in California. Wendi Silverman-Martin MSN, CRNI® was a wonderful mentor and friend. We lived in different cities but always tried to room together at conferences. Do you have stories from your practice that you would like to share with the infusion community? Yes, I have 40 years of stories to choose from. It is hard to choose one. Probably the cat jumping on my back when I was trying to place a PICC in the patient on his couch when I was in home infusion is the weirdest one. I finished placing the line while the claws were in my back. So glad we do things sterile now! I am working as an adjunct professor of nursing, and I love teaching infusion therapy and vascular access skills to prelicensure nursing students at the community college in the clinical setting. Teaching future nurses is a great way to give back to our profession. November/December 2021
S P O T L I G H T
Christina Fisher RN, CRNI
Regional Nurse Manager, Chartwell PA What led you into the nursing profession? Wanting to give back after watching the health care team support my gram my senior year of high school. I originally wanted to be a respiratory therapist, but realized there wasn’t enough options with RT. Through my RT courses, I saw how expansive the nursing profession was and the opportunities nursing presented. I knew nursing would allow me to care for others and provide the opportunity to find my passion. Nursing has certainly provided me with many opportunities! What made you decide to specialize in infusion therapy? I’ve always been fascinated with the “plumbing” of the cardiovascular system. I started my nursing career thinking cardiology was my niche, but then I took a position in the ICU resource unit at a large teaching hospital (staffed 5 specialty ICUs, the PACU, and ED). I quickly learned that I enjoyed learning and caring for the entire patient! Infusion therapy crosses all medical disciplines and therapies. I then took a position at an infusion center, where I became a VAD expert. Paring my knowledge base of disciplines, VAD and oncology makes me a perfect fit for home infusion nursing. I’ve been drawn to home infusion, and wasn't sure why. But after nearly 5 years in home infusion nursing, I am certain my choices and career have guided me to home infusion therapy and have made me very passionate about home infusion therapy. How has INS Membership benefited you in your journey? Yes, drastically! INS Membership and CRNI® certification has given me the knowledge and confidence to know I am speaking accurately. I have an excellent platform to fact-check myself! CRNI® certification has given me recognition amongst my colleagues and validates my knowledge base. I educate home health nurses, build training courses, and develop clinical programs with the pharmacy teams. Conviction in my knowledge is a necessity when standing in front of a room full of nurses and pharmacists! I’m often the one nurse in a meeting with several pharmacists building new programs. Having confidence and recognition of my peers allows me to collaborate with a room full of PharmDs and build successful clinical programs. INS Membership supports me every day! Has there been a mentor, colleague, or INS member who has helped along the way? I’ve had many mentors throughout my career. Another INS member who has helped me to develop and hone my infusion skills is Jennifer Ashner. She is an amazing woman and nurse, with a calm and reliable focus on excellence. Her ability to maintain a calmness in crisis, and consistently cite standards and guidelines to direct decisions is unwavering. Her influence has helped make me the nurse I am today, reaching for standards and evidence to support daily decisions and recommendations. Do you have stories from your practice that you would like to share with the infusion community? I would need to say various cross-specialty experiences have molded me and the way I work. We all make decisions based on our past experiences, and I am no different. I have an experience for most things I teach, be it using a longer Huber needle because of seeing infiltrates after a woman went home with 5FU and her breast tissue pushed her Huber out overnight (but was recessed when presenting back to the clinic), accessing a femoral DL port, or explaining the “why” behind P&P so the learner will remember what was taught. My practical experiences pared with my knowledge base (validated by CRNI® certification) allow me to function to the fullest extent in a pharmacy, to ensure programs are built with the patient as the central focus. Though I enjoy interacting with clinical teams, some of my most rewarding classes are teaching employees how their nonclinical skills impact the daily life of our patients, team members whom are often in awe of their patient impact.
S P O T L I G H T
Steve Cohen MSN, RN, CRNI
Director of Nursing What led you into the nursing profession? I worked as an occupational therapist and funding was being decreased for the school where I worked. I thought it would affect the entire occupational therapist profession and decided to use my current knowledge from that profession and use it for another profession: nursing. What made you decide to specialize in infusion therapy? It was an accident. I was not taught IV insertion in nursing school. At my first job at a hospital, I sometimes floated to various floors when the hospital was short-staffed. I was on a same-day surgery unit when another nurse’s patient’s BP began to bottom out after her IV had been removed. The ICU nurse, resident, and house nurse could not get it started. I had read an article the night before in AJN or RN about placing a PIV and even though I had not successfully placed a PIV, I asked if I could put the IV in. Because I was not well acquainted with terminology, I asked the ICU nurse to put the rubber (tourniquet) on the patient’s arm and just slid that cath in but I had to ask the ICU nurse to secure the line as I did not remember that part from reading. I became an IV nurse first in the hospital then went into patient’s homes for restarts. How has INS Membership benefited you in your journey? I received effective mentoring that required more than common sense. I was taught how to use research to develop and manage successful patient care using a number of specific identifiable skills that enabled me to not only learn skills but to make the appropriate changes to improve the infusion therapy programs I was part of. I was taught skills and provided tools for others to assess themselves. Has there been a mentor, colleague, or other INS member who has helped along the way? My last instructor in the first part of my nursing school who was known as “Sarge” helped me to triple-check everything and maintain the integrity of the staff I worked alongside. My nurse manager for the VNA instructed me on even more careful documentation and effective patient care. Do you have stories from your practice that you would like to share with the infusion community? I received a patient with GI burns related to a misplaced radiation. He was sent home with a 2-3 week sentence to die. I was to see the patient for only an assessment visit. The patient was being rolled by his wife side to side as he had no energy to stand, go to the restroom, or eat. I suspected that his adiation burn had constricted the bowel and encouraged him to increase his oral intake of fluids and small meals along with getting to the side of the bed, then walking with a walker. I also taught him self-hypnosis to visualize the movement of his river within (his GI motility). My patient who in July 1989 was given the 2-3 week sentence died in 1992.
Welcome New Members! NEW DOMESTIC MEMBERS
Johnny Adams Michele Agulia Samantha Ash Philip Aulbach Jeanette Bangalore Dawn Banning Bryan Barber Caridad Barr Linda Bay Ashley Bean Michelle Beitzel Kaye Belport Sarah Blair Stacy Bowen Cindy Braeunig Colleen Brock Natasha Brooklin Alexandra Browne Joan Bryant Kerri Buck Keona Burrell Jessica Butler Lara Byrd Luz Caicedo Lori Calabrese Kristen Calhoun Sara Canhoto Julie Carroll Kristine Charbonneau Rebecca Christensen Sandra Clifton Sarah Clusserath Melissa Comunale
Na Young Jeon
Marisol Garcia Washington
Kok Seng Low
Ma Adela Marquez
N E W I N T E R N AT I O N A L M E M B E R S
Sylvie Charette – Canada
Lilieth Gray Jarrett – Canada
Young Jeon – South Korea
Vincent Lucifora – Canada
Hyo Jung Park – South Korea
Iwona Stocka – Australia
Ana Clara Tolentino
Kok Seng Low – Singapore
Claire Stoddart – Canada Tatsurou Takezawa – Japan
INSide Scoop Our recurring feature, INSide Scoop, serves to keep you informed on things happening within INS as well as upcoming events, items of interest, new educational deliverables, certification news, and other current information. Here we communicate directly with our membership as well as with the larger infusion nursing community to keep you informed on topics—in real time.
Publications Department The INS Publications Department is pleased to announce that the Infusion Therapy Standards of Practice will now be published on a new 3-year cycle. A new Standards of Practice Committee will officially begin work on the 9th edition during a kickoff meeting in January 2022. The committee will perform a thorough review of scientific literature, compile best practice recommendations and clinical updates, and integrate the gathered information for release in 2024! The Publications Department is also excited to initiate a new volunteer committee that will support the Journal of Infusion Nursing (JIN). The JIN Editorial Review Board (ERB) members are volunteers who will serve as representatives of JIN, the Infusion Nurses Society (INS), and the larger infusion therapy community of caregivers for our patients, their families, and the public. Their role will include performing manuscript reviews, supporting manuscript acquisition, and advising editors on the vision, direction, strategy, and evidence-based focus of JIN.
Meetings Department Exhibit space for INS 2022 is now available! We invite you to exhibit with us June 4–6 at the Rosen Shingle Creek Resort in Orlando, Florida, and showcase infusion therapy–related products and services to hundreds of professionals. You can’t beat the power of face-to-face connections—so make sure to participate at the INS Annual Meeting! Visit our website to learn more about INS 2022 and to reserve a booth.
Executive Department Due to concerns related to COVID-19 and the Delta variant, the Nursing Alliance Leadership Academy, (NALA), hosted by the Nursing Organizations Alliance (NOA) held on August 27-28, 2021, transitioned from an in-person event to a virtual conference. President Sue Weaver, President Elect Max Holder, and CEO Mary Alexander represented the Infusion Nurses Society. The program, designed for newly elected and emerging volunteer leaders, provides a platform to gain knowledge about board governance and leadership development. Some topics addressed by the expert faculty included legal issues and financial stewardship, partnerships between the board of directors and the chief staff officer, applying equity to decisions and actions, and peer consulting. INS joined the National Home Infusion Association in supporting the Preserving Patient Access to Home Infusion Act (S. 2652; H.R. 5067), an act that would secure access to home-based IV treatments while also saving taxpayer dollars by shifting care away from more expensive settings. This act provides important clarifications to the 21st Century Cures Act (2016), ensuring that Medicare recognizes the full spectrum of professional services that make home infusion a safe and effective option for patients, including pharmacist services that minimize the need for face-to-face interactions. The Preserving Patient Access to Home Infusion Act would enable the delivery of infused medications in patients’ homes, protect those with underlying health conditions from the risk of disease, provide access in rural and underserved communities, relieve burdens on hospitals, and create savings for patients and taxpayers. INS is a supporting organization for the National Foundation for Infectious Diseases (NFID) Keep Up the Rates Campaign. This initiative focuses on the importance of all types of vaccines for all populations, since recommended vaccinations have been delayed during the pandemic. Supporting organizations pledge to promote the goals of the campaign—to ensure optimal use of vaccines currently available to protect all individuals in the United States.
End of Year Review In January, INS released the long-awaited revised 2021 Infusion Therapy Standards of Practice, and in February, we hosted a Resetting the Standards virtual conference, which consisted of five informative and impactful sessions that detailed the changes in the revised Standards. Our publications department continued releasing revisions in July/August with the five revised Policy and Procedures, and in September with the revised Point of Care Cards. We were so happy to have an in-person conference in Las Vegas in August 2021. 476 attendees, 44 speakers, and 40 exhibiting companies had a wonderful time learning and communing with one another. When not at an in-person conference, many of our members learn through our regular podcasts and webinars, the Journal of Infusion Nursing, the INSider, and the Community Discussion Board. All year, in the INSider, we have been spotlighting members’ stories. Why they became infusion nurses, how INS has benefitted them on their journey, their interactions with mentors, and any other stories they’d like to share. If you’ve missed any of these insightful features, you can find them here, here, here, and here. We’re happy to report that between the beginning of January 2021 and the end of September 2021, 1,119 people became INS members. As far as the ongoing pandemic goes, in January 2021, many nurses and other clinicians were receiving their vaccine against COVID-19. As more and more people received their vaccinations, many of us felt optimism that the harshest days of the pandemic were over. Around this time, in June 2021, INS asked our members for the reflections on COVID-19, which you can find in the INSider’s September/October 2021 issue. However, in the United States, many people refused to receive the vaccine, the Delta variant started spreading widely and rapidly, and nurses and other clinicians have begun dealing, again, with an overflow of COVID-19 patients and deaths. As of this writing, there have been over 4.5 million recorded deaths from COVID-19 worldwide, and over 700,000 of these deaths have been in the United States. “It’s as if an acute situation has become chronic: how do we live in this changed world?” Rebecca Doverspike, a hospital chaplain, writes in her essay in this issue of INSider. And later: “I have had to learn with more urgency what brings me joy, to sustain this work.” We hope you are receiving the joy, care, and rest you need, and we look forward to celebrating IV Nurse Day
with you in January.
HAL LO Close d System Drug gTran nsfer Deviice A true e closed system. e
Now availa able exclusively from Fresenius Kabi
Your Containm ment and Protection Ally
• Airtight an nd Leak-proof: Airtight, secu ure ns provide a proven physical barrier connection that preven nts the transfer of contamina ants into the system and the escape of drug or vapor v concentrations outside the system to protect against exp posure.1 • Intuitive and a Easy to Use: Designed for f simplicity and a comfort, with fewer piece es, fewer steps and ssingle-motion connections.2 • Compatible and Efﬁcient: Meets indusstry standards tto deliver a complete CSTD ssystem that aligns with your existing work proccedures and is desig gned to maximize medication extraction.3 Make the HAL LO system your standard of care c for enhanced pro egivers. otection of patients and care demonstration or to order th To request a d he HALO System, call 1-888-386-1300 or visit us at CSTD.com. www.HALO-C
HALO® is a registe ered trademark of Corvida Medical®, Inc. HALO® is a registe ered trademark of Corvida Medical® Inc
1. Health and Human Services, Federal Drug Administration, 5 510(k) Clearance Letter, July 24, 2015. 2. Bartel SB,, Tyler y TG,, Power LA,, Multicenter evaluation of a new closed system y drug-transfer g device in n reducing g surface contaminattion by antineoplastic hazardous drugs, Am A J Health-Syst Pharm. 2018; 75:199-211. 3. NIOSH Alert: Preventing occupational exposure to antineop plastic and other hazardous drugs in health care w.cdc.gov/ v/niosh/docs/2004-165/ Publicattion No. 2004-165. Washington DC: NIOSH; 2004. settings. http://www
©2021,, Fresenius Ka abi USA,, LLC. hts Reserved. All Righ ALO-05-07/ 7/21 1911-HA