Table Of Content

Vol. 16, No. 1, January/February 1993 Intravenous immune globulin (IVIG) ing for patients with indwelling vas- is administered prophylactically to cular access devices (VADs). Inser- reduce incidences of secondary in- tion, mechanical, and infectious JOURNAL OF fection in certain pediatric cases of complications are described. Intravenous HIV infection. Home administration, adverse reactions, and a re- Nursing cently published controlled study done by the National Institute of Child Health and Human Develop- ment are covered. Intravenous 23 Cyclophosphamide in Catheter-Related Lupus Nephritis Colonization Associated with Percutaneous Inserted Mary R. Leondike, RN, BSN, and Central Catheters Margaret A. Shattuck, RN, BSN Systemic lupus erythematosus (SLE) Susan Y. Pauley, CRNI, Nancy C. Vallande, BS, MT, CIC, Edna N. is a chronic disorder of the immune Riley, CRNI, Nancy M. Jenner, system that can lead to life-threaten- RN, and Donna G. Gulbinas, RN ing central nervous system and/or re- nal involvement. A definition and eti- The intravenous therapy team at ology of SLE are presented. Demo- Massachusetts General Hospital studied the potential infectious graphics, disease course, treatment, and nursing implications are dis- risks of maintaining percutaneous Interview with Irene cussed. inserted central catheters (PICCs). A clinical study analyzed cultures of Walsh, RN, BSN, MSN National Medical Care Stimulating New 37 100 PICC sites and catheters. Study materials, methods, results, and in- Homecare Developments: Colony- fectious complications are reported. Stimulating Factors The Journal speaks with Irene Walsh, Vice President of Clinical Dona Kare, RN, CRNI Services and Quality Assurance at Colony-stimulating factors (CSFs), National Medical Care Homecare available for intravenous or subcuta- Division in Waltham, Mass. She dis- neous administration, can stimulate cusses home care challenges, profes- production of new white blood cells. sional certification, and key clinical A brief overview of patient popula- and operational issues facing home tion, indications, actions, and ad- infusion companies. verse reactions of CSFs for hospital Erratum or home use is presented. INS News and Notices Vascular Access Devices: 44 1992 Annual Meeting Cassettes 6 Management of Common Call for Nominations 8 Complications 1993 Chapter Presidents List 10 Home Infusion of 18 Deborah Richardson, RN, BS, BSN, 1993 Annual Meeting and Intravenous Immune and Patricia Bruso, RN, BS, BSN, Industrial Exhibition 28 Globulin in Human OCN 1992 CRNI Certification List Immunodeficiency Virus— Developments in vascular access Membership Benefits and Infected Children technology and advances in therapy Application Jan K. Poole, CRNI challenge the intravenous nurse car- Information for Authors Vol. 16, No. 6, November/December 1993 Vol. 16, No. 1, January/February 1993 Intravenous immune globulin (IVIG) ing for patients with indwelling vas- is administered prophylactically to cular access devices (VADs). Inser- reduce incidences of secondary in- tion, mechanical, and infectious JOURNAL OF fection in certain pediatric cases of complications are described. Intravenous HIV infection. Home administration, adverse reactions, and a re- Nursing cently published controlled study done by the National Institute of Child Health and Human Develop- ment are covered. Intravenous 23 Cyclophosphamide in Catheter-Related Lupus Nephritis Colonization Associated with Percutaneous Inserted Mary R. Leondike, RN, BSN, and Central Catheters Margaret A. Shattuck, RN, BSN Systemic lupus erythematosus (SLE) Susan Y. Pauley, CRNI, Nancy C. Vallande, BS, MT, CIC, Edna N. is a chronic disorder of the immune Riley, CRNI, Nancy M. Jenner, system that can lead to life-threaten- RN, and Donna G. Gulbinas, RN ing central nervous system and/or re- nal involvement. A definition and eti- The intravenous therapy team at ology of SLE are presented. Demo- Massachusetts General Hospital studied the potential infectious graphics, disease course, treatment, and nursing implications are dis- risks of maintaining percutaneous Interview with Irene cussed. inserted central catheters (PICCs). A clinical study analyzed cultures of Walsh, RN, BSN, MSN National Medical Care Stimulating New 37 100 PICC sites and catheters. Study materials, methods, results, and in- Homecare Developments: Colony- fectious complications are reported. Stimulating Factors The Journal speaks with Irene Walsh, Vice President of Clinical Dona Kare, RN, CRNI Services and Quality Assurance at Colony-stimulating factors (CSFs), National Medical Care Homecare available for intravenous or subcuta- Division in Waltham, Mass. She dis- neous administration, can stimulate cusses home care challenges, profes- production of new white blood cells. sional certification, and key clinical A brief overview of patient popula- and operational issues facing home tion, indications, actions, and ad- infusion companies. verse reactions of CSFs for hospital Erratum or home use is presented. INS News and Notices Vascular Access Devices: 44 1992 Annual Meeting Cassettes 6 Management of Common Call for Nominations 8 Complications 1993 Chapter Presidents List 10 Home Infusion of 18 Deborah Richardson, RN, BS, BSN, 1993 Annual Meeting and Intravenous Immune and Patricia Bruso, RN, BS, BSN, Industrial Exhibition 28 Globulin in Human OCN 1992 CRNI Certification List Immunodeficiency Virus— Developments in vascular access Membership Benefits and Infected Children technology and advances in therapy Application Jan K. Poole, CRNI challenge the intravenous nurse car- Information for Authors Vol. 16, No. 6, November/December 1993 Vol. 16, No. 2, March/April 1993 An Overview of period. PICC placement, complica- Ondansetron for tions and their prevention, and man- Chemotherapy-Induced agement are discussed. JOURNAL-O! Nausea and Emesis Intravenous Fe San Angel, CRNI, OCN Nursing Ondansetron as an antiemetic agent is discussed, along with an overview How To Evaluate Study 110 of recent studies, manufacturers’ ad- Methodology in Published ministration recommendations, and nursing implications. Clinical Research Gregory J]. Stoddard, MBA, and Wallace H. Ring, MD How reliable are published clinical CLINICAL STUDIES studies? Clinicians must have an The Peripherally Inserted 92 awareness of what constitutes a solid study before applying results Central Catheter: A to patient care. Study validity mark- Retrospective Look at ers are discussed and research meth- Three Years of Insertions odologies are described. Mary L. Goodwin, CRNI, and Ingrid Carlson, CRNI This study takes a retrospective DEPARTMENTS look at 858 PICCS inserted in a 3-year period. A brief history of Letters to the Editor INTRANVURESINNG OPRIUNCISPLE S PICCS is provided; problems en- AND PRACTICE countered during the study are de- New IV Products and scribed; and principles of catheter A Clinical Productivity 74 management are presented. Services Management System for Home Infusion Therapy A Retrospective Look at 104 INS News and Notices Linda A. Grace, RN, BS, CRNI, Tip Location and Membership Benefits and Alice Illian, RN, MSN, CRNI, and Complications of Application Michael P. Rivers Peripherally Inserted CRNI Certification The Clinical Productivity Manage- Central Catheter Lines Videocassette on Implantable Ports ment System (CPMS) can prioritize Linda James, CRNI, Lynn Bledsoe, and maximize efficiency of home in- CRNI, and Lynn C. Hadaway, 1993 Chapter Presidents List fusion visits, while minimizing CRNI Information for Authors costs for down-time and after-hours This retrospective study reviews visits. CPMS is defined; its design medical record data on PICC inser- and use is discussed. tions at one institution over a 5-year Vol. 16, No. 6, November/December 1993 Vol. 16, No. 3, May/June 1993 but those costs were offset by sav- LPNs and LVNs before effectively ings in labor costs. integrating them into the specialty of IV nursing. JOURNAL OF Intravenous Methods for Determining 148 Central Venous Access 167 Nursing the Internal Volume of Devices: Current Central Venous Catheters Technologies, Uses, and Management Strategies Millie Lawson, RN, and Mathieu J. Vertenstein, PE, Leslie Baranowski, BSN, CRNI MSME, ASME Technological advances related to A lack of standards for central ve- CVCs have introduced a multitude of catheter designs that are available nous catheter (CVC) measurements and confusion about terminology for to us through numerous manufacturers. To initiate the appropriate describing catheter geometry are procedures for care, nurses involved partly to blame for catheter occlu- in the maintenance of CVCs must sions. This article aims to alleviate be familiar with a large variety of the problem, providing three meth- central venous access devices. ods for determining CVC internal Nurses must know how to evaluate volume with two reference tables a CVC and determine its type, size, and mathematical support for all manufacturer, specific characteris- calculations. A glossary of CVC tics and initiate the appropriate terms is also included. management strategies related to that device. The nurse must also be able to recognize the indications, ad- Integrating the Licensed 156 vantages and disadvantages associ- Practical Nurse and the ated with each device, to assist the patient in making an informed deci- A Comparison of Costs, 140 Licensed Vocational Nurse sion regarding the appropriate de- Labor Time, and Needle into the Specialty of vice for their therapy needs. Use Associated with Intravenous Nursing Single- and Multi-line Darnell Roth, CRNI Intravenous Infusion Licensed Practical Nurses (LPNs) Systems DEPARTMENTS and Licensed Vocational Nurses Janet Bostrom, RN, PhD, and (LVNs) can competently perform Letters to the Editor Marikay Batina, RN, MPH specific IV therapy procedures after This study compared single and successfully completing a _ well- INS News and Notices multiline infusion systems. When structured IV nursing continuing ed- a multiline infusion system was ucation process. This article pro- 1993 Chapter Presidents List used, less nursing time was re- vides an overview of the various Membership Benefits and quired and fewer needles were processes that need to be employed Application used. Equipment costs were higher to ensure IV nursing competency of Information for Authors Vol. 16, No. 6, November/December 1993 Vol. 16, No. 4, July/August 1993 CLINICAL STUDIES Recombinant Human The Use of Confirming X- 246 JOURNAL OI Granulocyte Colony- Rays to Verify Tip Position Intravenous Stimulating Factor: An for Peripherally Inserted Nursing Overview Catheters Gail Koloc, CRNI, and Krisha Sue LaFortune, RN, BSN Scharnweber, CRNI This study was done to determine, Recombinant granulocyte colony- using x-rays, the accuracy of place- stimulating factor (G-CSF) stimu- ment of peripherally inserted cathe- lates growth of blood cells. The re- ters that terminate in the subclavian cently achieved ability to clone vein or superior vena cava. G-CSF promises to be a major ad- vancement in treating neutropenia A Clinical Productivity 251 that develops in cancer patients. Management System for This article reviews the history and Home Infusion Therapy development, pharmacokinetics, ad- Linda A. Grace, CRNI, Alice F. ministration, and side effects of Illian, CRNI, MSN, and Michael P. G-CSF, as well as management and Rivers reimbursement issues around pa- The Clinical Productivity Manage- tients receiving this new product. ment System (CPMS) can prioritize and maximize efficiency of home infusion visits, while minimizing 1993 ANNUAL MEETING REPORTS costs for down time and after-hours visits. CPMS is defined; its design Chief Executive Officer's 208 and use is discussed. (This article is Report reprinted from our March/April 1993 issue to correct errors that ap- Mary Larkin peared in the original version) Presidential Address Levels of Performance for 239 Deborah Benvenuto, CRNI Intravenous Nursing Practice Presidential Report Brenda H. Dugger, CRNI Maxine Perdue, CRNI To feel satisfied in their careers, IV nurses need markers of their compe- 1993 Annual Meeting tency. The author discusses an as- Pictorial sessment tool that includes three Erratum levels of performance and specific associated skills for five areas: nurs- New IV Products and ing process, peripheral therapy, cen- Services tral infusion therapy, IV therapy, and pain management. INS News and Notices 1993 Chapter Presidents List Membership Benefits and Application Information for Authors Vol. 16, No. 6, November/December 1993 Vol. 16, No. 5, September/October 1993 ventable complication associated and other infectious materials and with IV therapy. The author reviews investigate ways to minimize risks. the clinical aspects of phlebitis and This article describes the experience describes a comprehensive approach of a community teaching hospital JOURNAIT ()} Intravenous for the treatment of infusion-related and the progressive steps involved phlebitis. in implementing a safety needle sys- Nursing tem. Effectiveness of 304 PRACTICE ISSUES Disinfectant Techniques An Innovative Preceptor 287 on Intravenous Tubing Program for Intravenous Latex Injection Ports Home Care Nursing Karen L. Ruschman, RN, MSN, Janet Haggerty Davis, RN, PhD, and Janet S. Fulton, RN, PhD Rebecca Kochheiser Berry, RN, This two-factor, randomized, exper- MS, Jessica Lettow, RN, MS, and imental-design study compared two Jean J. Foltin, RN, BSN different disinfectant techniques in This article describes a model pre- eliminating bacteria from IV tubing ceptor development program that latex injection ports. promotes collaboration in the orientation experience that has been developed. Competency for 1993 ANNUAL MEETING Intravenous Nursing PROCEEDINGS Differences Among 277 Practice Intravenous Extravasations Shared Vision 309 Using Four Common Brenda Dugger, CRNI Clateo Castellini Solutions A definition of intravenous nursing Endnote Address from the INS An- competency is performing IV therapy | Carolyn B. Yucha, RN, PhD, Marie nual Meeting, Orlando, Florida, May in an exact and effective manner, us- Hastings-Tolsma, RNC, PhD, and ing the appropriate skills. A compe- 1993. Nikolaus M. Szeverenyi, PhD tency-based evaluation tool has been A frequent complication of intrave- developed to establish guidelines for nous therapy is extravasation of the orientation and evaluation. infused fluid into the intrastitial tis- sues. This study compares infil- trates intentionally made using different IV solutions. | New IV Products and Services Treatment of Infusion- 282 A Process for Selecting a 299 INS News and Notices Related Phiebitis: Review Safety Needle System in a | Information for Authors and Nursing Protocol Community Teaching 1993 Chapter Presidents List Hospital Roxanne Perucca, CRNI, BSN, and | Videocassette for Implantable Jo Micek, RN, CIC Carolyn Hedrick, CRNI Ports | Infusion-related phlebitis is a fre- Healthcare institutions must exam- Membership Application and quently occurring, but often pre- ine occupational exposures to blood Benefits Vol. 16, No. 6, November/December 1993 Vol. 16, No. 6, November/December 1993 CELEBRAIVT NUIRSNE GDA Y A Comparison of Patient- 333 Chapter Scholarship 345 JOURNAL OF Controlled Analgesia Development Intravenous versus Traditional Alice Griebe, MS, CRNI, and Nursing Intramuscular Analgesia in Lorelei F. Papke, MSN, CRNI Postoperative Pain The Great Lakes Chapter of the In- Management travenous Nurses Society developed Sylvia T. Brown, RN, EdD, Josie a scholarship program to reward M. Bowman, RNC, DSN, and members for participation in INS ac- Frances R. Eason, RNC, EdD tivities and to promote the goals of education and knowledge sharing. This retrospective study compares This article describes the imple- patient-controlled analgesia (PCA) mentation of this program, includ- therapy with traditional intramus- ing the point system used for award- cular analgesia in a sample of 100 ing scholarships, program funding, patients with various surgical diag- and the organizational pitfalls the noses. Chapter encountered in setting up the scholarships. STANDANDA PRROCDEDSURE S Quality Improvement Processes Applied to Implementation of a 339 Infusion Nursing Practice Customized Needleless Brenda S. Gaines, MSN, CRNI, Intravenous Delivery CNA System The current emphasis on patient Fran Terrell, CRNI, and Beth outcomes and quality healthcare de- Williams, BA, MBA, MHA New IV Products and livery has inspired infusion therapy Occupational exposure to human Services nurses and managers to use quality- immunodeficiency virus (HIV), hep- 1993 Cumulative Table of improvement processes in clinicial atitis and other bloodborne patho- Contents practice. This article reviews the gens concerns all healthcare work- terminology associated with the ers, especially those in high-risk 1993 Annual Index quality-improvement process and clinical settings. This article de- provides a brief overview of meth- scribes the development of a cus- ods for identifying the various tomized needleless IV set and its INS News and Notices “quality points” in infusion therapy implementation as part of a risk- Membership Benefits activities that should be evaluated. reduction program. and Application Vol. 16, No. 6, November/December 1993