Learning Center

INS established a vesicant task force with the goal of developing an evidence-based list of noncytotoxic vesicant medications/solutions. Outside of oncology practice, there is not a list of noncytotoxic vesicants as established by a ­professional­ organization. ­INS ­identified ­the ­need ­to ­­address ­this ­gap ­based on ­the­ following­ ­premise:­the­ first­ step ­in­ preventing ­extravasation ­is ­the ­identification ­and ­recognition ­of ­vesicant­ drugs and solutions. The scope of work was limited to creating an evidence-based list of noncytotoxic vesicant medications/solutions and developing an extravasation checklist that outlines risk reduction strategies including early recognition of signs and symptoms of extravasation.

About 90% of hospitalized patients receive medication intravenously (IV), making IV therapy one of the most common practices performed by nurses and other clinicians. IV push medications can be particularly dangerous given the immediate bioavailability and the narrow therapeutic dose range, and reversing the effects may prove difficult. There are safety considerations associated with IV push medication preparation and administration. The results of an Institute for Safe Medication Practices (ISMP) survey revealed that 84% of the clinicians still dilute IV push medications, including prefilled syringes, and other clinicians enact additional improper practices including the manipulation of ready-to-administer (RTA) medications and dose adjustments. Unsafe IV push preparation and administration practices can lead to microbial contamination, medication errors, needlestick injuries, drug diversion, increase staff time, and medication waste. ISMP and the Infusion Nurses Society Infusion Therapy Standards of Practice recommend providing adult IV push medications in an RTA form to decrease the likelihood of errors and diversion. Clinicians have access to evidence-based practice standards, but in many organizations, a gap exists between understanding the evidence and implementing it. During this webinar, we will discuss the risks associated with IV push medication preparation and administration, barriers to implementation of evidence-based practice, and strategies to improve IV push medication safety including the benefits of RTA IV medications.

Management of hypersensitivity infusion reactions (IRs) with H1-antihistamine premedication and/or treatment is recommended for several biologics and chemotherapies used in infusion centers. The sole second-generation intravenous H1-antihistamine recommended is cetirizine. In this session, the presenter will review key clinical data available with IV cetirizine as well as clinical profiles of first- and second-generation H1 antihistamines used to manage infusion reactions.

Iron deficiency anemia (IDA) is a common diagnosis which occurs when body iron stores fall below the necessary levels to maintain steady state hemoglobin. IDA can be categorized into two main causes, low iron input (inadequate dietary intake or malabsorption) or increased iron output (usually from blood loss and rarely with urinary iron loss such as in nephrotic syndrome).

The Infusion Nurses Society asserts that a comprehensive organizational approach to vascular access device (VAD) care and management is imperative to ensure safe and efficacious patient care. It is essential that each organization (1) develops policies and procedures to align VAD care and management with recognized standards of practice; (2) integrates unique aspects of organization-selected VAD care products into policies and procedures and establishes expectations for adherence to these organizational directives; (3) develops a framework for gathering and analyzing clinical data related to patient outcomes for VAD care and management; (4) utilizes quality outcome data to facilitate evidence-based best practices within the organization; and (5) evaluates and facilitates educational programming to validate clinician competency. [Approved April 2020]

The National Institute for Occupational Safety and Health (NIOSH) provides an ongoing, continually revised list of drugs and biologic agents that meet the definition of hazardous drugs (HDs). Clinicians who prepare and administer hazardous drugs are potentially at risk by direct and indirect contact. Safe handling requirements, by the Occupational Safety and Health Administration (OSHA), NIOSH, USP 800, and INS 2021 Infusion Therapy Standards of Practice (SOPs), provide guidance to protect clinicians from hazardous drug exposure. Specifically, NIOSH recommends health care workers use a close system transfer device (CSTD) throughout the hazardous drug-handling chain, from drug compounding to administration. In this presentation, we will define hazardous drugs and clinician risk, discuss various safety requirements, evaluate various CSTDs, and learn to apply the INS 2021 SOPs into practice.

Many people do not understand what is happening with peripheral intravenous catheters (PIVCs), a seemingly innocuous device. Did you know that up to 69% of all PIVCs fail with an estimated excessive cost of $475,000 per 10,000 catheters used?—And the financial burden is only part of the story. Patient complications from PIVCs was number nine in the top 10 patient safety concerns in 2021, as identified by the ECRI Institute, one of the largest health care quality and safety entities in the world. To an observer, PIVCs often lie: we see no external signs and symptoms, and thus complications are often undetected. Yet when we look inside the vein, we see complications have begun, and we find the internal catheter positioning (the lie of the catheter) a contributing factor. Join us as we explore why the complications we see with PIVCs are late signs and symptoms of where the true problems lie.

As the result of requests from several state boards of nursing, INS convened a task force to determine if insertion of central vascular access devices by appropriately trained registered nurses (RNs) should be recommended. The task force consisted of RNs and advanced practice registered nurses with infusion therapy experience in various practice settings. The results are presented in the following INS position paper. [Approved September 2017]

Infiltration and extravasation will sometimes occur, despite best efforts in prevention. Overcoming barriers to prompt and appropriate treatment requires identification of vesicants and treatment options. This webinar is the second in a two-part presentation. During this session, we will learn about the evidence and principles guiding use of temperature therapy, antidote administration or use of an enzyme dispersal agent, along with other supportive therapies, that will facilitate appropriate treatment selection.