Once again we are pleased to present Infusion Nursing Grand Rounds and Educational Posters (ePosters) from the Infusion Nurses Society's Annual Convention and Industrial Exhibition. The range of topics reflects the scope of the infusion specialty practice. We encourage all infusion professionals to share their research and best practices as we seek to provide safe, quality patient care.
Poster presentations were shared with conference attendees in a multimedia ePoster format. Data were presented through digital presentations on flat-panel HD monitors, complete with animation, videos, and other features that enhanced learning. To view the ePosters online, visit http://ins1.posterview.com. The winner of the Infusion Nursing Grand Rounds is noted with an asterisk (*).
-Mary Alexander, MA, RN, CRNI(R), CAE, FAAN
Editor, Journal of Infusion Nursing
INFUSION NURSING GRAND ROUNDS
PICC or Midline? That Is the Question
Stephanie Alessandroni, BSN, RN, OCN(R), CCRN
A retrospective cohort study was completed evaluating the effectiveness of the midline program in reducing the numbers of peripherally inserted central catheter placements. An analysis was completed of the data in relation to central vascular access device infections and cost-effectiveness. Midline catheters can be a successful alternative for a large portion of patients.
Prefilled Normal Saline Syringes to Reduce Nursing Time and Infusion Failures: A Pilot Brazilian Study
Tathiana Silva de Souza Martins
Raquel de Souza Dantas
Fernanda Jardim Guerra
A quasi-experimental pilot study was conducted to determine how infusion outcomes were affected with the use of conventional flushes versus prefilled syringe flushes.
Reflections on Infusion Practice: Variability in the Field
Patricia Petroulias, PhD, RN
Variations in the care and flushing of central vascular access devices are potential sources of adverse events for patients. This intervention study presents 3 case studies that identify variations of practice among home care nurses and how infusion nurses can be the ambassadors for dissemination of evidence-based practice.
Perceptions of the Patient With Poor Venous Access Experiencing Multiple Attempts for Peripheral Intravenous Access
Ann Plohal, PhD, APRN, ACNS-BC, CRNI(R)
Short peripheral catheter insertion is experienced by more than 90% of hospitalized patients, yet is reported as the highest dissatisfier during a hospital stay. The purpose of the study was to describe the experience of adult hospitalized patients with poor venous access who received multiple attempts for intravenous insertion.
*The Implementation of Near-Infrared Technology to Decrease PICC Placements-Changing Patient Outcomes
Patti Wilcox, BSN, RN, VA-BC
This presentation describes how product research led to the implementation of near-infrared technology that increased patient satisfaction, significant cost savings, and vein preservation. Data related to peripherally inserted central catheter insertion rates are presented.
ePOSTER PRESENTATIONS
Does Measuring a PICC's External Catheter Make a Difference in Patient Safety?
Darlene C. Brown, MSN, RN, WCC, CCHP, CRD-USPHS
Mary Emanuelle, BSN, RN, CNOR, CCHP, CCDR-USPHS
Kelly MacIntosh, RT, (CT), (CCT), (ARRT)
The aim of this study was to observe and analyze peripherally inserted central catheter (PICC) external measurements in relation to complications of malposition. A total of 100 patients who underwent insertion of a PICC were reviewed. In 25 patients, the external measurements were increased by 4-plus centimeters on exam and required chest x-rays to determine the tip location. The safe use of PICCs needs strict guidelines and dedicated staff to change the dressings.
Midline Administration of Long-Term Intravenous Vancomycin
Jona V. Caparas, MSN, RN, CRNI(R), VA-BC
Jean-Ping Hu, BSN, RN
Long-term intravenous vancomycin was administered through a midline catheter for a total of 264 catheter days. No instances of bloodstream infection, thrombosis, or phlebitis occurred. Though preliminary, vancomycin administration in the deep veins of the upper arm for up to 25 days appears safe when delivered via the study midline.
Catch a Wave: Using ECG Waveform to Confirm PICC Tip Location
Tara Coble, BSN, RN
Jane M. Kirmse, MS, APRN, CNS
Angela Lowrie, MAN, RN
Jennifer Larson, MSN, RN
Clarissa Gana, BSN, RN
Rene Ean, BSN, RN
Electrocardiograph (ECG) technology in peripherally inserted central catheter (PICC) insertion is suggested to be a reliable and safe means of tip confirmation. Learn how a nursing PICC team used an evidence-based practice model to guide implementation of ECG technology for PICC tip location confirmation. A description of how ECG technology enhanced care quality, the patient experience, and patient outcomes are explored. Outcome evaluation includes ECG and x-ray correlation, efficiency, and cost analysis.
Advocating for a Standardized Infusion Therapy Curriculum in Nursing Programs
Judy M. Comeaux, DNP, ARNP, CRNI(R)
Cynthia L. Cummings, EdD, MS, RN, CHSE
Dayna J. Cohen, BSN GN
Clinical facilities report a deficiency in the readiness of new graduate nurses to perform infusion therapy. New graduates express doubt in their ability to provide quality, safe infusion and vascular access therapy. It is imperative that all nursing students receive comprehensive preparation in infusion therapy and vascular access. The purpose of this poster is to promote the need for a standardized infusion therapy curriculum in all undergraduate nursing programs.
Use of Peripheral and Central Intravascular Device-The INTO Cohort in Brazil
Raquel de Souza Dantas
Tathiana S.S. Martins
Fernanda J. Guerra
Zorahyde R. Pires
Ivanise A.G. Souza
A prospective cohort study was aimed at analyzing the use of peripheral and central intravascular devices in orthopedic patients. It was observed that 63% of patients experienced infusion failure:
37% phlebitis; 24.6% infiltration; 28% phlogosis with central venous catheters; 6% obstructions;
3% extravasation of drugs; and 1.5% leakage extrusion. The conclusion was that the probability of patients having phlebitis after 11 days of infusion drug therapy was 60%.
Clinical and Economic Impact of Increasing Infusion Rates in IVIG Patients
Ashley DesRocher, MSN, BS, BSN, RN, NP-C
Katie May, BSN, RN
A protocol change was implemented in an infusion clinic to assess how increasing infusion rates might impact costs, satisfaction, and tolerability. Average infusion rates (within principal investigator guidelines) for 21 intravenous immunoglobulin patients were doubled, cutting infusion times in half. Although side effects increased minimally, patient satisfaction levels were high. The results demonstrate that faster infusion rates can be safe, leading to lower clinic infusion costs and improved clinic efficiencies with high patient satisfaction.
Needle Length Considerations During Hyaluronidase-Facilitated SCIg
Kimberly Duff, BSN, RN
Peg Gruenemeier, RN, CRNI(R), CHC
Carol Ernst, RN
Tamara Palagashvili, PharmD
Currently, needle length selection for hyaluronidase-facilitated subcutaneous immunoglobulin (IGHy) administration is based on clinical judgment. No objective data exist for IGHy replacement, for which infusion volumes can be as high as 600 mL. The goal of this poster is to present an update to a previous retrospective data analysis on needle length in relation to tolerability and body mass index and other considerations in IGHy-treated patients to assist in providing guidance for choosing appropriate needle length.
Foam Dressings as an Alternative Dressing for Central Venous Access Devices
Valarie Haisley, BSN, RN, CWCN
Karen Johnson, MSN, MBA, BSN, RN, CRNI(R), VA-BC
Robin George, BSN, RN
Jamie Wallace, BSN, RN
Three case studies revealed the effectiveness of foam dressings as an alternative to central catheter/peripherally inserted central catheter transparent film dressings in the presence of moisture, skin erosion, and bleeding. The frequency of dressing changes decreased because of the ability of foam dressings to absorb moisture and adhere in the presence of moisture. Skin erosion healed. Infection risk decreased. Patients experienced less pain. Patient satisfaction improved. The significant reduction in billable, unscheduled dressing changes provided financial savings.
90% of Pump Programming Events for High-Alert IV Drugs Are Titrations
Tim Hoh, RPh
Idal Beer, MD, MBA, MPH
Shannon Kayler, BSN, RN
Pamela Krueger, MS
High-alert intravenous (IV) medications are titrated during infusions to achieve a targeted response. Each titration creates an opportunity for a programming error, potentially within the drug library's safety limits. There are no published data on the frequency of titration programming. A retrospective analysis of infusion pump data from 45 hospital sites over 6 months indicates that 90% of programming events for high-alert IV medications are titrations. Understanding titration frequency can guide safer infusion protocols and systems.
Evaluating the Safety, Efficacy, and Cost Effectiveness of Midline Catheters
Britt M. Meyer, PhD, RN, CRNI(R), VA-BC, NE-BC
As organizations scramble to meet the demands of payers for provision of high-quality, cost-effective health care, central catheter use has come under scrutiny. Questions regarding the safety, efficacy, and cost-effectiveness of midline catheter use are a part of this discussion. This poster's focus is to communicate the results of a performance improvement project that compares the dwell times, complication rates, and cost-effectiveness of antithrombogenic midline catheters with silicone midline catheters.
Early-Stage Detection of Peripheral IV Infiltrations
William J. Naramore, BS
Gregory J. Schears, MD
Garret T. Bonnema, PhD
A clinical study was performed to measure the sensitivity of the ivWatch device for early detection of infiltrations. The objectives of the study were to determine the sensitivity of the ivWatch device for detecting early-stage infiltrations (<= 10 mL of saline solution) and to demonstrate a significant improvement for early-stage detection of infiltrations compared to hourly observations by a "perfect" clinician. Results of the study included a 96% notification rate for early-stage infiltrations.
The Effect of Infiltration Rate on Infiltration Detection
William J. Naramore, BS
Gregory J. Schears, MD
Garret T. Bonnema, PhD
A clinical study was performed to assess what effect infiltration rate has on early-stage detection of infiltrations. Adult volunteers received infusions of saline in either the forearms or dorsal aspect of the hands. The objectives were to determine how the infiltration rate affects: (1) the sensitivity of the ivWatch device and (2) the detection volume of the ivWatch device. Study results included the ivWatch device issued notifications of an infiltration before 10 mL infiltrated volume.
Taking Pediatric IV Assessments to the Next Level
Sylvia A. Rineair, MSHA, BSN, RN, VA-BC
Darcy Doellman, MSN, CRNI(R), VA-BC
Peripheral intravenous (IV) injuries from infiltration/extravasation can cause serious harm. Nurses are challenged with consistent, effective, and timely peripheral IV assessments. To eliminate serious harm from peripheral IVs, an intervention with a higher level of reliability is required to take assessments to the next level. This presentation focuses on research completed using technology containing an optical sensor and monitoring device to detect infiltrations and extravasations more quickly than the current standard of care.
Pediatric Peripheral Venous Access: The Importance of a Specialized Team
Karine Gottardo Severino
Renata Goncalves de Souza
Luciana de Souza Pedrosa
Many times, invasive procedures end up with the child crying. Likewise, intravenous procedures are stressful for children and their companions. A total of 1254 patients were analyzed over 3 years. In the first year, there was no specialized team, and the rate of patients who needed a second procedure was 8%. After a pediatric team was established, the rate of patients who needed to repeat a procedure was 6%.
The Implementation of Near-Infrared Technology to Decrease PICC Placements in Patients With Limited Venous Access
Patti Wilcox, BSN, RN, VA-BC
The need to obtain peripheral access in patients with limited venous access was identified. Product research was conducted. Near-infrared technology was chosen. Peripherally inserted central catheter (PICC) placements in 2012, before the implementation of near-infrared technology, were compared to PICC placements postimplementation in 2013, 2014, and 2015. The result was a decrease in PICC placements of 340 in 2013, 339 in 2014, and 341 in 2015.
Improvement in outcomes: Increased success in obtaining peripheral intravenous access; increased patient satisfaction, cost savings, and vein preservation.
Catheter Occlusion in Home Infusion: Does Needleless Connector (NC) Design Matter?
Ann Williams, RN, CRNI(R)
Background: Following successful conversion by a sister hospital to MaxZero, standardization across the system was considered.
Purpose: Do differently designed NCs reduce intraluminal catheter blood occlusions?
Methods: Retrospective performance analysis
Results: Five months following conversion, a 2.4% drop in occlusions per 100 catheter days, 65% reduction of alteplase use was demonstrated.
Conclusions: Significant improvement occurred. Deaconess Home Care converted to MaxZero.