Are your nurses current on infusion therapy?
May 1, 1998 4 minutes read
Are your nurses current on infusion therapy?
Here's what they should know
For many home care nurses, learning about infusion therapy is a little like taking organic chemistry: a chore one groans about.
Yet, learning about infusion therapy is just as necessary since increasing numbers of hospitals are sending home patients who have catheters.
"The hospitals are just discharging patients earlier, and they still have their IV, so we have to finish up their course of therapy," says Susan Shrecengost, RN, staff development and education coordinator for Clarion Forest Visiting Nurse Association in Knox, PA. The full-service agency serves a rural area in mid-to-northwest Pennsylvania.
Clarion Forest Visiting Nurse had a hospital nurse, Jane Deeter, RN, at Clarion (PA) Hospital, conduct an inservice on Mediports. Also, the agency uses a model of a human chest to demonstrate the various IV ports, Shrecengost says.
Bayfront Home Health of St. Petersburg, FL, has established a standing protocol for the care of all IVs, including peripheral lines, midlines, triple lumens or central lines, implantable ports, and others, says Claire Malczyk, RN, BSN, PHN, quality improvement coordinator for the hospital-affiliated agency, which covers most of the peninsula around St. Petersburg.
"We had a problem with nurses doing IVs too infrequently and with the agency not having an IV team," Malczyk says. "So basically what we did is establish a protocol." (See IV protocol, p. 74.)
Bayfront also developed an IV intake order sheet that has all physician orders. (See IV medication administration physician's orders, p. 83.)
The IV protocol now is part of the agency's admission packet to go out with all IV teaching tools, says Michelle Barlow, RN, BSN, Bayfront manager.
"The tool makes it a lot easier for the nurses out in the field," Barlow says. "We tried to take the guessing game out of caring for the IV patient population by giving nurses all the tools they needed to pull the full picture together."
Before the tool was developed, the nurses had to hand write everything, Barlow adds. "Now all they have to do is look at the order form, and they can go through and check what's applicable."
Bayfront provided small group inservices for nurses to discuss the new forms and how they should use them, Malczyk says.
Clarion Forest Visiting Nurse's IV training for nurses during their orientation includes placing nurses with as many IV patients as possible so their skills can be checked, Shrecengost says. (See Clarion Forest's infusaport competency, p. 84.)
"Our IV cases used to be pretty few and far between, so it's good to have reviews periodically, to keep nurses current," Shrecengost adds.
The training partly involves having home care nurses watch hospital nurses handle infusion therapy, says Deeter, who is a head nurse of the special procedures unit for Clarion Hospital.
If your agency needs to begin regular IV training, Deeter recommends you focus on these areas:
· Accessing ports. It takes a minimum of three times to learn how to access these ports, Deeter states. Nurses first can observe a nurse accessing a port, and then they will be assisted with accessing a port, and finally they can access one port on their own while being observed, Deeter says.
Accessing ports can be tricky because nurses must learn to put the needle through the skin to the top part of the port, which is between the size of a dime and a nickel, Deeter says. "They're not always easy to feel, depending on the size of the patient and how much subcutaneous fat overlaps the port."
· Discontinuing needles in infusaports. Nurses need to learn how to handle a needle in an infusaport, Deeter notes.
"It looks like the head of a stethoscope that's threaded into the subclavian vein in the upper part of the chest," Deeter says.
Her chief advice is that the nurse make sure the needle is flushed with Heparin and removed from the port. "It's very important these ports are flushed with Heparin."
· Handling problems. Deeter once handled a home care case in which a patient made it very difficult for nurses to take care of his port, and this in turn upset the patient's physicians.
"We ended up teaching the wife how to do it because he was a real stinker and was pulling the needle out and saying it was never in," Deeter comments, adding that she was brought into the case to teach the wife.
Deeter also teaches nurses how to position patients to obtain a blood return when pulling the needle back. That means the port is in the right place in the vein so the nurse can inject medication through it.
"If you aren't getting a blood return, then have the patient turn from side-to-side, and have him cough," Deeter suggests. "The port could have slipped out of the vein, but that doesn't happen very often."
Sometimes, ports could be pushed up against the wall of a vein, so when the nurse pulls back to aspirate the blood, the port is up against the wall, and it won't let any blood come back, Deeter explains. "Push it, and sometimes that will do it, and it will float into the vein again."
Another problem involves rotating sites by a centimeter or so. The spots for inserting needles should be changed every 72 hours, rotating like positions on a clock at 12 o'clock, 3 o'clock , 6 o'clock , 9 o'clock, and in the middle, Deeter says.
"You change spots just so you're not infecting the patient by putting it in the same hole," Deeter says. "You could be pushing bacteria down into the port, and they could get the port infected from it."
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