Journal of Infusion Nursing最新文献

There is a growing body of evidence about physiological changes with age that impact fluid and electrolyte balance. It is important that infusion nurses have knowledge in managing care for geriatric patients so they can identify these changes when they are exhibited. Knowing how to minimize the effect of these changes on the health of older adults is critical. The infusion nurse with knowledge of geriatric-focused care can avoid complications and critical illness in older adults. In addition, it is important to provide specific patient education that is grounded in geriatric best practices. This information will assist older adults to better protect themselves from dehydration, kidney injury, and other complications associated with fluid balance, such as delirium. This article reviews the literature on specific changes with aging that predispose older adults to adverse complications with fluid imbalance. New technology in geriatrics that can improve management of fluid status, such as dehydration and electrolyte monitors, are also discussed. This review included searches of the Medline®/PubMed® Database using MeSH terms (National Library of Medicine). Search terms included the following: aging-biological; aging kidney; water-electrolyte imbalance; dehydration; hypo-hypernatremia; hypo-hyperkalemia; delirium; wearable technology; and hydration monitors.

Natalizumab (TYSABRI®) was the first high-efficacy monoclonal antibody disease-modifying therapy (DMT) approved as a monotherapy for the treatment of adults with relapsing forms of multiple sclerosis (MS), including clinically isolated syndrome, relapsing-remitting MS, and active secondary progressive MS. Because natalizumab is administered by intravenous infusion, infusion nurses play a key role in the care of natalizumab-treated patients. In the 16 years since approval, substantial data have been gathered on the long-term, real-world effectiveness and safety of natalizumab. This article provides a synopsis of this data, as well as practical information for optimizing patient care. This includes information on strategies to mitigate the risk of progressive multifocal leukoencephalopathy in natalizumab-treated patients, natalizumab use during pregnancy, and use with vaccines. It also includes guidance on the preparation and administration of natalizumab and monitoring of natalizumab-treated patients.

Hyperemesis gravidarum can result in life-threatening physical and psychological maternal morbidity, including severe dehydration, weight loss, electrolyte imbalance, depression, and suicidal ideation. The reported prevalence of hyperemesis gravidarum ranges from 0.3% to 3.6%. The purpose of this qualitative study was to investigate what blogs can tell us about women's experiences of hyperemesis gravidarum. Thirty-three blogs written by hyperemesis gravidarum survivors posted on Hyperemesis Australia's website were analyzed using Krippendorff's qualitative content analysis method. Clustering was used and yielded 6 themes: (1) debilitating physical and mental health problems: digging deep to persevere, (2) heartbreaking choices, (3) lack of understanding and dismissed, (4) so much guilt surrounding their unborn infant, (5) it takes a village to support women with hyperemesis gravidarum, and (6) warriors and survivors: giving back. Infusion nurses are in a perfect position to provide support and compassionate care for women who are repeatedly coming to the hospital for rehydration treatment. Infusion nurses can validate women's physical and emotional struggles with hyperemesis gravidarum and help to no longer make women feel stigmatized.

The objective of this study was to compare hemolysis marker levels after in vitro infusion of red blood cells (RBCs) according to storage time, infusion rate, and peripheral intravenous catheter size. This is an experimental study with randomly administered RBCs in quintuplicate, according to storage time shorter than and longer than 14 days, as well as infusion rate (50 mL/h and 100 mL/h) using catheters with calibers of 14-, 18-, and 20-gauge. Aliquots were collected from RBCs (V1), after equipment and catheter (V2) free-flow filling and after controlled infusion through the catheter (V3). The hemolytic markers analyzed were degree of hemolysis (%), hematocrit (Ht) (%), total hemoglobin (THb) (g/dL), free hemoglobin (FHb) (g/dL), potassium (K) (mmol/L), and lactate dehydrogenase (LDH) (U/L), considering a probability of error ≤5%. Sixty experiments were performed with the analysis of 180 aliquots. When RBCs aged <14 days were used, all catheters tended to increase THb, FHb, and K; while >14 days, RBCs presented increased FHb and degree of hemolysis with catheters of 18-gauge and THb levels at 14-gauge. Among the conditions analyzed, only 20-gauge catheters (the smallest) did not influence changes in hemolysis markers, regardless of RBC storage time.

Repeated access of peripheral intravenous (IV) devices theoretically increases the risk of bacterial exposure. PIVO™ (VelanoVascular) is a needleless, single-use device that enables blood sampling from an existing peripheral IV. The goal of this retrospective observational exploratory study was to evaluate the influence of PIVO use on rates of hospital-onset bacteremia and fungemia (HOB) by comparing HOB rates in the year before and after PIVO introduction in hospitals implementing PIVO and over similar time periods in "control" hospitals with no PIVO. Two hospitals implementing PIVO (Hospital 1, a large community hospital; Hospital 2, a tertiary oncology center), and 71 control hospitals were included. During the 1-year period before and after PIVO introduction, HOB rates decreased in hospitals 1 and 2 by 31.9% and 41.8%, respectively. Control hospitals that did not use PIVO had a 12.4% decrease in HOB rates. Multivariable logistic regression analyses found that PIVO was associated with a lower risk (Hospital 1 odds ratio [OR]: 0.63; 95% CI, 0.42-0.94) or no change (Hospital 2 OR: 1.05; 95% CI, 0.72-1.52) in HOB rates. Control hospitals also showed no change in HOB rates between the 2 time periods. These data do not support concerns about increased risk of bacteremia with PIVO.

Placement of peripheral intravenous catheters (PIVCs) is a frequent occurrence. Yet, PIVCs consistently require multiple attempts for successful cannulation, leading to an increased use of resources and risk of complications. Even though hospitals have established vascular access teams to improve outcomes and increase longevity of PIVCs, not every facility has one, and some struggle to meet demand. In these cases, PIVC placement depends on the confidence and skills of bedside nurses. Difficult access risk identification tools, as well as vein visualization technologies, like near infrared (nIR), have been developed to assist nurses with cannulation. This study sought to explore how hospitals are using vein visualization technology in nurse-driven protocols and to evaluate whether the technology is being meaningfully integrated into venous assessment and PIVC access protocols. In a survey sent to facilities utilizing nIR technology, 48% of respondents incorporated nIR in nurse-driven protocols. Of these respondents, 88% reported improvement in patient satisfaction, 92% saw a reduction in escalations, and 79% reported a reduction in hospital-acquired infections associated with PIVC placement. Integrating vein visualization technology into nurse-driven PIVC placement protocols has the potential to make a positive impact but requires future research to reproduce these findings in clinical studies.

Extravasation occurs when injectable drugs leak out of the blood vessels, damaging the surrounding tissues and causing a variety of skin injuries. This study aimed to comprehensively analyze extravasation risk, skin injury profiles, and outcomes for suspect drugs from the Japanese Adverse Drug Event Report (JADER) database. Adverse events were defined according to the Medical Dictionary for Regulatory Activities/Japanese version; the term extravasation (Standardized MedDRA Query Code: 20000136) was used in this analysis. The names of adverse events were entered as unified preferred terms and redefined to evaluate skin injury profiles. In addition, skin injury outcomes were divided into 2 broad categories: "improvement" and "no improvement." Reporting odds ratios were used to detect signals for adverse events. A total of 656 cases of extravasation-related adverse events were reported between April 2004 and January 2022. Signals for extravasation-related adverse events were detected from 11 drugs. Then, their respective skin injury profiles and outcomes were determined. These results suggest a relationship between adverse events associated with extravasation and 11 drugs and identify the characteristics of each skin injury and their outcomes. These findings will contribute to improving the quality of infusion management in clinical practice.