Col. Binu Sharma
Lt. Col. Saravjeet Kaur
General Secretary, INS-India
Organizing Secretory, INS-India 2016
Lt. Col. Anitha Philip
Organizing Committee, Hyderabad, INS-India 2016
Organizing Committee, Hyderabad, INS-India 2016
Organizing Committee, Hyderabad, INS-India 2016
Organizing Committee, Hyderabad, INS-India 2016
1st National Conference, Bangalore
2nd National Conference, Delhi
3rd National Conference, Amrita Institute - Kochi, Kerala
4th National Conference, National Library - Kolkata
More than 1000 professionals will gather together at this mega event of INS-INDIA 5th National conference. These two days will be exhilarating with educational sessions, competitions, exhibitions, interactive discussions and cultural event.
Professional development learn Infusion therapy best practices and clinical advance from the abstract posters and presentations.
Network with colleagues and Infusion Experts from across the country meet infusion professionals face-to-face, connect and learn from them at hands-on clinical sessions.
Standardization of practices in infusion therapy know about the set forth standards on best practices and developing patient-centered plans of care in order to provide safer patient care. Specially designed to assist you with challenges you face each day.
Industrial Exhibitions, Panel discussions, poster presentations, workstations, competitions and much more...
Make use of an opportunity to build your professionalism by participating in scientific sessions, activities etc.
INS –India offers you...
INS India is investing in creating a national data repository for:
Infusion Nursing Standards of Practice
An invaluable guide for decision making and developing patientcentered plans of care in order to provide safer patient care.
Infusion Therapy Basic Module - Being current and relevant is necessary in order to provide safe patient care.
Key Note Presentations:
The evolution of INS - Past, Present & Future.
Launch of INS SOP 2016 – What is new for me?
General Sessions: IV Therapy Basics / Sharing Best Practices
The Journey to Standards of Practice, Core competencies for Infusion therapy to enhance healthcare outcome.
Additional educational opportunities during select hours of the meeting from industry experts provided by INS-INDIA Platinum corporate members.
Hot Topic Discussion: Infusion Therapy- Challenges / Managerial Issues
To address subject with current challenge, concerns with experts opinion through panel discussions.
Breakout Sessions: IV Therapy Advanced
Intended for all attendees who currently meet the infusion therapy needs of the specialty population viz. Pediatric, Oncology etc. with focus on safety, best practices and novel strategies to care for the unique need of these patient population.
Evidence Based Practices:
Scientific Paper Presentations [Four Best Papers will get opportunity to present].
Each year INS-India Announces Best Scientific Paper Presenters and Poster Competition.
Exciting Future Plan…
Online Registration Gateway Mobile APP
TOT- Certification Programme
INS-SOP Implementation Research Opportunity
PRODUCTS, TECHNOLOGY, SERVICES AND EDUCATION
Discover innovative products, emerging technology and scientific advances at the industries in the conference exhibit hall. While there, you can also stop by the INS membership booth. Meet with INS-INDIA Council Members at the INS booth to learn more about membership, Standards of practice Guidebook and voluntary participation.
Best Practices in Peripheral IV Cannulation : Challenges and Impact
Sai Bala.M (MSN), Lakshmi Priya Ravi N (MSN), Sreeja Mohan (RN) Amrita Institute of Medical Sciences, Kochi
Peripheral intravenous cannulation is the most common procedure in any health care setting. Even though perceived as a safe method, several complications can arise from unsafe and improper practices. The risk is higher in pediatric population and more so in a cardiac surgical setting due to multiple physiological reasons related to age and cardiac conditions.
To identify the challenges and impact of implementing best practices in Peripheral IV Cannulation in Pediatric Cardiac Surgical Intensive Care Unit, AIMS, Kochi.
This prospective study consisted observation of approximately 2500 total IV placements among patients in Pediatric Cardiac Surgery Intensive Care unit with bed strength of 11 over a period of three years from August 2012 to July 2015. Data was collected on individual cannulation, resulting complications and analyzed quarterly and yearly to find out areas for improvement. We followed the FADE model of Quality improvement.
Goals were set for every year, taking one or two challenges to be addressed at a time. Important findings observed in quarterly analysis paved way to establishing guidelines and changes in practices.
3.1 2012 August to 2013 July
3.2 2013 August to 2014 July
Though implementation and sustenance of best practices is a challenge, it is not unachievable. An interested team of enthusiastic nurses can foster change to positively influence patient care outcomes through collaboration and team work.
Standards of Practicet
Michelle Berreth, RN, CRNI, CPP
Nurse Educator: INS-US
Standards of practice along with scope of practice, code of ethics, regardless of practice setting. Standards of practice, not to be confused with standards of care, “focus on the provider of care and clearly state the acceptable levels of practice in patient care delivery”.
The Foundation of Professional Nursing
The origins of nursing standards of practice likely began with Florence Nightingale. She believed that "well educated women, using scientific principles ... could dramatically improve the care of sick patients," Nightingale kept detailed records of the results she observed when patients received care from trained nurses. She continually analyzed data and was able to show a significant drop in the mortality of injured and sick soldiers who received "standardized care."
Also known as the "Lady with the Lamp: Florence Nightingale taught nursing with the intention that graduate nurses would "teach nursing to the entire world" Over the next several years, training programs and schools for nursing increased. Hospitals provided the setting for many of the schools, where students were expected to work in exchange for an education. Having students provide care saved hospitals money.
Clinical experiences were limited, related either to the size of the hospital or the specialty, e.g., sanatoriums for tuberculosis or state mental hospitals." The length of training programs ranged from several months to three years; there were no standards regarding the education of professional nurses. This lack of standardization resulted in the formation of one of the first national organizations related to nursing. The American Society of Superintendents of Training Schools of Nursing was charged with the task of "elevating the standards of nursing education." The association continues its work to this day as the National League for Nursing. In the late 1800s, 90 percent of people in the United States who cared for the sick did not receive much, if any, hospital training. Concerned for public safety, as well as the image of nursing, nurse leaders of the time sought to unify nurses in an effort to bolster the nursing profession. The Nurses' Associated Alumnae of the United States and Canada, now known as the American Nurses Association (ANA), was organized "with the intent of achieving licensure for nurses." In addition to nurse licensure, ANA's goals included the "establishment of a code of ethics, promotion of the image of nursing, and provision of attention to the financial and professional interests of nursing,"! Individual states formed their own nursing associations that contributed to the passage of nurse registration acts. Nursing practice could now be regulated and a code of ethics and scope of practice established, and nurses received a license and the title of registered nurse."
Building on the Foundation
Another important part of the foundation of the Model of Professional Nursing Practice Regulation' is standards of practice. ANA established standards of professional nursing practice and describes them as follows:
". .. a competent level of nursing care as demonstrated by the critical thinking model known as the nursing process. The nursing process includes the components of assessment, diagnosis, outcomes identification, planning, implementation, and evaluation. Accordingly, the nursing process encompasses significant actions taken by registered nurses and forms the foundation of the nurse's 7 decision - making. "
ANA's standards of nursing practice apply to all nurses across all practice settings, defining "criteria relative to nursing accountability and professional competency' The standards are the foundation each nurse uses to develop and build a strong personal and professional practice. Standards of nursing practice, just as the practice of nursing itself, constantly change and are remodeled based on research, legal guidelines, and evidence affecting nursing practice. Continuing nursing education, maintaining competencies, and seeking professional certification demonstrate that "nurses, individually and collectively, are responsible and accountable for their practice" Specialty nursing organizations, such as INS, speak "for nurses and nursing, based on their mission and vision statements that are specific to their specialty interests, goals, and purposes." Many nursing organizations develop and maintain standards of practice specific to their specialty. INS' most recent revision of the Standards supports a piece of its mission statement of "developing and disseminating standards of practice."
At the beginning of this article, it was noted that standards of practice "focus on the provider of care and clearly state the acceptable levels of practice in patient care delivery'? The focus for standards of care is the recipient of the care, the health care consumer, the patient. According to The Joint Commission, "standards of care must be developed within the (health care) organization." Standards of care are statements of outcome, or what the end results of patient care should be.
These standards, which contribute to an organizations policies and procedures, vary from location to location. Standards of practice often contribute to the development of standards of care.
With a focus on evidence-based practice, safety, and quality, the standards of practice developed by ANA provide a solid foundation for the profession of nursing. The Standards developed by INS adds to this foundation, providing the specialty of infusion nursing with materials to build a nursing practice that exceeds “the public's expectations of excellence by setting the standard for infusion care”.
Contrast Extravasation, A Clinical Practice & Management
In CT department, various types of patients comes for scan every day, such as brain, neck, chest, abdomen/pelvis angiograms, liver, peripheral angiograms. Among these patients, some may have undergone chemotherapy whose vein are very fragile and thrombosed. There are two ways of injecting contrast in the body:
Mode of infusion of contrast:
Contrast should be injected through peripheral & central line since the contrast has high Osmolarity than blood. It should be given through proper gauge cannula. Contrast should not be given through Hickman’s catheter or port line, as it may block the opening of catheter and or extravasation can happen.
Contrast extravasation is the accidental extravascular injection of intravascular contrast media caused by dislodgment of the cannula, contrast leakage from the vessel puncture site, or rupture of the vessel wall. Contrast extravasation is a well-recognized complication, with reported frequencies of 0.25% (56/22,254), 0.7% (475/69,657) and 0.9% (48/5,106) in three large CT series where power injectors were used. Extravasation usually causes some combination of immediate pain, erythema, and swelling, but fortunately these are usually self-limiting. However, severe skin and subcutaneous ulceration can occur, and subfascial extravasation may cause compartment syndrome (neurovascular signs and symptoms due to increased volume in the confined spaces formed by the deep fascia). These major complications may occur even with small volume (< 10cc) extravasations and non-ionic contrast media. Research shows that contrast extravasation is a rare problem that occurs in less than 1% of patients, and very rarely patient requires surgical intervention like fasciotomy for compartment syndrome.
Risk Factors and Prevention:
Small children, the elderly, and unconscious patients are at higher risk for extravasation, partially because of reduced reporting of injection site pain. Other risk factors are use of an injection site other than the antecubital fossa, use of an indwelling venous cannula that has been in place for over 24 hours, and multiple attempts at venous access. When extravasation does occur, complications are more severe in extremities with poor vascular or lymphatic circulation (e.g., on the side of a prior mastectomy with radiation or lymph node dissection) or when extravasation occurs on the dorsum of the hand or foot. Based on these considerations, and realizing that prevention is the key to avoiding contrast extravasation, the following practice guidelines are suggested:
|Contrast Agent||Date and time||Amount of contrast extravasated||Amount of saline extravasated||Site of extravasation|
As soon as we see swelling or pain during the injection of contrast stop injection immediately try to aspirate it as much as you can and remove the I.V. line, do the proper dressing and apply ice pack, and inform the overseeing radiologist.
Immediately put ice pack on it, if the swelling is persistent, then MgSO4 dressing should be applied for certain period and elevation of hand should be done.
Wait and watch: if pain is persistent then analgesic and antibiotic should be administered as per physician’s order.
Advice patient for follow up after a week, if required.
Patients with extravasation should be assessed and reassured, and referred to the Emergency Department if there is skin blistering, altered tissue perfusion, increasing pain, or change in sensation distal to the site of extravasation.
Scenario: Contrast Extravasation at CT department
A 44-year-old female was referred for contrast-enhanced CT. A catheter was placed into a vein in the metacarpal site, and approximately 50 mL of nonionic low-osmolar contrast medium was injected using a power injector. The patient complaint of pain after the injection, and the site of the injection was noted to be swollen and tender. The contrast medium has been extravasated into the skin and subcutaneous tissues around the injection site. An observation supported by the visible protrusion at site catheter placement. After observation from radiologist and further assessment, there was no risk of compartment syndrome, and immediate intervention was followed as per hospital protocol and swelling subsequently reduced over period of time. Patient has been sent home and advised for further follow up by the radiologist. The incidental documentation and reporting was required in this case.
So one has to be very careful while inserting an I.V. line; that it should be properly placed. One cannot take it easy. “This develops with the skill. Skill develops by practice and practice makes you perfect” in I.V. cannulation. Updating the knowledge and skill becomes important aspect of a nurses career hence participation in organizations/associations like Infusion Nurses Society - INS is very important!
Policies, Procedures, and Pharmacokinetics
Michelle Berreth, RN, CRNI, CPP
Nurse Educator: INS-US
There has been a noticeable questions regarding the policies and procedures. Common questions mainly pertain to obtaining the samples and interpreting the results. To answer those questions, a basic understanding of pharmacokinetics is helpful. This article will discuss aspects of IV drug pharmacokinetics that are relevant to infusion therapy, as well as how these aspects help ensure patients receive the most benefit from the IV medication.
The reasons for monitoring the amount of medication in a patient's system have evolved over the years. In the 1960s, studies of how medications were distributed, absorbed, metabolized, and excreted by the human body fueled the new clinical practice of therapeutic drug monitoring. At that time, pharmacokinetic studies introduced a connection 2 between “mathematical theories to patient outcomes:”
Pharmacokinetics and Infusion Therapy
Three aspects of pharmacokinetics are applicable to infusion therapy: drug distribution, therapeutic index, and plasma concentration. Drug distribution refers to the movement of an IV medication from the blood into the tissues of the body. In order for medication to have a therapeutic effect, it needs to reach the receptor site, the place where the drug performs its action. The time it takes for the drug to reach the tissue and appropriate receptor sites is dependent on how fast the blood can reach the tissue, how much tissue there is, and the permeability of the blood to the tissue. Once the amount of medication administered is equal to the amount eliminated, the medication has reached a "steady state." Plasma concentration represents this equilibrium between tissues and plasma.
Therapeutic index indicates a range in which an IV medication produces the desired therapeutic effects, but is not high enough to be toxic. Every medication has its own range, even within the same category of drugs.
Plasma concentration provides a snapshot of the amount of medication in the plasma at any given time. A sample of blood obtained 30 to 60 minutes after administration of an IV medication will provide the highest level, or peak, of the medication at that time. A trough level is the lowest level of the medication. It is obtained just before the administration of the next dose of medication. Not all medications have the same requirements for peak and trough times. Be sure to follow your organization's policies and procedures or guidelines.
Factors Affecting Drug Monitoring and Interpretation
Various factors can affect the accuracy of drug monitoring, which, if inaccurate, can lead to inappropriate dosing of the IV medication.
Implications for the Infusion Nurse
Monitoring therapeutic levels of IV medications contributes to the best outcomes for the infusion therapy ordered. In addition, the clinical assessment and critical thinking skills of the infusion nurse help ensure the results of laboratory testing are as accurate as possible by:
And that brings us back to the original question: What are the policies and procedures for obtaining blood samples to monitor IV medications? Ultimately, the organization you work for develops and maintains policies and procedures, and you are responsible for following them. As the infusion nurse, you should be an active participant in the development and/or review of the policies. The policies and procedures reflect your state Board of Nursing's scope of practice, as well as the competencies required to perform the procedures and standards of 5 practice applicable to your nursing practice. To help ensure your patients receive the most benefit from their infusion therapy, communicate and collaborate with the pharmacy and laboratory departments, as well as the licensed independent practitioner.
Seamless Patient Care, with an IV Catheter that Lasts
Longer dwell times can Reduce painful restarts.
Let’s admit it. Few people look forward to having an IV catheter placed. Patients don’t like it.Clinicians don’t enjoy it. And all that is compounded when a catheter falls or has to be replaced. Use the BD NexivaTM Closed IV Catheter System enables longer dwell times and clinically indicated catheter replacement.1 A 2014 Clinical study demonstrated that BD NexivaTM Catheters had a median dwell time of 144 hours for catheters in place > 24 hours. The same study showed that the longer dwell times of closed system led to a cost reduction of approximately $1M/year/1,000 beds compared to an open system.1 That’s good for you and your patients.
To order or learn about all the ways BD is caring for you and your patients, visit bd.com/iv start
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INS India’s Family Just Going Bigger!!!
A hearty welcome to all new members
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