Objectives
Section 1 - New Hampshire Legalities of Infusion Therapy
Upon completion of this section, the participant will be able to:
- List the 2 components required for the LVN to practice IV therapy in the state of New Hampshire.
- Describe delegation procedures for New Hampshire nurses.
- Explain how the Nurse Licensure Compact impacts the nurse's provision of infusion therapy.
Section 2 - Basics of Peripheral IV Therapy; Current Standards of Practice
Upon completion of this section, the participant will be able to:
- List specific measures that will protect against malpractice.
- Identify infusion related complications, causes and appropriate treatment.
- Demonstrate the correct calculation of an IV flow rate.
- Identify methods of infection control related to IV therapy.
- List the components of accurate and complete documentation of IV procedures and complications.
Section 3 - Current Practices in the Management of Central Lines
Upon completion of the section, participants should be able to:
- List reasons for use and advantages of central lines.
- List veins used for central venous device placement and proper tip position.
- Identify the various types of central lines.
- Identify symptoms and prevention of complications.
- Describe assessment criteria and documentation required for patients with central venous catheters.
Section 4 - It's All About Ports
Upon completion of this section, the participant will be able to:
- Distinguish an implanted venous port from other types of central venous access devices.
- Describe the procedure for accessing and de-accessing an implanted port.
- Describe the procedure for drawing a blood specimen from a port.
- State at least 3 potential port complications.
Section 5 - Goal: Zero Catheter Related Blood Stream Infections
Upon completion of this section, the participant will be able to:
- Identify at least three negative effects of central line related bloodstream infections.
- Identify at least two methods by which central lines become colonized.
- Identify at least three strategies to reduce the risk of CRBSI at the time of catheter insertion.
- Recognize the proper time intervals and procedures for dressing change, injection port change, and site observation.
- State the recommended methods for obtaining blood cultures for CRBSI diagnosis.
- State the recommended methods for treating CRBSI.
Section 6 - IV Push Medications
Upon completion of this section, the participant should be able to:
- Explain the difference between IV push medication administration and IV infusion medication administration .
- Recognize potential negative effects of administering IV push medications incorrectly .
- Demonstrate the proper procedures involved in the preparation and administration of IV push medications.
Section 7 - Prevention and Management of Intravenous Extravasation
Upon completion of this section, the participant will be able to:
- Distinguish the difference between an infiltration and an extravasation.
- Describe INS and ONS standards of practice related to vesicant administration.
- Discuss appropriate measures to prevent an extravasation.
- Recognize at least three classes of drug generally accepted as vesicants.
- Discuss at least four measures used to treat extravasations.
Section 8 - Hypodermoclysis
Upon completion of this section, the participant will be able to:
- Identify at least 3 factors that contribute to dehydration in the elderly.
- Define hypodermoclysis.
- Describe the advantages, disadvantages, indications, and contraindications of hypodermoclysis.
- Describe the appropriate sites, solutions, volumes and rates for hypodermoclysis.
- Describe the procedure for hypodermoclysis administration.
- State at least 3 potential complications of hypodermoclysis.
Section 9 - Intravenous Antibiotics: Antifungals
Upon completion of this section, the participant will be able to:
- Identify the indications, proper administration, and side effects of available intravenous antifungal medications.
- Explain two potential causes of antifungal resistance.
Section 10 - Intravenous Antibiotics: Antivirals
Upon completion of this section, the participant will be able to:
- Describe the mechanisms of viral infection in a human host.
- Describe the use of various intravenous antiviral delivery systems.
- Identify the indications, proper administration, and side effects of available intravenous antiviral medications.
Section 11 - Intravenous Antibiotics: ß-lactams
Upon completion of this section, the participant will be able to:
- Identify at least two actions that have increased the incidence of antibiotic resistance.
- Describe the use of various intravenous antibiotic admixture containers and delivery systems.
- Identify the classifications of intravenous beta-lactam antibiotics and medications belonging to each class.
Section 12 - Intravenous Antibiotics: Glycopeptides
Upon completion of this section, the participant will be able to:
- Identify at least two actions that have increased the incidence of antibiotic resistance.
- Describe the use of various intravenous antibiotic admixture containers and delivery systems.
- Identify the classifications of intravenous glycopeptide antibiotics and medications belonging to each class.
Section 13 - Intravenous Antibiotics: Additional Classifications
Upon completion of this section, the participant will be able to:
- Identify at least two actions that have increased the incidence of antibiotic resistance.
- Describe the use of various intravenous antibiotic admixture containers and delivery systems.
- Identify the classifications of intravenous antibiotics and medications belonging to each class.
Curriculum
Chapter 1: Nursing Regulations and State Boards of Nursing
- Boards of Nursing
- Nurse Practice Acts
- Licensure
Chapter 2: New Hampshire State Board of Nursing
- Mission
- Board Meetings
- New Hampshire Board of Nursing Bulletin
Chapter 3: New Hampshire Nurse Practice Act
Chapter 4: New Hampshire Scope of Practice
- Licensed Practical Nurse Scope of Practice
- Registered Nurse Scope of Practice
- Advanced Practice Registered Nurse Scope of Practice
- Scope of Practice Advisories
Chapter 5: Delegation
Chapter 6: New Hampshire Rules and Advisories
- Position Statements and Advisories
Chapter 7: Legal Issues
- Regulatory Agencies and Governing Bodies
- Components of a Complete Physicians Order
- Legal Terms and Applications in Nursing
- Protective Measures for Guarding against Malpractice Lawsuits
Chapter 8: Peripheral Anatomy and Physiology
- The Vascular System: Veins, Arteries and Bone Marrow
- The Three Layers of the Vessels and Their Function
- Differentiating Arteries from Veins
- Veins used in Peripheral Intravenous Therapy for Pediatrics and Adults
- Intraosseous
- Skin: Anatomy and Physiology
Chapter 9: Psychological Needs of the IV Patient
- Age Specific Needs of Children
- Elderly Patient Needs
- Cultural Aspects
- Patients with Sensory Deficits
- Methods of Reducing Patient Anxiety
- Patient Teaching/Education
Chapter 10: Fluid and Electrolyte Balance
- Water: The Primary Fluid of the Body
- Hypovolemia - Dehydration: Assessment, Causes, Treatments
- Hypervolemia - Fluid Overload: Assessment, Causes, Treatments
- Fluid Compartments
- Electrolyte Imbalances: Assessment, Causes, Treatments
Chapter 11: pH, Osmolality, and Incompatibilities of Solutions and Medications
- pH of Intravenous Solutions and Medications
- Tonicity: Isotonic solutions, Hypotonic solutions and Hypertonic Solutions Incompatibilities
Chapter 12: Fluid Regulation
- Methods of Fluid Regulation
- Patient Considerations in Fluid Regulation
- External Factors that Affect the Rate of Flow
- Calculation of IV flow rates
Chapter 13: Infection Prevention and Safety Compliance
- Hand Hygiene
- Sharps Management
- Medical Waste Disposal
- Durable Medical Equipment Disinfection
- Standard Precautions
- Transmission-Based Precautions
Chapter 14: Vascular Visualization
- Trans-illuminator Technology
- Near Infrared Technology
- Ultrasound
Chapter 15: Site Selection and Device Placement
- Criteria for Peripheral Devices
- 3 Types of Peripheral Access And Criteria For Placement
- Special Considerations of The Specific Age Groups
- General Considerations of Short Peripheral Access
- Veins to Avoid
Chapter 16: Vascular Access Device Management
- Needleless Connectors
- Filtration
- Add-on Devices
- VAD Stabilization
- Joint Stabilization
- Site Protection
- Flushing and Locking
- Assessment, Care, and Dressing Changes
- Administration Set Changes
Chapter 17: Peripheral IV Complications
- Local Complications
- Hematoma
- Infiltration
- Extravasation
- Phlebitis
- Site Infection
- Catheter Occlusion
- MARSI
- Nerves and Nerve Damage
- Compartment Syndrome
- Systemic Complications
Chapter 18: Peripheral IV Procedures Guides and Videos
- Pre-insertion Procedures
- Peripheral IV Insertion
- Primary and Secondary Administration set-up
- IV Push Administration
- Catheter Discontinuation
Chapter 19: Peripheral IV Assessment and Documentation
- Catheter Insertion Documentation
- Catheter Removal Documentation
- Assessment, Monitoring and Documentation by Therapy
Chapter 20: Central Line Review
- Definition of a Central line
- Reasons for use of a central line
- Advantages of a central line
- Overview of Central Venous Access Devices
- Lumens
- Non‐valved and valved catheters
- Non‐tunneled catheters
- Tunneled catheters
- Implanted ports
- PICC or Peripherally Inserted Central Catheter
Chapter 21: CVAD Anatomy
- Veins used for placement of central venous access devices
- Catheter tip placement
Chapter 22: Assessment and Preparations for CVADs
- Considerations for selection of the device
- Preparations for central venous catheterization
Chapter 23: CVAD Management
- Needleless Connectors
- Filtration
- Add-On Devices
- CVAD Stabilization
- Site Protection
- Flushing and Locking
- Assessment, Care, and Dressing Changes
- Administration Set Changes
- Blood Sampling from a CVAD
Chapter 24: CVAD Procedure Guides and Videos
- Central venous catheter dressing change
- Needleless access device change
- Central venous catheter flushing
- Blood Sampling from a CVAD
Chapter 25: CVAD Complications
- Catheter-related complications
- Systemic complications
- Insertion-related complications
Chapter 26: Discontinuation of Therapy
- Removal of devices
- Central venous access device removal procedure
Chapter 27: CVAD Assessment, Documentation, and Patient Education
- Documentation of insertions, removal, infiltration or extravasations
- Assessment, monitoring, documentation by type of therapy
Chapter 28: Ports
- Port vs. Other Central Venous Access Devices
- Advantages and Disadvantages
- Indications
Chapter 29: Assessment and Preparations for Implanted Port
- Assessment Criteria for Insertion of an Implanted Port
- Preparations for Implanted Venous Port
Chapter 30: Accessing a Port
- Equipment
- Needle Choice
- Procedure
Chapter 31: De-accessing a Port
Chapter 32: Drawing Blood from a Port
Chapter 33: Port Complications
- Malpositioned catheter
- Reservoir malposition
- Catheter separation
- Catheter occlusion
- Infiltration
- Extravasation
- Site Infection
- Catheter Related Bloodstream Infection (CRBSI) or Septicemia
- Skin breakdown
Chapter 34: CRBSI - Scope of Problem
- Morbidity/mortality
- Cost
- Surveillance
Chapter 35: Catheter Insertion
- Site selection
- Sterile rechnique
- Antimicrobial impregnated catheters
Chapter 36: Catheter Site Maintenance
- Dressing
- Needleless connector
- Observation
Chapter 37: Medication Administration
- Infusate
- Administration Set
- Flushing
Chapter 38: CRBSI Diagnosis and Treatment
- Clinical Findings
- Cultures
- Treatment
Chapter 39: Introduction to IV Push
Chapter 40: IV Push Drugs
Chapter 41: IV Push Medication Administration
Chapter 42: IV Push - Assessment, Education, and Documentation
- Assessment
- Patient education
- Documentation
Chapter 43: Introduction to Extravasation
- Definitions
- Scope of the Problem
- Liability
- Standards of Practice
Chapter 44: Extravasation Prevention
Chapter 45: Vesicant Lists
- Antineoplastic Agents
- Non-cytotoxic Agents
Chapter 46: Extravasation Treatments
Chapter 47: Extravasation Documentation
Chapter 48: Dehydration and Hypodermoclysis
- Scope of Problem
- Contributing Factors
- Signs and Symptoms
- Assessment
Chapter 49: Introduction to Hypodermoclysis
- Advantages
- Disadvantage
- Indications
- Contraindications
- Use in Terminally Ill Patients
Chapter 50: Hypodermoclysis Infusion Parameters
- Sites
- Solutions
- Volume and Rate
- Hyaluronidase
Chapter 51: Hypodermoclysis Administration
Chapter 52: Hypodermoclysis Complications
- Systemic Complications
- Local Complications
Chapter 53: Communication and Documentation
Chapter 54: Introduction to Antifungals
Chapter 55: Polyene Antifungals
- Amphotericin B deoxycholate
- AmBisome®
- Abelcet®
- Amphotec®
Chapter 56: Echinocandins
- Anidulafungin
- Caspofungin
- Micafungin
Chapter 57: Azoles
- Fluconazole
- Itraconazole
- Voriconazole
- Isavuconazole
Chapter 58: Antivirals Introduction
- Mode of viral infection
- History of antiviral treatment
- Antiviral resistance
- Intravenous antiviral administration systems
Chapter 59: Acyclovir
- Indications
- Administration
- Side Effects
Chapter 60: Cidofovir
- Indications
- Administration
- Side Effects
Chapter 61: Foscarnet
- Indications
- Administration
- Side Effects
Chapter 62: Gancyclovir
- Indications
- Administration
- Side Effects
Chapter 63: Zidovudine
- Indications
- Administration
- Side Effects
Chapter 64: Peramivir
- Indications
- Administration
- Side Effects
Chapter 65: Antivirals - Antibiotic Stewardship
- Combination therapy
- New antivirals
- Adoptive Transfer of Virus-Specific T Cells
Chapter 66: Introduction to ß-lactams
- Antibiotic resistance
- Intravenous antibiotic administration systems
- Clostridium difficile
Chapter 67: Penicillins
- First through fourth generation penicillins
- Aztreonam – monobactam
Chapter 68: Carbapenems
- Indications
- Adverse Effects
- Imipenem/Cilastatin
- Meropenem
- Ertapenem
- Imipenem/Cilastatin/Relebactam
Chapter 69: Cephalosporins
- First through fifth generation
- Indications
- Administration
- Adverse Effects
Chapter 70: Introduction to Glycopeptides
- Antibiotic resistance
- Intravenous antibiotic administration systems
- Clostridium difficile
Chapter 71: Vancomycin
- Indications
- Administration
- Side effects
Chapter 72: Daptomycin
- Indications
- Administration
- Side effects
Chapter 73: Televancin
- Indications
- Administration
- Side effects
Chapter 74: Dalbavancin
- Indications
- Administration
- Side effects
Chapter 75: Oritavancin
- Indications
- Administration
- Side effects
Chapter 76: Teicoplanin
- Polymixins
- Peptide Antibiotic Pipeline
Chapter 77: Additional Classifications of Antibiotics
- Antibiotic resistance
- Intravenous antibiotic administration systems
- Clostridium difficile
Chapter 78: Aminoglycosides
- Indications
- Dosing and administration
- Adverse effects
Chapter 79: Fluorquinolones
- Class Adverse Effects
- Ciprofloxicin
- Delafloxacin
- Moxifloxicin
- Levofloxicin
- Clinical Trials
Chapter 80: Licosamides, Macrolides, Oxazolidones, and Streptogramins
- Lincomycin
- Clindamycin
- Azithromycin
- Erythromycin
- Linezolid
- Tedizolid
- Oxazolidone clinical trials
- Quinupristin/dalfopristin
Chapter 81: Tetracyclines
- Doxycycline
- Eravacycline
- Omadacycline
- Tigecycline
- Clinical trials
Chapter 82: Antibiotic Stewardship
- New antibiotic initiative
- Financial challenges
- Clinical pipelines
- Phage therapy
- Nanoparticles
82: References