Extravasation may result in severe patient injuries including scarring, permanent functional impairment, and even loss of a limb. Such injuries are preventable when clinicians identify which medications and solutions are vesicants, understand infusion-related risks, and implement preventative interventions. Vesicant medications and solutions not used in cancer treatment are commonly administered by nonspecialty nurses, often via peripheral intravenous (IV) catheters. There are critical issues and risks especially related to peripheral vesicant administration, increasingly via midline catheters. An INS task force was formed to review and update the 2017 vesicant list, identify current issues and risks relative to vesicant administration, and revise the extravasation prevention checklist.  In this session, the task force, in a panel presentation, will present the updated 2023 vesicant list and discuss critical issues in extravasation prevention.  

Learning Objectives: At the conclusion of this session, participants will be able to:

1. Identify vesicant medications and solutions.
2. Examine issues associated with peripheral vesicant administration.
3. Analyze extravasation prevention strategies.
4. Apply extravasation prevention strategies in their health care organization.

Contact Hours: 1
CRNI® RUs: 2

Phlebitis is one of the most frequent complications related to the use of intravenous catheters. Knowing the variables associated with phlebitis occurrence can contribute to the improvement of processes and patient outcomes. This presentation analyzes variables associated with the occurrence of phlebitis in the clinical-surgical inpatient units of a large, private hospital in Brazil through a case-control observational study. The findings of this study revealed factors that increase the risk of phlebitis and demonstrate how patient education strategies can help reduce its risk.

Learning Objectives: At the conclusion of this session, participants will be able to: 

1. Discuss the incidence and causes of phlebitis.

2. Analyze variables associated with the occurrence of phlebitis. 

3. Implement patient education strategies to lower incidence of phlebitis in high-risk patient populations.

Contact Hours: 1
CRNI® RUs: 2

The bolus or continuous infusion of saline prior to and after medication delivery is a critical requirement of safe IV practice. However, little evidence exists to guide practice, leading to substantial variation in practice and outcome in terms of catheter survival time. This presentation will review the latest published and recently collected unpublished evidence regarding how clinicians flush peripheral intravenous catheters (PIVCs). This evidence will help to improve our understanding of the importance of flushing for 1) the clearance of catheters of drug and thrombotic precipitate and 2) importantly discuss the impact of flushing on the vein, its physiology and risk of thrombosis and thrombophlebitis. This presentation will argue for a balance to be achieved between clearing the catheter without irritating the vein. Evidence-based guidance will be provided in terms of flushing frequency, volume, catheter size and the rate of flushing to complement existing INS Standard of Practice recommendations and identify areas of further study to further inform the guidelines.

Learning Objectives: At the conclusion of this session, participants will be able to: 

1. Discuss why flushing of IV catheters is required and how flushing can remove intracatheter precipitate. 
2. Describe the relationship between catheter size, flushing velocity, and shear stress.
3. Explain how forceful flushing might impact the catheter and the infused vein.
4. Identify the impact of adjusting saline flushing frequency, volume, and rate on PIVC failure and associated thrombosis.
5. Review individual flushing practice in light of the INS Standards of Practice and assess whether individual practice meets the recommendation.
6. Identify practical solutions that can be used to optimize flushing practice.

Contact Hours: 1
CRNI® RUs: 2

Vascular access literature continues to illustrate considerable variation in vascular access practices and outcomes. This variability continues to negatively impact patient safety and health care costs. The root causes for inconsistent practice are challenging, including inconsistent vascular access resources, inadequate competency development, varied product selection, and policies that do not reflect evidence-based guidelines. The nursing executive council of a large health care system approved the creation of a corporate vascular access collaborative composed of vascular access experts across the system. Their priority assignment was development and deployment of a corporate vascular access policy bundle to facilitate standardization of policy and clinical practice. This session will describe the process used to identify current state of vascular access policies, to engage clinicians across the system in policy development, to gain multidisciplinary policy consensus, and to successfully deploy the policy bundle across a large health care system.

Learning Objectives: At the conclusion of this session, participants will be able to:

1. Identify essential components of system-wide vascular access policy development. 
2. Describe processes to promote clinician engagement in creation of a system-wide policy bundle. 
   1. Identify implementation strategies to successfully deploy a corporate vascular access policy bundle across multiple divisions.

Contact Hours: 1
CRNI® RUs: 2

Intravascular catheter infections remain a source of morbidity and mortality in all health care settings. These infections result from microbes entering subcutaneous tissues and/or the bloodstream extraluminally from the skin, intraluminally from catheter hubs/connectors, or less commonly from infusates contaminated at point of care or during product manufacturing. This session will identify strategies to prevent catheter associated bloodstream infections including the 2022 prevention recommendations from the Society for Healthcare Epidemiology of America, the Infectious Disease Society of America, and the Association for Professionals in Infection Control and Epidemiology. 

Learning Objectives: At the conclusion of this session, participants will be able to: 

1. Describe the various sources of catheter-related bloodstream infections.
2. Discuss infection prevention strategies focused on insertion and maintenance of intravascular catheters.
3. Explain antimicrobial lock therapy for the prevention and management of catheter-related infections.

Contact Hours: 1
CRNI® RUs: 2

Patients in our care have varying needs for intravenous (IV) device dressing and securement. Each year, new IV device dressing and securement technology is made available. Many products which are vital to promote optimal IV device performance need to be available in our toolkit. However, choosing what, when, and for whom takes careful consideration and navigation. In this presentation, we will explore the role of these various products available for the variety of indications in which they are used, in accordance evidence-based data.

Learning Objectives: At the conclusion of this session, participants will be able to:

1.   Describe the role of IV dressing and securement technologies to promote optimal IV performance.

2.  Discuss contemporary evolutions and effectiveness of new products, across device and population types.

3.  Apply knowledge gained to both simple and complex presentations in the learners’ health care practice.

Contact Hours: 1
CRNI® RUs: 2

Anemia in the elderly is an often-undiagnosed condition that is associated with increased falls, confusion, dementia, hospitalizations, and mortality. Anemia is most commonly treated via transfusion of red blood cells. Historically, patients residing in skilled nursing facilities (SNFs) requiring transfusions had to be transported via ambulance to either an outpatient transfusion center or an emergency department to receive this care, resulting in disrupted care, increased exposure to nosocomial infections, hospital admission for the patient, and lost revenue and increased health care costs for the SNF. Transfusing red blood cells at the SNF bedside is a viable solution to this problem. This presentation will describe the implementation of a mobile transfusion from its inception to implementation, with initial findings of the service in the first year of operation, including the discussion of several case examples. The goal of the presentation is to make a positive impact on current practice that providing transfusions as the bedside in a SNF is a safe, cost-effective practice that should be considered for the SNF patient with anemia.

Learning Objectives: At the conclusion of this session, participants will be able to: 

1. Describe the process of blood transfusion in the SNF setting. 
2. Describe the costs related to receiving a blood transfusion at the bedside versus the hospital setting. 
3. Describe the most common transfusion reactions.
4. Explain the indications for blood transfusion.
5. Assess a patient for blood transfusion reactions and their response to the transfusion.

Contact Hours: 1
CRNI® RUs: 2

Increases in central line-associated bloodstream infections (CLABSI) infections during the COVID-19 pandemic revealed gaps in processes that were previously considered unalterable. Changes in workflow related to crisis conditions and staffing shortages exposed those gaps, and as a result, new areas in which infection prevention efforts can be focused have been identified. While overseeing infection prevention for a 54-hospital system, the presenter and team gathered data through observations and interviews that were used to drive targeted quality improvement interventions. This session will describe the key process gaps identified and those interventions that proved effective in reducing the gaps and in turn decreasing infection rates.

Learning Objectives: At the conclusion of this session, participants will be able to: 

1. Discuss methods for determining where practice gaps are occurring.
2. Describe three practice gaps for CLABSI that are not typically included in prevention bundles.
3. Describe quality improvement interventions for eliminating identified practice gaps. 

Contact Hours: 1
CRNI® RUs: 2

Estimating CLABSI rates in home infusion therapy is essential in driving patient safety interventions in the home setting. However, until recently, there has not been a validated home infusion CLABSI surveillance definition for use in benchmarking CLABSI rates. Understanding how to implement a validated home infusion CLABSI surveillance definition is an important step in setting and meeting infection prevention goals. This session will describe how to perform CLABSI surveillance in the home infusion setting, and strategies to mitigate common barriers.

Learning Objectives: At the conclusion of this session, participants will be able to: 
1. Describe the elements of the validated home infusion CLABSI surveillance definition.
2. Define secondary bloodstream infections as they apply to home infusion CLABSIs and to home infusion-onset bacteremia.
3. Explain common barriers to home infusion CLABSI surveillance.
4. Discuss ways to access resources to aid in CLABSI surveillance in the home.

Contact Hours: 1
CRNI® RUs: 2

Peripheral intravenous catheter (PIVC) insertion can be difficult, traumatic, and time-consuming in pediatric patients. More than 50% of first-insertion attempts fail and some patients require upwards of 9 attempts. Children who are at the highest risk are those with difficult intravenous access (DIVA), due to physiology, pathology, or damage from previous therapies or catheterization. Early identification of children with DIVA and escalation to an appropriately skilled clinician is vital to improve patient outcomes and insertion success; however, at present, there is a lack of standardized DIVA identification and escalation tools for use in pediatrics. In this session, we will discuss a mixed-methods approach used to develop a DIVA identification and escalation pathway (DIVA Key), as well as tested the utility of ultrasound to improve first-time insertion success.

Learning Objectives: At the conclusion of this session, participants will be able to: 

1. Describe risk factors for PIVC insertion in children.
2. Identify current tools, clinical resources, and technology available to clinicians and current challenges associated with the sustainable implementation of these tools.
3. Describe end-user requirements (including consumers) for difficult intravenous access identification and escalation tools.
4. Discuss the results of a clinical trial, stratified by DIVA risk comparing ultrasound guided PIVC insertion to traditional palpation and visualization in a pediatric tertiary hospital.
5.  Describe potential facilitators and barriers of sustainable implementation of DIVA identification and escalation processes.

Contact Hours: 1
CRNI® RUs: 2