Infusion50

I am so glad to hear that! And please don't stress about your skill level. ALL OF IT will come in time. Be confident in yourself enough in understanding that you at least know when to ask questions and get clarifications. No one expects you to be an expert at this point. The expectation is competence. Then comes proficiency with mastery shortly thereafter. Good luck sister nurse!

It's been a while. Just wondering how you folks are doing in your new roles?

Hi bebe101, Infusion nursing does seem to be a specialty that is difficult to get info on. I think that's because most(but not all) infusion nurses are a subspecialty coming out of oncology. Infusion specific jobs are usually associated with Cancer Centers. Infusion centers are considered Ambulatory Care units ...often on a hospital campus or can be free standing within a hospital network's geographical area so patients have better access. In order to work in one, you need to be chemotherapy certified (through ONS). Many of my nursing colleagues started out on an in-patient oncology unit where they were also required to get chemotherapy certified while on the job. That might be a good place to start. That's where all your valuable experience will originate from. In that role, you will certainly become an expert on all manner of venous access( and troubleshooting them) AND learn how to manage chemotherapy and infusion reactions. Most PICC nurses are infusion nurses with extra training. Both Chemotherapy Certification (ONS website) and PICC Certification are done on-line. While challenging, neither were very difficult. They are time consuming though because they require clinical preceptorships to go along with the on-line stuff. Thats why most infusion centers want you to come in with experience. There is also a professional organization for Infusion only ( INS website). There might be more job info for you there , especially if you become an associate member.

Hi NYRN and BrownLuxe, I see no one has responded so I will give you my 2cents. I've tried 6 different specialties in my 30+ years as an RN and can tell you that Infusion nursing has been my favorite for many reasons. I wish I had discovered it sooner in my career. But I work in an ambulatory infusion center connected to a teaching hospital where I am also a PICC nurse. I can't speak to home infusion specifically, rather Infusion nursing in general. 1)In ambulatory infusion you rarely work beyond 1630, nor holidays or weekends. 2)The pt population is very pleasant in my experience... even though they are suffering with cancer there is much hope and uplifted spirits. It's not depressing at all (which was my initial worry). That's not to say you don't have heartbreaking experiences as in all nursing specialties. 3)You REALLY get to know and enjoy your patients and their families...and they you. They come to see you as more than just their healthcare provider. You develop friendships( even though some maybe short-lived). Many of my patients have been coming to my infusion center for years for some kind of maintenance therapy. You get to celebrate their many milestones (and sometimes their funerals). 4)Continuity of care!! You see pts VERY regularly and get to know their physical assessments inside and out, and can pick up even subtle changes. This makes for better outcomes. 5) You see direct results of your care. A real ego stroke for what is often a thankless profession. 6) You will become an expert at interpretation of lab values. 7) Theres lots of opportunity to enjoy pharmaceutical rep education about the drugs you are giving...often delivered at a very nice restaurant in a relaxed environment. I have learned TONS at these presentations that carry over into other aspects of care. 8) The ONS is a great resource. Be sure to join your local chapter. 9)The advances in oncology care is astounding and fascinating to learn about. 10) There is lots of opportunity to treat conditions other than cancer as well( i.e.IVIG, long term antibiotics, hydration, Rheumatology, phlebotomy, iron infusions). 11) I learned another subspecialty because of my infusion nurse status as well. I was trained to insert PICC lines which I find fun and challenging. Some of my colleagues branched off into Research Nursing as well. Best of all, you don't need to be a BSN for these fields. All of these pluses apply to home infusion as well ( with the exception of weekend call). Good luck and let me know how it's going.

Hello Jenapos, I know its been a while but I was curious about your choice and how you are enjoying your new job. I have experience in both specialties and can say that my Infusion Unit position is one that I love and wished I had explored much earlier in my worklife. Hope you are enjoying your choice as much as I am mine.

Hi there Kindatheart35, I work at an infusion center. When I got the job, they paid the fees for me to take an on-line PICC course through BARD. We use their PICC products. After I completed the on-line course, I then had to spend a few weeks with the PICC team to achieve at least 5 successful PICC insertions independently start to finish. Once that competency was signed off by my preceptor, I was considered a qualified inserter. Then you need to do so many PICC insertions per quarter and/or have an >80% success rate to maintain competency. This all gets recorded in your annual evaluation. The first few days I shadowed and learned how to evaluate a pt, their labs and history. Then, I started poking around arms under guidance. (Learning how to hold the US hand piece steady with my non-dominant hand and inserting the needle while looking at a screen was my biggest challenge... but quickly conquered). It's really pretty easy when it all goes text-book. Once you get the skill down pat, you have to practice your system of setting up the room/patient/sterile kit/charting/charging&billing chores. I do know of people who have paid out of their own pockets for PICC training from an independent PICC education company. It's so expensive that I wouldn't do it.

If any of you are still reading this post, I have another dilemma requiring advice please. I had 2 challenging PICC accesses yesterday on bariatric patients who had TONS of flabby tissue hampering my needle access. What tricks do you use to prevent tissue displacement as you try to needle your vessel? No matter how hard I tried to maintain the basilic vessel in a centered US location, my needle(positioned in a needle guide) somehow ended up off to the side totally missing the vessel altogether! I've gotten pretty good at doing PICCs , but when I have all this extra flabby skin, my success rate dwindles.

Let me put another question out there for all you generous PICC nurses... With the Sherlock Sapiens 3CG technology, do you always place your needle into the needle guide or do you have the best shot free-handing the needle? I was trained to ALWAYS use the needle guide, but wonder if free-handing it is easier for any of you.

Thank you mta1976! Everyone responding to my original question has been so helpful! Just last week, I have employed several tips with great success. The question I have is...How do you know you are near nerves? Using my Sherlock Sapiens 3CG, I can see some white streaks on US. Is this the nerve tissue? Some say yes and some say no. How can you tell for sure?

There was a time I would agree with you IVRUS. But for the purposes of having a "looksee" for a student who won't be doing many Central Line dressings or seeing PICC insertions for a while, it's really not such a bad idea to just see what might be involved. In fact, several of the instructional videos that were shown at a recent hospital vascular access workshop turned up on you tube. Of course this doesn't take the place of hands-on instruction or P&P, and nor did I insinuate that. Also ,many nursing schools upload their instructional videos as well for anyone curious about a procedure. I have 3 daughters in 3 different nursing programs around the east coast and they have all been directed to You Tube among other places to see examples of many procedures.

WOW! I'm a nurse for 30+ yrs and would never agree to that kind of staffing. We are never without 2 RNs in our small infusion center. Usually there is 3 of us. Transfusions are labor intensive. If you have other pts on the floor, you need to monitor THEM for infusion reactions for their meds as well. Dunno how you can possibly do that efficiently without proper staffing. I'd run!

Check out You Tube for TONS of IV insertion demos, PICC management techniques and central line dressings. You will be surprised by how informative they can be. Many of them are produced by nursing schools.

I agree with you IVRUS, however, I have a hard time getting docs to order that. When they do, I only get 1mg out of them which doesn't really do the trick for many of my pts. Have you found that? When they do order for you, how many mgs of Ativan do you usually see written for?

Thank you to everyone who has responded.You all have generously provided a wonderful compilation of tips that could not be found anywhere else! I will be sharing this thread and checking in regularly for anything new.

Thank you VascularNurse! I will definitely give that one a try! It makes perfect sense to use gravity to help the line drop. About midlines.....I always wondered what folks are talking about when they say to use the PICC as a midline. I have never learned to insert midlines and understand that it is a completely different kit with a much shorter catheter. If you used a PICC line as a midline, wouldn't there be a large amount of exposed catheter coiled up under the dressing? Not a good idea. What am I missing? Our hospital never uses midlines.

Yes , I agree Ellie. I use blankets and towels to cushion and immobilize the arm. Sometimes my pts can't outward rotate or extend their arms all the way though...makes things a lot more challenging.

Thank you ILUVIVT! When I need to do the time-out and drape the pt, I use the call bell to get someone in the room and make then stay until that process is done (they often leave the room at this point.) Then I keep the call bell hidden under the sterile drape in case I need to get them back to help with repositioning. NOT the ideal , I know, but its all I've got to work with....believe me, I've tried to change this to no avail! Still working on it! Anyway, I am interested in your positioning technique. Just to clarify... you are advancing the catheter WHILE the pt is doing this arm rotation palm up, then palm down? Or are you trying one way, then if not successful, retrying the other way? I'm trying to get an idea of how fluid of a motion this is?

Thanks Ellie, I will definitely give that a try. I have hyperextended the arm a bit before but never to the extent you mentioned. It makes sense though.

Thank you so much for the quick response IVRUS!!! I misspoke regarding the axilla thing..... I meant to write PICC catheter. When you have the patient tuck their chin in, do you also have them turn their head toward you? I was taught to have the pt lie flat without a pillow but have found more success when they keep their pillow. Maybe because that's like a mini chin tuck. Also , do you ever use a cope wire, and if so, under what circumstance?

To all the experienced PICC nurses out there...Will you please share your tried and true tricks of the trade for getting your PICC tip pass the axilla and also to drop down toward the CAJ? I've been doing PICCs for about 1 yr now. I only have approximately 50 under my belt with a 90% success rate. Unlike many PICC nurses who go out with an assistant to the bedside, I am alone in the procedure. I am trying to get more efficient and faster in my placements (which take me about 1.5 hours soup to nuts), but because I am alone, finessing the tip to go where I want it is sometimes a challenge and therefore extremely time-consuming. Sometimes I have to break sterility to remove a pillow or help the pt reposition an arm. Then re-don new sterile gloves to continue (I always have at least 3 pair open and ready to go). My biggest challenges have been 1)unable to thread guide wire passed the axilla with both basilic and cephalic veins and 2) getting the tip to drop down toward the heart instead up the neck. Sometimes I've used cope wires with variant success. On several occassions, I have had to send puts to IR. I would appreciate any advice you may have regarding any of these issues. Soon I will be expected to precept another nurse who will also be going solo so I thought you all would be a great resource. Anyone out there doing this solo? If so, how long does it take you start to finish (from room set-up, assessment and clean-up to charting)?

Nurses smoking weed? Why? How does it benefit anyone let alone nurses (not talking about medical marijuana here)? Certainly we've been educated about healthier measures to relax and de-stress. Let's use our expertise to "nurse" ourselves.

I have recently changed my specialty at age 50 and absolutely LOVE it! I took a part-time position in a small infusion center. As an ADN with previous experience in ICU/CCU/NICU/Homecare, it was still difficult finding positions in my area teaching hospitals which prefer BSNs. However, infusion centers really value nurses with IV skills which is the reason I was hired. Within six months, the hospital trained me to do PICC insertions and I obtained my Chemo/Biotherapy certification on-line. At first I was really anxious about mastering all these new skills and pharmacology.....but I can tell you that old dogs really can learn new tricks. Infusion environments are intimate ones and you have the opportunity to develop mutually satisfying relationships with your patients as many of their regimens are months or years in length. Our infusion center has almost a family atmosphere. I only wish I had found this specialty earlier in my career. Its never boring and there is always something new to learn. The work is stimulating without being overly stressful (as long as staffing is adequate) and not physically taxing. The ONS is a very active and social professional association that offers tons of program dinners and educational activities. I plan to get my OCN this year (one of the few certifications that don't require a BSN) and finish out my career in Infusion. Home infusion is also in high demand. Its just an all around versatile specialty with many job openings. My only caveat would be to only work in an infusion center that does NOT mix their own chemo. Mercifully, our pharmacists do all that dirty work for us.

Thank you soooo much for those pointers HMarie!!! Your tip about being careful with the probe pressure was especially helpful. I have had about 10 successful inserts so far. But for several times I could not advance the wire even though I SWORE I was in the middle with great blood return, I never considered the probe pressure issue. It all makes sense now!

Allentown, Pa area...New RNs approx $24/Hr. 10-15yrs experience as a hospital RN is approx $27-$30/Hr. Those floor nurses in my circle who have >30 yrs full time work are only at about $33-$35/ hr but have almost 8 weeks of PTO. They tell me that administrations seem to always look for excuses to get rid of those nurses..... it's really hard for a hospital floor to accommodate that kind of time off if they are lucky enough to have several seasoned nurses. Also, these nurses are usually maxed out in pay which wreaks havoc on unit budgets in these days of institutional cuts and "right-sizing". There seems to be a trend to utilize lower level caregivers to do the hands-on care while the BSNs are doing more supervising&managing along with their assessment responsibilities. As for me, I prefer hands-on care...not managing others. My ADN has served me well as I make the same $ as my BSN counter parts...but I am 50 and work mostly per diem or part time jobs ( which makes me quite disposable). I have encouraged my own daughters ( who are in nursing school now) to go the BSN route. In this part of the country, teaching hospitals will rarely hire a full time nurse without a BSN.

Same here IVRUS....6 month wait for inserting on the ipsilateral side. However, in the pt I did last week, the pacer was 3 days old and the cardiologist still cleared me to insert PICC , but on the contralateral side. I still ran into probs dropping the line as we kept bumping into the subclavian central line already in place. It was quite the learning experience. LOL