Air Embolisms and IV Therapy

Although the chances of an air embolism occurring is rare, it is still a significant potential side effect during infusion therapy. An air embolism occurs when an air bubble or group of air bubbles enter a vein or artery and block the normal flow of blood. Air embolisms can travel throughout the body and cause severe cardiovascular and pulmonary issues.

Several of the common causes for air embolism include:

• Infusion lines that are not properly filled and completely vented.
• Errors occurring during the execution of a pressure infusion.
• Accidentally during specific surgical interventions that require the opening of the vascular system (neurosurgical, vascular, obstetric, gynecological, orthopedic, etc.)
• During parallel infusions (gravity infusions and infusion pumps).
• Air entering through open IV access and infusion systems. This can be influenced by the position of the vein and patient with respect to the right side of the heart.
• Non Intravenous/ non health care oriented causes include cases of scuba diving and rare cases involving orogenital sex during pregnancy.

Regardless of how they occur, an Air Embolism is a serious complication that can endanger the well being of a patient and add significant costs to any form of patient care. The best way strategy of handling air embolisms is prevention. Several key preventive strategies are listed below:

• When a peripheral cannula is inserted, the risk of air embolism can be reduced by ensuring that the selected arm of the patient is kept below the level of the heart during the insertion or removal procedure.
• The supine or Trendelenburg position is ideal for the insertion of a central venous catheter.
• The use of Luer-Lock connections can minimize the potential for the accidental disconnection of administration sets and syringes from intravenous catheters.

The above listed items are in no way all inclusive. For a detailed and evidence based discussion of air embolisms in the clinical setting it is advisable for nursing teams to seek out continuing education on the topic. There are several excellent sources of nursing continuing education available online and it is crucial for health care providers to stay up to date on the latest evidence based practices.

The Growing Luxury World of Vitamin IV Therapy

Within the last 4 years the growth of “party IVs”, Vitamin IVs, and other forms of alternative IV therapies has been tremendous. Across the United States, swanky luxury clinics have opened up across California, Nevada, Arizona and Florida. Many other practitioners in other states have also added vitamin IVs to their menu of additional infusion solutions.

 

Although the main stream Vitamin IV phenomenon in the US and Canada are relatively new, Vitamin IV drips have been offered throughout Europe and Asia for years now. The movement within the United States can be traced back to the late Dr. Myers and his work throughout the mid-60s and 70s.

 

Dr. Myers designed and administered a unique solution of vitamins and minerals which would later become known as the Myers’ Cocktail (or simply the Myers). Dr. Myers would administer the solution to patients of his who suffered from a variety of chronic issues such as migraines, fatigue, depression, etc..

 

Even though there are few clinical trials investigating the efficacy of the Myers cocktail, the number of ardent supporters of the infusion are significant. Many regular patients claimed that without the infusion, their symptoms would return quickly. Recognizing this need, entrepreneurial clinicians quickly began to satisfy these needs across the nation.

 

Recently, practitioners have expanded their offering to include high dose Vitamin C infusions (used in a variety of situations), and other targeted infusions to create a health living sort of appeal Thus, clinic owners have begun to appeal to athletes, mothers, the elderly, etc. as potential clients. The clinics themselves are now built to resemble luxury spas and high end retreats, and the costs of the infusions have increased tremendously. In certain cities (Miami and Las Vegas), there are practitioners who offer Vitamin IV therapies straight to hotel rooms, to homes, or even on a schedule bus or shuttle. In these cities which have traditionally been associated with partying and heavy drinking, practitioners are capitalizing on both the healthy living and the hangover cure aspects of their infusions.

 

Celebrities and athletes are now frequent patients and public interest seems to be continuously increasing. As such, health care providers have begun to receive more and more inquiries into the safety of said infusions. Unfortunately, the amount of available online continuing education courses for nurses on this subject is minimal and there is a great deal of conflicting messages on this point. Moving forward, both nurses and physicians will need to be able to communicate the benefits and potential complications of vitamin IV therapy to their interested patient populations.

Forensic Nursing within the United States

Forensic nursing is commonly defined as the application of the forensic aspects of health care combined with the bio/psycho/social education of the registered nurse in the scientific investigation and treatment of trauma and/or death of victims and perpetrators of violence, criminal activity, and traumatic accidents. Although forensic nursing is often associated with sexual assault investigations, it is truly a diverse field. Forensic nurses can be found at nearly all points where health care and legal systems interact (correctional nursing, death investigations, trauma nursing, etc.). Programs within the United States have been operating since the mid-70s, and it was in 1995 that the American Nurses Association formally recognized forensic nursing as a specialty in the US.

Interestingly, of all the medical professionals that prosecutors may come into contact with, forensic nurses can be extremely beneficial expert witnesses. Forensic nurses often have extensive experience with victims of violence and can help address crucial issues such as delayed reporting and ranges of trauma reactions.

Many states across the nation have begun to change their requirements in regards to Forensic Nurse presence. This is especially significant in states that have large rural populations and large distances between major cities. Texas for example, which has a high number of cities that are over 200 miles from a major medical center, recently enacted a Senate Bill requiring all hospitals to have medical personnel trained in basic forensic evidence collection. The purpose of this bill was to reduce situations in which a rural patient entered an emergency room, was treated for injuries, and then was referred 100+ miles away to have evidence collected.

A detailed report of the overall impact within Texas rural communities is not yet available, but the current belief is that the bill will have a positive effect for rural patients. To help in the effort, the Texas state nursing Board, recently instituted specific continuing education requirements in regards to Forensic Nursing nursing CE. The point being to introduce all nurses to the skill set and to thus drive interest in the materials.

Homeopathy in a Glance

Homeopathy is easily on of the most interesting and polarizing topics facing modern medicine today. Practitioners and supporters continually profess their belief in the efficacy of their system while detractors point towards the complete lack of scientific evidence supporting any of the popular claims. Despite the arguments of both sides, homeopathy as an industry has grown to become a multi-billion dollar international industry. So, what is homeopathy?

 

Homeopathy originated in Germany approximately 200 years ago and is centered on two key tenets. These are:

 

• Like cures Like – This is the idea that a disease or symptom can be cured by a substance that produces similar symptoms in normally healthy people.
• The law of minimum dose – The idea that the lower the dose of a specific medication, the greater its effectiveness.

 

The idea of “like cures like” is similar to the idea of modern vaccinations. Vaccines contain dead or weakened parts of a specific virus that help to stimulate your body’s immune response in order to fight the disease and protect against future infections. Of particular concern to conventional medicine is the “law of minimum dose”. The vast majority of homeopathic medicines are diluted and diluted in the attempt to gain greater levels of potency. Most commonly prescribed items are thus so completely diluted that they cannot be distinguished.

 

The issue though is that there have been very few large scale well organized studies that have resulted in homeopathic medicine being more effective than a placebo medication. Further, the homeopathic community has remained stringently opposed to the traditional medical community and in many cases is hostile to outside questioning or concern.

Since, in essence, most homeopathic “medicines” contain very little active ingredients they are regulated for sale by the Food and Drug Association under specific Homeopathic regulations and often require a prescription from a homeopathic practitioner. Recently, there has been a push by homeopathic practitioners to recommend special homeopathic vaccines to their patients. The Center for Disease Control and Prevention recommends that parents utilize traditional vaccination measures, as the homeopathic vaccines have not been proven effective in any clinical trials.

 

For health care providers, it is important to by aware that patients may be utilizing these treatment options in place of conventional medicine. In recent years, there have been an upsurgence of homeopathic treatment solutions that claim to either prevent or cure different forms of cancer. Again, there is no actual clinical evidence supporting these claims and patients should be wary of any practitioners making claims such as this.

 

Health care providers must stay up to date on the most recent evidence regarding complementary and alternative medicine. The popularity of which has grown tremendously and many patients are seeking out ways in which they can incorporate complementary and alternative cancer therapies with their conventional treatment programs.

Illegal Drug Use among Emergency Department Patients

The use of illegal drugs is a major issue for health care providers around the world. Drug use has been associated with cardiovascular disease, HIV/AIDS, and a wide range of health related issues. Further, it is believed that current drug users underutilize preventative and regular medical care and over utilize hospital and emergency room care.

It is estimated that approximately 9.2% of the United States’ population have used some form of illegal drugs within the past month. Within the health care system, it is estimated that over 6.5% of all patient attendances are either directly or indirectly related to illegal drug use. In 2011, over 5 million of the 125 million general emergency room visits can be considered drug related. These numbers have increased steadily and represent a 100% increase in relation to the 2004 numbers.

Of particular concern is the sharp increase in emergency department visits involving the non-medical use of pharmaceuticals (Over the counter, prescription, and dietary supplements). Within the past ten years the amount of emergency room visits related to non-medical usage of pharmaceuticals increased by over 95%. The most commonly reported drugs involved were hydrocodone, alprazolam, and oxycodone. Each of those three drugs reported increases of over 100% in reported emergency room visits.

The only other “traditional illegal drug” to have increases in emergency room visits by over 100% is ecstasy. Which has seen a tremendous resurgence in both attributable emergency room visits and popular culture.

Another key driver of emergency room visits related to illegal drug use is the combination of alcohol and other drugs. Alcohol combinations are most commonly linked with the non-medical pharmaceuticals listed earlier, cocaine, heroin, and marijuana. In 2009, approximately 32% of all drug abuse emergency room visits involved the use of alcohol alone or in combination with another drug.

For health care providers it is important to understand the ramifications of drug abuse throughout the United States health care system. Further, it is important for health care providers to be knowledgeable in regards to the referral options and additional follow-up support options that are available within your organization and community in the event that a patient requests additional help in detoxification and helping with drug addiction. For many, emergency room visits present a valuable intervention point where the health care team can inform the patient about the risks associated with continuing drug abuse behaviors.

Looking At Illegal Drug Use and America’s Emergency Departments

Around the world, illegal drug use continues to remain a burden to health care systems. Drug abuse is associated with increases in the risks of cardiovascular disease, HIV and AIDS, and a wide range of other health related issues. Further, it is believed that current drug users under utilize preventative and regular medical care and over utilize hospital and emergency room care.

 

It is estimated that approximately 9.2% of the United States’ population have used some form of illegal drugs within the past month. Within the health care system, it is believed that over 6.5% of all patient attendances are either directly or indirectly associated with illegal drug abuse. In 2011, over 5 million of the 125 million general emergency room visits can be considered drug related. The 2011 numbers represent a 100% increase when compared to 2004 levels.

 

Of particular concern is the sharp increase in emergency department visits involving the nonmedical use of pharmaceuticals (Over the counter, prescription, and dietary supplements). This segment of drug abuse has increased by over 95% in the last ten years (the single largest gain of any one drug category). The three most commonly abused drugs that lead to emergency room visits are: hydrocodone, oxycodone, and alprazolam. Each of those three drugs reported increases of over 100% in reported emergency room visits.

 

The only other “traditional illegal drug” to have increases in emergency room visits by over 100% is ecstasy. Which has seen a tremendous resurgence in both attributable emergency room visits and popular culture.

 

Alcohol and alcohol use in combination with other illegal drugs continue to be significant drivers of emergency room visits. Alcohol combinations are most commonly linked with the non-medical pharmaceuticals listed earlier, cocaine, heroin, and marijuana. In 2009, approximately 32% of all drug abuse emergency room visits involved the use of alcohol alone or in combination with another drug.

 

For health care providers it is important to understand the ramifications of drug abuse throughout the United States health care system. It is crucial for health care providers to be knowledgeable in regards to the options available for either follow up care or addiction and detoxification services. Many communities and organizations have well-structured addiction support systems. For many, emergency room visits present a valuable nursing intervention point where the health care team can inform the patient about the risks associated with continuing drug abuse behaviors.

A Crucial Skill – Infusion Nursing

Gaining access to a vein, venous access, is a critical skill necessary for basic patient care in both the hospital and ambulatory patient settings. There are several different forms of Venous Access Devices and today we will briefly examine each of the different devices and their uses or contraindications.

 

Peripheral IV – These are the traditional IVs that come to mind. They are ideal for short-term access (no more than 72 hours in the same site).. The majority of short term situational needs can be meet with a conventional PIV line. Veins can be accessed on the hand, arm, or even foot.

 

Peripherally Inserted Central Catheters – PICC’s are commonly inserted in either the basilic, brachial, or cephalic veins and many facilities utilize skilled nursing teams to insert them. Common uses for these insertions are for repeated blood transfusions, parenteral delivery of nutrition, antibiotics, analgesics, and chemotherapy.

 

Centrally Inserted Catheters – The three main types are listed below:

 

Non-Tunneled Catheters – used for short term time frames in an emergency department, operating room, or intensive care unit.

 

Skin-Tunneled Catheters – Used in situations where the catheter will need to stay inserted for longer period of time. Regular infusions of medication or blood are potential examples. Again, skilled staff and protective measures are needed for successful insertion.

 

Implantable ports – A much more technically complex device, consists of a catheter attached to a reservoir that is implanted into a surgically created pocket on the chest wall. These devices are expensive, difficult to insert, and time consuming to remove.

 

It is important to note that there are no “infection or complication proof” venous access devices. Each process runs the risk of complications and it is absolutely crucial that nursing teams are familiar with the different forms of complications and that they are able to educate the patient and family as well. Educating patients is another important factor – patients who are educated about potential complications are better positioned to identify issues earlier.

 

IV insertions and infusions are among the most common hospital procedures performed in health care facilities around the world. Despite their regularity of use, it is essential for health care providers to consistently seek out the most current evidence based IV therapy information in order to provide consistently high levels of patient care.

 

Even though there are a number of online IV therapy CE providers, real world bedside training of nurses remains the key. Regular training consisting of evidence based material reviews and practical hands-on learning are essential to maintaining an evidence based nursing culture.

Complementary and Alternative Medicine: Acupuncture

Within the past ten years there has been an increase in the amount of both new acupuncture practices and patients. The practice itself is 1,000s of years old and originates in China and ancient Chinese medicine. It has come to recent prominence due to a variety of western studies illustrating the potential benefits in reducing Cancer treatment related vomiting and nausea.

In the past, the only large clinical studies investigating Acupuncture were based in China and overwhelmingly positive. So much so that western clinicians began to dismiss these due to the discovery that the Chinese medical community was censoring and disregarding negative side effects, data, and outcomes.

The most promising study results have been in relation to acupuncture treatment and cancer care. Studies found that for patients undergoing chemotherapy or radiation therapy acupuncture was effective in reducing vomiting after care.

The majority of the side effects or issues have been caused by either unsanitary practices (dirty needles or environment) or poorly trained practitioners. Recently, the Food and Drug Administration recognized the Acupuncture needle as a medical device and regulates its sanitary practices as such (single use, sanitary needles).

Complementary and Alternative medicine is a difficult topic for many health care providers. For many patients, the belief and expectations of the effectiveness of the practice may exceed the clinically proven evidence. Further, specific Complementary and Alternative Medicines (CAM) may encompass spiritual or cultural beliefs that may be difficult for many health care providers to describe objectively. In all, complementary and alternative medical practices are growing in popularity and can be a beneficial part of a patient’s medical care.

Nurse Sensitive Indicators: What Are They and How You Can Use Them

The idea of quality improvement has become synonymous with the classic image of a hard-nosed businessman. For many, words like driving quality, QI initiatives, and focusing on quality seem like tired phrases commonly spoken once a year in an annual meeting. However, for nurses, improving “quality” means improving the level of patient care and safety. That is something that has to be done each and every day.

Although most nurses focus on providing the best care that they can, it helps to measure the frequency at which trouble issues occur. Let’s imagine that we are working within a surgical unit and that we would like to reduce the number of unnecessary patient falls. In order to “reduce a number” we first have to understand what the current number is.

This is where nurse sensitive indicators come into play. They are simply a way of measuring and monitoring the “numbers” that you are trying to reduce or improve. Nursing sensitive indicators are especially powerful in that they are easy to communicate and can be understood by all levels of an organization.

Looking at the example above, if we know the amount of patients (per every 100 or 1,000) patients that fall within a unit we can then begin to examine why the patients are falling. From that point we can then begin to investigate different nursing interventions that may be able to help reduce the current number.

There is tremendous variety in the amount of available nurse sensitive indicators. They can examine every facet of nursing care with the overall goal of improving the levels of patient care and safety.

What Do All of the Different CE Terms Mean?

One of the most common questions about online education for nurses is about the difference between CE, CEU, and CNE. This is a source of confusion for both new nurses and experienced professionals and the goal here is to clear this up once and for all.

 

Many online providers use these terms interchangeably and without concern for their meaning. It is true that each of these terms is referring to continuing education in some way; however they all mean something slightly different. The definitions are listed below:

 

CE – This is the basic abbreviation for the term continuing education. It is not referring to any units of time or measurement, rather it is simply classifying the type of material concerned.

 

CEU – This is the abbreviation for continuing education unit and is perhaps the most misunderstood item in online education. Traditionally, this refers to 10 hours of material. However, it is common to see course descriptions such as, “This course is worth 2 CEUs”. Now, this description would literally mean that the course is worth 20 contact hours, but it is often used incorrectly to describe a 2 hour course. Most state nursing boards are now pushing for the elimination of the term CEU due to the amount of confusion that it has caused. As a good rule of thumb – be sure that any provider you interact with has outlined the courses in the amount of hours (preferably contact hours) and that you know exactly what you will be taking

 

Brief Note On Contact Hours – The term contact hours is the preferred way to describe a unit of continuing education. It refers to 60 minutes of learning material. Normally, when referring to the length of a continuing education course the amount of hours are referred to as contact hours. An example would be: “This course is worth 2 contact hours”.

 

CNE – This common abbreviation refers to Continuing Nursing Education. It is a general term that does not refer to any sort of unit of measurement. Providers should ideally identify their courses as CNE when they are providing continuing education designed for nurses. This can help avoid confusion for doctors and other medical professionals.

 

In the end, each of these terms have their own distinct definitions and uses. The online world has created a diverse range of continuing education options for nurses and a basic knowledge of these differing abbreviations can help an individual better search through the array of online options.