Infusion therapy has become an increasingly valued specialty as invasive administration of medications, blood products, and fluids moves from the inpatient setting to clinics and patients' homes.
"It facilitates the patient being in their home environment, where they are more comfortable, and it's more cost-effective," said CarolAnn Liebold, RN, BSN, CRNI, president of the Metro-Island Chapter of the Infusion Nurses Society of Earlton, New York.
Infusion therapy types
Therapy durations can range from a 15-minute drip to a continuous infusion for total parenteral nutrition. The medication often determines the setting.
"We administer almost anything that can be infused," said Rulijo Legaspi, RN, an infusion nurse at Englewood (New Jersey) Hospital and Medical Center, who enjoys the variety.
Certain drugs are more prone to adverse reactions, such as IV monoclonal antibodies that require administration in an ambulatory center, said Marvin Siegel, RN, CRNI, Director of Clinical Services at Town Total Health in New York, and a national INS board member.
The Infusion Center at Hackensack (New Jersey) University Medical Center frequently administers monoclonal antibodies for rheumatoid arthritis and Crohn's disease. It also treats patients with anemia, infections, lupus, and nephritis, said Mary Lamontagne, RN, CRNI, Director of the Infusion Center at Hackensack.
Debra Tomassetti, RN, Director of RegionCare in Great Neck, New York, part of the North Shore-LIJ Home Care Network, reported her agency's number 1 therapy is administering IV antibiotics to treat infections, followed by chemotherapy and pain management. The nurses also give IV immunoglobulin for patients with immune deficiencies and dobutamine, a life-sustaining drug for heart failure.
In addition, RegionCare infusion nurses manage intrathecal pump therapy, administering antispasmotics for cerebral palsy or multiple sclerosis or opioids for pain management.
At Memorial Sloan-Kettering Cancer Center's new Brooklyn Infusion Center, patients receive chemotherapy and related injections or infusions in a comfortable setting with web access.
The patient meets with the physician the day before in Manhattan. Labs are performed at the main facility, and the drugs are delivered to the satellite facility. Nurses at the center have received training in Reiki and may give patients a treatment or a massage or other relaxation activity during their infusion.
"We also want during treatment to improve patients' quality of life," said Jeanine Gordon, RN, MSN, OCN, ambulatory nurse leader at the Brooklyn Infusion Center, who added the relationships that develop are one of the most rewarding aspects.
Chemotherapy also is the most common treatment at The Children's Hospital at Montefiore's Outpatient Pediatric Hematology/Oncology Clinic, said Joan O'Hanlon Curry, RN, MS, CPNP, CPON, administrative nurse manager of the clinic.
The nurses also administer transfusions, fluids and pain medications to children with sickle cell anemia presenting with a pain crisis; IV antibiotics; and biologic treatments, steroid pulses and other drugs to treat rheumatology patients.
Patients may spend the day at the clinic and then go home with an ambulatory pump in a backpack. Then the patient returns the next morning.
"Everybody sleeps better in their own bed and feels better in their own surroundings," Curry said. "It's a great way to do it. It keeps kids out of the hospital and keeps the family unit as intact as possible."
Infusion nurse Carol Fisher, RN, a research nurse at New York University Medical Center, administers agents to manage genetic lysosomal storage disorders that are in clinical trials.
She said patients and families often prefer coming to the center every two weeks because they do not want their homes to become a treatment center or neighbors to know they have a genetic disease. Infusion sessions may last for hours, providing opportunities to talk, teach, and assess. Fisher says she finds reward in forming relationships.
Dialysis nurses cleanse renal failure patients' blood through infusions, said Linda Hicks, RN, who works for Fresenius Medical Care New Jersey Home Team in Parsippany and teaches patients how to perform home hemodialysis.
"I love watching them take control of their own treatment," Hicks said. "When they go home, they live a different lifestyle. They have more control and feel better."
Required skills
Infusion nurses must be experts in infusion needles and catheters, critical thinking, responding to emergencies, anticipating what could go wrong, and mitigating such issues. The Infusion Nurses Society offers education programs to help nurses keep their skills and knowledge current, and the Infusion Nurses Certification Corp. offers certification in infusion nursing.
RegionCare and Hackensack hire nurses with at least two years of acute care and IV experience.
"It's more than just giving a medicine or changing a dressing," Liebold said. "There's a lot that goes on behind it to understand the type of medication, the disease process, the complications to look for, and the device that's in the patient."
It also takes teamwork, said Madelyn Bromley, RN, OCN, an infusion nurse at Englewood Hospital. "With infusions, anything can happen, patients can have bad reactions," Bromley said. You need your coworker to jump over and help you."
In home care, teaching is the key to success, Siegel added. Nurses may visit weekly to change the dressing and assess the patient and monitor the response to therapy. He also finds that one-on-one patient-nurse relationship satisfying.
Tomassetti agreed. "The most rewarding thing is working with the patients and allowing them to sustain their lives," she said.
