Table Of Content(c) 2015 Wolters Kluwer. All Rights Reserved.
Core Curriculum
for
Infusion Nursing
FOURTH EDITION
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FOURTH EDITION
Core Curriculum
for
Infusion Nursing
INFUSION NURSES SOCIETY
NORWOOD, MASSACHUSETTS
E D I T O R S
Editor-in-Chief
Mary Alexander, MA, RN, CRNI®, CAE, FAAN
Chief Executive Officer
Infusion Nurses Society
Norwood, MA
Editors
Ann Corrigan, MS, BSN, RN, CRNI®
Customer Account Manager
PackRoom, LLC
Stone Mountain, GA
Lisa A. Gorski, MS, HHCNS-BC, CRNI®, FAAN
Clinical Nurse Specialist
Wheaton Franciscan Home Health & Hospice
Milwaukee, WI
Lynn Phillips, MSN, RN, CRNI®
Professor Emeritus, Butte College
Nursing Education Consultant
Chico, CA
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Acquisitions Editor: Shannon Magee
Developmental Editor: Leslie H. Nicoll
Product Manager: Ashley Fischer
Production Project Manager: Marian Bellus
Design: Holly Reid Mclaughlin
Manufacturing Manager: Beth Welsh
Production Services: Integra Software Services Pvt. Ltd.
Printer: RR Donnelley Asia
4th Edition
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.
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Copyright © 2004, 2000 by Lippincott Williams & Wilkins. All rights reserved. This book is protected by
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textbook. Printed in the United States of America. For information write Lippincott Williams & Wilkins,
530 Walnut Street, Philadelphia, PA 19106.
Materials appearing in this book prepared by individuals as part of their official duties as U.S. G overnment
employees are not covered by the above-mentioned copyright.
9 8 7 6 5 4 3 2 1
Library of Congress Cataloging-in Publication Data
Core curriculum for infusion nursing / Infusion Nurses Society ; editor-in-chief, Mary A lexander ; editors,
Ann Corrigan, Lisa A. Gorski, Lynn Phillips. — Fourth edition.
p. ; cm.
Infusion nursing
Includes bibliographical references and index.
ISBN 978-1-4511-8409-9
I. Alexander, Mary, 1955- editor of compilation. II. Corrigan, Ann, 1948- editor of compilation. III. Gorski,
Lisa A., editor of compilation. IV. Phillips, Lynn Dianne, 1947- editor of compilation. V. Infusion Nurses
Society, issuing body. VI. Title: Infusion nursing.
[DNLM: 1. Infusions, Parenteral—nursing—Outlines. 2. Fluid Therapy—nursing—O utlines. 3. Parenteral
Nutrition—nursing—Outlines. WY 18.2]
RM170
615.8’55—dc23
2013007057
Care has been taken to confirm the accuracy of the information presented and to describe g enerally
accepted practices. However, the authors, editors, and publisher are not r esponsible for errors or omissions
or for any consequences from application of the i nformation in this book and make no warranty, express or
implied, with respect to the content of the publication.
The authors, editors, and publisher have exerted every effort to ensure that drug se lection and dosage set
forth in this text are in accordance with the current recommendations and practice at the time of publication.
However, in view of ongoing research, changes in government regulations, and the constant flow of information
relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any
change in indications and dosage and for added warnings and precautions. This is particularly i mportant when
the recommended agent is a new or infrequently employed drug.
Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA)
clearance for limited use in restricted research settings. It is the responsibility of the health care provider to
ascertain the FDA status of each drug or device planned for use in his or her clinical practice.
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Contributors
Chapter 1: Technical And Clinical Chapter 3: Pharmacology
Application Michelle S. Turner, Pharm. D., BCPS
Mary Alexander, MA, RN, CRNI®, Clinical Pharmacist
CAE, FAAN Cone Health—The Moses H. Cone Memorial
Chief Executive Officer Hospital
Infusion Nurses Society Greensboro, North Carolina
Norwood, Massachusetts
Susan K. Poole, MS, BSN, RN, CRNI®, CNSNCIC
Lisa A. Gorski, MS, HHCNS-BC, Principal
CRNI®, FAAN Southwest Horizons Consulting
Clinical Nurse Specialist Peoria, Arizona
Wheaton Franciscan Home Health &
Hospice
Chapter 4: Infection Prevention
Milwaukee, Wisconsin Mary McGoldrick, MS, RN, CRNI®
Home Care and Hospice Consultant
Ann Corrigan, MS, BSN, RN, CRNI® Home Health Systems, Inc.
Customer Account Manager Saint Simons Island, Georgia
PackRoom, LLC
Stone Mountain, Georgia
Chapter 5: Pediatrics
Darcy Doellman, MSN, RN, CRNI®, VA-BC
Melody Bullock, MS, BSN, RN, CRNI® Vascular Access Nurse
Assistant Director Pediatrics and PICU Cincinnati Children’s Hospital Medical Center
Cone Health System Cincinnati, Ohio
Greensboro, North Carolina
Chapter 6: Transfusion Therapy
Alicia Dickenson, RN, CRNI® Deb Richardson, MS, RN, CNS
Staff Nurse Vascular Access Consultant & Educator
Tuality Healthcare President/Owner—Deb Richardson & Associates
Hillsboro, Oregon Houston, Texas
Ann Earhart, MSN, RN, ACNS-BC, CRNI® Chapter 7: Antineoplastic And Biologic
Clinical Nurse Specialist-Vascular Therapy
Access/Infusion Therapy Lynn M. Czaplewski, MS, RN, ACNS-BC,
Banner Good Samaritan Medical Center CRNI®, AOCNS®
Phoenix, Arizona Oncology Clinical Nurse Specialist
Columbia St. Mary’s Hospital
Chapter 2: Fluid and Electrolyte Milwaukee, Wisconsin
Balance
Lynn Phillips, MSN, RN, CRNI® Cora Vizcarra, MBA, RN, CRNI®
Professor Emeritus, Butte College President/CEO
Nursing Education Consultant MCV & Associates Healthcare, Inc.
Chico, California Indianapolis, Indiana
v
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vi C o n t r i b u t o r s
Chapter 8: Parenteral Nutrition Chapter 9: Quality Improvement
Elizabeth Krzywda, MSN, APNP Grace Fletcher, MSN, RN, CRNI®, CPHQ
Nurse Practitioner Director of Quality Assurance and Regulatory
Medical College of Wisconsin Compliance
Milwaukee, Wisconsin Vital Care, Inc.
Meridian, Mississippi
Doug Meyer, RPh, MBA, BCNSP
Assistant Dean for Student Affairs
and Assistant Professor
Pacific University School of Pharmacy
Hillsboro, Oregon
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Preface
Recognized as the global authority in infusion therapy, the Infusion Nurses Society (INS) is dedi-
cated to exceeding the public’s expectations of excellence by setting the standard for infusion
care. We set the standard by developing and disseminating standards of practice, advancing the
specialty through evidence-based practice and research, and supporting professional certification.
The Core Curriculum for Infusion Nursing is an example of our commitment to education and
certification. It is designed for use as a comprehensive, preparatory resource for clinicians taking
the Certified Registered Nurse Infusion (CRNI®) exam administered through our sister organiza-
tion, the Infusion Nurses Certification Corporation (INCC), and as a framework from which
infusion-related educational programs and courses can be developed. With the current changes
in health care in general and nursing in particular, it is imperative that the information contained
within the Core Curriculum is accurate and current.
Historically, there have been nine major domains of practice identified as content categories.
While the format of this edition of the Core Curriculum still has nine core content areas, INCC
has made two changes. As a result of feedback received from a recent role delineation study, there
will be eight content categories and a new domain “Special Populations” will replace “Pediatrics.”
The Pediatrics category was broadened to reflect the current practice and will be included in the
Special Populations category along with topics related to older adults and pregnancy.
INCC conducts role delineation studies approximately every five years to survey infusion nurs-
es about their practice, and update the examination detailed content outline (DCO) to reflect cur-
rent practice. In the most recent role delineation study, completed in 2012, the Role Delineation
Advisory Committee (RDAC) discussed whether the performance improvement topics and tasks
should remain as a freestanding content category on the outline or be integrated throughout the
outline. On the survey, eight topics were listed within the performance improvement domain, and
those topics were rated by the survey respondents as significant to practice. Following discussion,
the RDAC decided to drop “Performance Improvement” as a separate content category in favor
of including items on performance improvement throughout the DCO to better reflect infusion
nursing practice. Although not listed as a separate domain, the RN Examination Council will
ensure that five to ten percent of the examination will cover performance improvement.
The goal of this revised edition of the Core Curriculum is to provide information related to
new technological advances and the expansion of the specialty practice of infusion nursing. The
information contained in each chapter provides a basis for the development of test questions for
the CRNI® exam. In addition, a bibliography is supplied to provide the nurse with additional
resources. The content of this publication is also suited for those seeking continuing education
and professional development opportunities while providing a broader understanding of the spe-
cialty practice.
Whether it is in preparation to take the CRNI® exam or to expand one’s knowledge base of the
specialty practice, the Core Curriculum for Infusion Nursing is an invaluable resource. Certification,
coupled with life-long learning, will enhance the fundamentals of nursing practice so that compe-
tent clinicians are delivering the safe, efficient, quality care that our patients deserve.
Mary Alexander, MA, RN, CRNI®, CAE, FAAN
Editor-in-Chief
vii
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Acknowledgments
INS recognizes the significance that the certification serves for the specialty practice of infusion
nursing. Hence, providing reliable resources for potential exam candidates is critical for their suc-
cess. Without our clinical editors and contributors, INS would not have been able to revise the
Core Curriculum for Infusion Nursing, 4th edition.
I thank the authors for their thoughtful reviews and revisions. I appreciate their time, commit-
ment, and contributions made to revise this edition of the Core.
I am especially grateful to the Core’s clinical editors, Ann Corrigan, Lisa Gorski, and Lynn Phil-
lips. At every phase of the revision process, they supported each contributor. As accomplished
authors themselves, their knowledge and expertise were invaluable as we completed this project.
Lastly, I thank the Wolters Kluwer Health—Lippincott Wilkins & Wilkins staff for their profes-
sionalism and skill in improving this work. Of note, I’d like to recognize Leslie Nicoll, Develop-
mental Editor, for her assistance with chapter reviews.
Mary Alexander, MA, RN, CRNI®, CAE, FAAN
Editor-in-Chief
ix
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Contents
Contributors v
Preface vii
Acknowledgments ix
1
C H A P T E R
Technical and Clinical Application 1
Mary Alexander, Lisa A. Gorski, Ann Corrigan,
Melody Bullock, Alicia Dickenson, Ann Earhart
2
C H A P T E R
Fluid and Electrolyte Balance 86
Lynn Phillips
3
C H A P T E R
Pharmacology 131
Michelle S. Turner, Susan K. Poole
4
C H A P T E R
Infection Prevention and Control 163
Mary McGoldrick
5
C H A P T E R
Pediatrics 192
Darcy Doellman
6
C H A P T E R
Transfusion Therapy 235
Deb Richardson
7
C H A P T E R
Antineoplastic and Biologic Therapy 258
Lynn M. Czaplewski, Cora Vizcarra
8
C H A P T E R
Parenteral Nutrition 309
Elizabeth Krzywda, Doug Meyer
9
C H A P T E R
Quality Improvement 356
Grace Fletcher
Index 371
xi
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1
C H A P T E R
Technical and Clinical Application
Mary Alexander, MA, RN, CRNI®, CAE, FAAN
Lisa A. Gorski, MS, HHCNS-BC, CRNI®, FAAN
Ann Corrigan, MS, BSN, RN, CRNI®
Melody Bullock, MS, BSN, RN, CRNI®
Alicia Dickenson, RN, CRNI®
Ann Earhart, MSN, RN, ACNS-BC, CRNI®
Part I: Anatomy and Physiology
I. Vascular System
A. Cardiac Circulation
1. Heart
a. A hollow muscular organ made of four chambers that functions as a
two-sided pump
1) Right side is a low-pressure system pumping venous or deoxygenated
blood to the lung
2) Left side is a high-pressure system pumping arterial or oxygenated
blood to systemic circulation
b. Right atrium (RA) is a thin-walled muscle that acts as a receiving chamber
1) It receives systemic venous blood from the superior vena cava (SVC),
which drains blood from the upper part of the body, and from the
inferior vena cava (IVC), which drains blood from the lower extremities
2) It receives blood from myocardial circulation by the coronary sinus
3) Blood flow to RA occurs during inspiration
a) RA pressure drops below the pressure in veins outside the chest
cavity
b) Blood flows from the area of high pressure to the area of low
pressure
c. Right ventricle (RV) is the most anterior chamber of the heart, lying directly
beneath the sternum
1) Functions as both an inflow and an outflow tract
1
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