2023 INSider March/April

INS BOARD OF DIRECTORS 2023-2024

PRESIDENT

Inez Nichols, DNP, FNP-BC, CRNI®, VA-BC

PRESIDENTIAL ADVISOR

Sue Weaver, PhD, RN, CRNI®, NEA-BC

SECRETARY/TREASURER

Joan Couden, BSN, RN, CRNI®

DIRECTORS-AT LARGE

Nancy Bowles, MHA, RN, OCN®, CRNI®, NEA-BC, CPC, CHONC

Pamela McIntyre, MSN, RN, CRNI®, IgCN, OCN®

PUBLIC MEMBER

Lisa M. Ong, CPA, PCC

CHIEF EXECUTIVE OFFICER

Mary Alexander, MA, RN, CRNI®, CAE, FAAN

FUSION NURSES SOCIETY

INS STAFF

Chief Executive Officer: Mary Alexander, MA, RN, CRNI®, CAE, FAAN

Executive Vice President: Chris Hunt

Director of Operations and Member Services: Maria Connors, CAE

Director of Publications and Educational Design: Dawn Berndt, DNP, RN, CRNI®

Marketing Manager: Whitney Wilkins Hall

Editorial Production Coordinator: Rachel King

Associate Managing Editor: Donna Knauss

Director of Clinical Education: Marlene Steinheiser, PhD, RN, CRNI®

Education and Member Services Project Manager: Jill Cavanaugh

Meetings Manager: Meghan Trupiano, CMP

Certification Administrator: Darlene Leuschke

Member Services Associate: Susan Richberg

Bookkeeper: Cheryl Sylvia

INSider encourages the submission of articles, press releases, and other materials for editorial consideration, which are subject to editing and/or condensation. Such submissions do not guarantee publication. If you are interested in contributing to INSider, please contact the INS Publications Department. Photos become the property of INSider; return requests must be in writing. INSider is an official bimonthly publication of the Infusion Nurses Society.

©2023 Infusion Nurses Society, Inc. All rights reserved.

For information contact: INS Publications Department One Edgewater Drive, Suite 209 Norwood, MA 02062

(781) 702-5908

rachel.king@ins1.org

In this Issue

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23

Too Much of a Good Thing: Could Excessive Flushing of Vascular Access Devices Be Detrimental? by Andrew Bulmer, PhD

Leadership Award Winner

Deborah Prinzo, MSN, RN, MEDSURG- BC

Celebrate 50 Years of INS at the Annual Meeting

Welcome New INS Members Domestic and International

Celebrating Mary Alexander INS Learning Center Webinars and Podcasts

Celebrating Mary Alexander

Mary Alexander, MA, RN, CRNI®, CAE, FAAN, has served as the chief executive officer of the Infusion Nurses Society (INS) and the Infusion Nurses Certification Corporation (INCC) for 26 years, from 1997 to 2023. As CEO, she has been responsible for the management of an international, nonprofit specialty nursing organization of 5,000 members and for providing the consistent delivery of the highest-quality education and professional services. She has had the honor and privilege to travel nationally and internationally promoting the specialty practice of infusion nursing and INS as well as teaching best practices and the application of Infusion Therapy Standards of Practice (the Standards). As INCC’s CEO, Mary has overseen the Certified Registered Nurse Infusion (CRNI®) certification program, including accreditations by the American Board of Specialty Nursing Certification (ABSNC) and the National Commission for Certifying Agencies (NCCA).

Mary received her nursing diploma from Massachusetts General Hospital School of Nursing in 1976, her Bachelor of Science in Health Care Administration from Emmanuel College in Boston, Massachusetts in 2000, and her Master of Arts in Business Administration from Framingham State College in Framingham, Massachusetts in 2005. She became an INS member in the late 1970s while working in infusion therapy in the acute care and home care settings, and immediately entered INS leadership at the local level. In 1985, Mary received her CRNI® in the very first class; in 1992, the same year she began her national involvement, she was named the INS Member of the Year; from 1992-1994, she served as the INS secretary/treasurer; and in 1996-1997, right before she became CEO, Mary served as the INS president. In 2005, she achieved the Certified Association Executive (CAE) designation from the American Society of Association Executives, and in 2008, she was inducted as a Fellow of the American Academy of Nursing. As someone who has strongly supported the importance of both achieving and maintaining certifications, Mary has always led by example, keeping her CAE and CRNI® up to date: her CRNI® has never lapsed since 1985, and she is currently recertified for over two years beyond the date of her retirement.

For over 25 years, Mary has been the editor of the Journal of Infusion Nursing, the scientific, research-based, peer-reviewed publication of the Infusion Nurses Society, and has written an editorial for each issue. Mary has served as an editor of INS’ textbook, Infusion Therapy: An Evidence-Based Approach, and as one of the editors for the 2nd, 3rd, and 4th editions of Core Curriculum for Infusion Nursing. She has been involved with the Standards revisions since 1998. Other examples of her numerous publications include chapters in Anatomy of Writing for Publication for Nurses and Nursing Without Borders: Values, Wisdom, Success Markers. In 2002 and 2011, she was part of a team to revise the CDC Guidelines for the Prevention of Intravascular Catheter-Related Infections.

Mary’s leadership roles have been many and various, including the American Board of Nursing Specialties (ABNS), Global Education Development Institute (GEDI), New England Society of Association Executives (NESAE), Nursing Organizations Alliance (NOA), and Nurses on Boards Coalition (NOBC), and she has been invited to serve on numerous expert panels and advisory boards.

For over 45 years, Mary has worked in the field of infusion therapy, starting at the bedside in her home state and eventually traveling the world promoting her passion for infusion nursing and the impact it has on the patients we serve. Clinicians and patients across the globe owe Mary a debt of gratitude for her contributions and dedicated service to the Infusion Nurses Society and INCC.

Mary truly cares about everyone she meets associated with INS. She sent a personal sympathy card to me when my dad died in 2020. I didn’t get that from my employer.

Denise Harper, member

I have only met Mary in the last year as a new public board member. She warmly welcomed me and patiently answered all of my questions. I appreciated how she verified that I had all the information I needed to feel prepared and able to contribute to meetings. I see how inclusive she leads to welcoming all voices. I regret not having a chance to work with her longer. Her leadership legacy is beloved by the INS members and staff.

Lisa M. Ong, member

I met Mary in the early 1990s when I was what she called “a baby nurse.” She was right—I had only been a nurse for about 4 years. My first impression of Mary was how professional and knowledgeable she was. She and a couple other key INS members inspired me to earn my CRNI® in 1991. I continued as an INS member while advancing in my nursing career, and when Mary became the INS CEO, I connected with her while attending many INS meetings. Mary watched both my career and life unfold—I even attended a fall INS meeting just days before I delivered my second child. My association with and admiration for INS and Mary created clinical confidence as I moved through my career as a clinical nurse, educator, manager, and clinical consultant in various practice settings: skilled nursing, acute care, home infusion, the Arizona Board of Nursing, and prelicensure nursing education. The INS Standards of Practice guided me in my roles and policy development. At my PhD dissertation defense, Mary was in the virtual audience to listen and support. When the position as the director of clinical education for INS was posted, I applied and received it, knowing it would be my dream to work with Mary and the organization. For me, Mary has been synonymous with INS: I have truly enjoyed my professional journey with her and will miss her guidance and expertise.

Marlene Steinheiser, staff member

When I was a very new employee, less than one month on the job, much to my surprise I received a handwritten birthday card from Mary. It made me smile and realize what a caring person she is!

Darlene Leuschke, staff member

Mary, I have always admired your leadership: you are a great ambassador for the INS, professional yet friendly and open! One of my most treasured memories is coincidentally running into you in London and having dinner at the Dorchester with you and Beth Fabian. Enjoy your retirement. I hope you are still golfing! It is an honor to know you!

Anne Marie Frey, member

I will best remember Mary as a compassionate leader, someone who uses her head and heart to inspire and influence people so they can, in turn, inspire and influence others. Mary never failed to remember and acknowledge those around her, whether it was a birthday or simply to commend them on their contributions to the organization. She is kind and thoughtful to others, and always finds ways to show her gratitude. Mary recognizes that every team member is a significant individual who is essential to the success of an organization. She uses empathy to connect with employees to bring out their best work while also boosting their morale. To me, this was one of Mary’s greatest contributions to INS.

Cheryl Sylvia, staff member

I have only worked for Mary for 2 years now, but in that time I have truly enjoyed working with and getting to know her. As a leader, I respect how she commands respect from her peers but is humble about all of her successes. She is kind and authentic to everyone she meets and can engage with an audience like she has known them forever. That is something that always impresses me about Mary! I admire Mary for her attention to detail, especially with editing. As our CEO, she was authentic, trustworthy, and reliable, and I am grateful for the opportunity to have worked for her.

Whitney Hall, staff member

Mary, you have exemplified the true heart of a leader, the guidance of a mentor, and the compassion and sincerity of a friend. It’s seldom that we have the privilege to work alongside one who has not only steadfastly led a mission but helped others capture the same vision. Your unwavering commitment to the Infusion Nurses Society is remarkable, and your commitment to individuals is even more exemplary. Your thoughtfulness, kindness, and concern for others defines your tenure as the leader of a great organization. Thank you for your dedication and leadership.

Dawn Berndt, staff member

When I joined the board of directors, Mary made me feel welcome and made sure I was in the loop as far as procedures, etiquette, and the finer points of representing our organization. Her experience combined with her manner of engagement allowed me to feel a part of the team early on. I am grateful for having been able to observe and work alongside her for a relatively short period of time, and will benefit from her wisdom for years going forward. Congratulations on your well-earned retirement, Mary!

Pamela McIntyre, member

When my first novel was published, Mary purchased a copy for each staff and board member. This thoughtful gesture made me feel as though she saw me as someone who existed outside of the workplace, and I appreciated that recognition of dignity. I will also remember her for her graciousness and precision.

Rachel King, staff member

Mary, Congratulations on your upcoming retirement! It’s hard to believe that 26 years has passed so quickly, but then I’m sure there are probably times when it seems like it has been much longer ��.

There have been many changes since 1997 but the constant that remains is INS’ success and its position as the voice for infusion nursing. INS owes much of its success to your leadership and direction. We have gone from a mostly domestic organization that offered 2 face-to-face meetings each year to an international leader offering hundreds of virtual education programs and resources used throughout the world. You are synonymous with INS and have represented the organization extremely well throughout your career. To borrow a phrase from the old EF Hutton commercials, “when Mary Alexander talks, people listen.”

On a personal note, I want to thank you for everything you have done for me and my career. It has been a pleasure working with you for these many years, carrying out my role as your “sidekick” as you worked the room filled with your many friends, colleagues, and admirers!

In all seriousness, I learned a great deal from you and appreciate your guidance, your support, and your friendship. Enjoy and be well.

Chris Hunt, staff member

Mary makes the best chocolate chip cookies ever!

Denise Dreher, member

It has been an honor and pleasure to work with Mary Alexander. Mary has inspired me in many ways, but mostly by her belief in the value of education and certification. Mary truly walks the walk of the INS and INCC missions. When Mary stepped into the CEO role 25 years ago, she chose to educate herself further, earning a graduate business degree and becoming a certified association executive (CAE), not only for personal goals but to ensure that she would better both organizations. Inspired by her pursuit of higher education, I found the courage to go back to school to earn my MBA—later in life, like Mary, but certainly never too late! I also followed in Mary’s footsteps to earn my CAE, wanting, like her, to learn the complexities of the association industry.

Though Mary will be missed around the office on a daily basis, the legacy she leaves behind will live on through those of us lucky enough to have been inspired by such a strong role model, mentor, and leader.

Maria Connors, staff member

I am proud to call Mary my friend and colleague. I have known Mary her entire infusion career. She epitomizes the true meaning of leadership and dedication. INS is fortunate to have had Mary lead its membership for the past 25 outstanding years, both nationally and internationally. Mary, I wish you the very best in your well-deserved retirement. Thank you for all you have done for INS.

Nancy Delisio, past president

I have had the privilege of working with Mary as a past board of directors’ member and a past president. Mary has led the INS/INCC organizations successfully over the past 25 years by prioritizing the growth and well-being of the members, the staff, and the organizations. She is a recognized leader globally and as such has been instrumental in INS/INCC being recognized as the global leader in infusion therapy. Her attention to detail with staff and the many volunteers (board members, committee members, etc.) makes each person feel that they make a difference in their commitment to their role within the organizations.

Mary, thank you for your leadership and friendship over the years and congratulations on your next great adventure—retirement! Enjoy.

Angie Sims, past president

Sue Weaver, past president

I met Mary 35 years ago when she was a board liaison for a volunteer committee I was in. At that time she was still working nights as an IV nurse but was always available anytime we needed her advice. She was a very personable, friendly, knowledgeable, and supportive advisor. We remained colleagues and saw each other at INS annual meetings, and occasionally in volunteer INS committee meetings. But it was during my term as president and board member of INS that I got to spend quality time with Mary. The CEO designation didn’t change Mary; she is still that personable, friendly, knowledgeable, supportive advisor I met years ago. It is not easy to be a president of a large nursing organization and hold down a full-time job, but with her guidance and support, I successfully completed my presidential term. It was a pleasure working with her, and I am honored to call her a friend. Thank you Mary for everything you’ve done for INS; for your hard work, dedication, and enthusiasm for our specialty; and for your friendship throughout the years. Enjoy retirement. You will be greatly missed!

Cora Vizcarra, past president

The highlight of my career was serving INS as president from 2019-2020 and working with Mary to lead INS through the pandemic. Mary’s mentorship instilled confidence in me to be a strong leader, and Mary’s guidance was instrumental in my personal growth and development. She taught me I could be a leader in my workplace, in a bedside position.

In addition, Mary is one of the most thoughtful people I have ever met. She is so kind and caring toward all who meet her. She remembers birthdays and holidays by sending cards with personal notes. Mary’s influence and mentoring are beyond words. I am so grateful I served INS with her.

Lynn Deutsch, past president

Mary, I obtained my CRNI credentials in 2007. Although I have not met you personally, I wanted to take this opportunity to say thank you for all the opportunities you have given infusion nurses across the globe. Your sacrifice and dedication to our field is highly appreciated! Blessings to you as you retire from this great work.

Roland Lee Fisher, member

I have known Mary for over 20 years. Her incredible dedication and leadership to INS has made all of us stronger clinicians and leaders ourselves. Cheers to Mary for all that she has done over the years.

Kathy Puglise, past president

I knew of Mary Alexander since obtaining my CRNI in 1991; however, my personal relationship with Mary began in 2006 when I received the CRNI Nurse of the Year. We continued to get acquainted from 2007-2011 when I was on the INCC Board of Directors and when I was INS president 2017-2018. I believe every person who has served with INS has gotten to know Mary in a very personal way. Mary is hands-down the most flexible and relationship-building leader ever.

I remember being anxious about becoming the president because I was following in the footsteps of incredible past presidents I had admired for years. Mary was able to calm my fears by saying, “Pamela, the key is really to just be yourself ” Mary always seems to know the right thing to say at the right time. She has become friends with her colleagues and even into retirement, I expect Mary will maintain life-long friendships.

I am thankful to have worked with Mary. She is the best

Pamela Jacobs, past president

Mary Alexander is the epitome of a great nursing leader. Her love for INS and the people we serve is unrivaled. Over the years, I’ve watched her mentor, challenge, and nurture a multitude of board members, staff, CRNI applicants, vendors, and members. She always knows just the right thing to say or do to bring about the most positive outcome for everyone involved. She’s the first to reach out when any of her colleagues have personal losses or celebrations. She’s kind, smart, and intuitive. INS as an organization owes her a great deal of gratitude, and we as her colleagues will miss her in a multitude of ways—many of which are hard to describe.

Britt Meyer, past president

Mary, on your retirement, thank you for INS opportunities you provided me over the years, especially the Standards Committee! I value you as a friend as well as a colleague, and I know we will continue to stay in touch. I will never forget our trips to China—while having the opportunity to educate about the INS Standards, we had a lot of fun: long flights, very fast drivers (while you calmly read a book, I was convinced we would die in a car crash on our way to the Shanghai airport at 90 plus miles per hour), interesting dinners, wonderful entertainment, and many glasses of wine! It was a pleasure to serve as INS president and INCC Chairperson; I value my work with you and INS as the most important in my career. I wish you the greatest happiness and contentment in retirement

Lisa Gorski, past president

Mary, for 25 years I’ve watched you take the reins of a small professional organization and lead it into greatness! Thank you for your tireless efforts and work to support infusion nursing and the professionals who practice it daily! Many blessings for your retirement! See you in Boston!

Laurie Crozier, member

Mary is truly an example of an excellent leader! With dignity and honor, she represented infusion nursing and all nurses well. She is respected by nursing leaders all over the world. She always did what was in the best interest of INS. She elevated our specialty to great heights among other nursing specialties.

Mary is a true friend. In all the years that I have known her, she remains caring, friendly, and beautiful inside and out. She taught me how to become a better leader, how to run board meetings, how to get a point across without offending, and how to stand proud for nursing. Mary leaves a legacy of having been an example to so many leaders. We are proud of you, Mary. Thank you for who you are and for what you have been to us all. We are forever grateful.

Brenda Dugger, past president

I have had the privilege of working with Mary as a partner to advance awareness and importance of vascular access across the globe. The authority and passion she brings to every speaking engagement and activity is overwhelming. Seeing clinicians around the globe learn and ultimately provide better care to their patients through interactions with Mary and INS has been a great thing to be a part of. Mary has the ability to make everyone in the room (even a virtual room!) feel seen and appreciated and ignites others with her same passion to drive optimal outcomes for their patients.

Shannon Hillyer, member

I had the privilege of hiring Mary twice to the Intravenous Therapy Team at Massachusetts General Hospital. During her work time at MGH, she became interested in being a CRNI and the rest of her career is history. She was a role model in sharing her pursuit of high standards of care, expertise, and dedication to this specialty. Her work with INS to advance the practice in so many ways is exemplary. I wish her a wonderful retirement.

Susan Y. Pauley, past president

Mary, it has been an honor and a privilege to work alongside you, and to call you a friend.

From the beginning, I knew that you had what it would take to lead the association forward, and you proved me right. When I think back to our meeting with the late Charlie Boone and others, I realize how far you have come. You quickly transferred your leadership skills from elected official to chief executive officer of the Infusion Nurses Society, the Infusion Nurses Certification Corporation, and the Gardner Foundation. In the process, you obtained both baccalaureate and master’s degrees in an 8-year period, obtained your CAE and FAAN (for which it was a pleasure to nominate you).

As a board member of the Global Education Development Institute, you were an ambassador and a trusted colleague, and you earned the respect of our growing global community.

Your most significant contribution has been steering us in the right direction as a society, and a profession and giving infusion nurses across the globe a voice!

Congratulations on a stellar career, one in which you put INS on the map, and congratulations in the next chapter in your life. Your someday has arrived. Enjoy it!

Sharon M. Weinstein, past president

Mary is the quintessential leader. She listens, thinks, acts, shares. Mary is always open to talking about what is new and exciting but also what is tried and true. Mary has bridged gaps in practice and always encouraged growth. She will be sorely missed but the mark she has made on the field of infusion nursing is indelible!

Judith LaJoie, member

I have been an infusion/vascular access nurse for just a short time. Mary Alexander’s name is stuck in my mind. Her name stands out in books, articles, studies, etc., including the sought-out Infusion Therapy Standards of Practice. During her tenure, she practiced and acknowledged such a wealth of knowledge and information. Maybe our path will cross one day. I wish her good luck.

Mary Jean Ramirez, member

Mary has made a huge difference at INS, shaped the future of the profession, and made a positive and safe difference in our patients’ experiences as well as positive outcomes.

Lynn Razzano, member

Mary and I go way back to our earlier days as IV nurses at Mass General, working nights. We covered our assigned units until around 4 a.m., when we would meet on one of the many units for that last cup of coffee before completing our final responsibilities before the next shift.

One morning, one of the nurses asked us to restart a peripheral device before we left. So I moved toward the patient's room while Mary was chatting with a friend. While I was waking the patient and educating the patient about the reason I was there, Mary peeked around the curtain to inquire whether I needed assistance. The patient immediately questioned, “Is this a mother-daughter act?” I giggled when Mary responded, “Which of us is the mother?” Naturally, my response was “Be careful! I’m the one with the IV catheter in my hand!” Mary roared with laughter until the patient looked at me and answered, “Why darling, you must be the beautiful young daughter!”

Of course, I readily agreed!

It was always great fun working with Mary Alexander. Her quick wit and ready humor were always evident. In addition, her compassion and dedication to her family and friends were exemplary. Who knew that when she won her election as president-elect, she would become the CEO of the Infusion Nurses Society?

PS. Just don't ask her how to make a hamburger!

Deborah Barrio Belisle, member

Mary, Congratulations on a job well done. Thanks for your leadership all these years! Enjoy your retirement!

Sandy Maney, member

The Infusion Nurses Society’s Standards of Practice were well-known to me as an oncology nurse. Every new edition was purchased and annotated for relevant changes to policies, procedures, and answers to questions at the different medical centers where I worked over the years. Through a mutual colleague, I was introduced to Mary Alexander. I was in awe of the person behind the Standards; luckily Mary filled in the silence of my being speechless! Since then, I’ve been privileged to enjoy a professional collaboration and friendship over many years.

I’ve admired Mary as a passionate voice for patients and nurses. She has advocated, and pushed, for patient safety, effective treatments, and quality care. Equally, Mary is focused on providing professional development opportunities and evidence-based practice knowledge that support nurses’ and other clinicians’ expertise. Through her leadership of the Infusion Nurses Society and Infusion Nurses Certification Corporation, Mary has advanced the practice of infusion therapy for nurses and clinicians worldwide. Mary’s energy, enthusiasm, expertise, and community are inspiring!

If you have the chance at the meeting, say hi to Mary and enjoy her warmth, Boston accent, and wicked good humor!

Mary Hagle, member

Mary has always been amazing at networking for the benefit of INS and infusion nurses. Nursing, medical, and pharmacy professional organizations know our work because of Mary’s extensive and skillful efforts. Her influence extends to governmental agencies and many others. Her involvement and efforts on the part of infusion nurses everywhere has been phenomenal. Many thanks and happy retirement.

Lynn Hadaway, member

Mary, thank you for your steadfast leadership and advocacy for infusion therapy.Your vision has been key to making INS a global presence in the field. And thank you for your support of so many infusion experts over the years, allowing us to expand our knowledge and abilities through volunteerism in INS endeavors. Congratulations on your well-earned retirement.

Barb Nickel, member

Mom, as you retire, we just want to remind you how proud we’ve always been of you and the work you do. You’ve set the example for us right from the start. You inspire us still, and you always will. As you celebrate, I hope you’re feeling incredibly proud, and also very loved from all. We look forward to all the excitement to come with the grandkids and granddog. Happy Retirement.

Rob Alexander and Corey Alexander, children

Mary, congratulations on your well-deserved retirement. I have been with you from the time you graduated nursing school and worked at Mass General on white 6 surgical floor to the time you decided you wanted to be on the IV team at Mass General. I could see how much you enjoyed being on the IV team. You decided to help improve the experience of IV nurses and you joined the Massachusetts Infusion chapter of NITA You worked your way up to chair of the local chapter, then made a decision to continue to the national level. Your excitement grew. Each time you took on more responsibilities until you became president of INS.You continued to demonstrate your love for IV therapy alongside your dedication to INS. When the position of CEO of INS opened, you naturally jumped at the opportunity to take on more responsibility. That was 25 years ago, and you have enjoyed every minute leading the way for infusion therapy. The time has come for you to pass on the torch of leadership, and now you can look forward to fully enjoying the rewards that you have earned with your hard work and dedication.

May the years ahead be filled with happiness and joy. I look forward to our new adventures together. Happy retirement!

Brad Alexander, spouse

Too Much of a Good Thing: Could Excessive Flushing of Vascular Access Devices Be Detrimental?

by Andrew Bulmer, PhD

Have you ever wondered why peripherally or centrally inserted vascular catheters fail? Try to think back to a catheter that you worked with that failed. It might be yesterday, last week, or perhaps last month. The rate of vascular access device failure is surprisingly high, with about 50% of peripherally inserted devices failing within 48 hours of insertion. Having to replace these devices costs time, delays procedures, and can cause pain and discomfort to patients; therefore, we should do everything in our power to preserve their function. Of course, we can improve the function of these devices only by reflecting on our own practice, attending conferences, and reading published studies that study these problems.

In this article, I’d like share a little information about flushing. Before we jump to the conclusion that I’m talking about toilet habits, I’d like to clarify: I’m referring to the testing and clearing of vascular access devices with saline (usually). When was the last time you actively thought about your flushing practice, either during, before, or after the act of this procedure? In my conversations with clinicians, often the answer is “I don’t think about it.” I then ask, “Why do we need to flush devices?” If you answer “to keep the catheter from blocking” or “to flush out any precipitate or blood clots,” you would be right. I then ask, “How do you flush?” How clinicians flush devices is about as variable as the weather in my hometown of the Gold Coast in Australia. Sometimes it’s blustery, other times calm; ultimately it is highly unpredictable. This got me thinking: why don’t we have better definitions/procedures regarding how to flush or devices that help us flush appropriately? Well, the answer to this question is probably 2-fold. Firstly, there is very little relevant data to guide our practice: very few people have

studied flushing, and therefore we can’t set explicit guidelines. Secondly, it’s likely that we simply don’t see it as being important— or perhaps not as important as infection prevention, the insertion process, etc.— so we just don’t think about it.

I believe how we flush devices is very important. I’m not only referring to the clearing of the device (which is clearly beneficial): evidence now suggests that the simple act of flushing a device with saline, or more accurately how we flush a device, could contribute very importantly to their failure. Yes, just to clarify, how we flush devices could lead to vascular access devices failing. How did we come to this conclusion?

Colleagues of mine recently published some intriguing data. Together, four studies demonstrate that about 60-80% of PIVCs have small thrombi in front of the device tips within 4-24 hours. We have shown that these clots develop about 1 cm (a quarter inch) in front of the device tip. These clots develop even when medications are not delivered—when just saline is used, for example—which reduces the likelihood that chemical injury is to blame. Furthermore, clots develop in patients on medical/surgical wards, in emergency departments, and even in healthy participants in my lab. These data suggest that the cause of these clots is common in all studies. What is common across all sites? Well, every participant had a cannula inserted, every device was maintained (at the least) with saline, and obviously, all individuals were human, whose bodies respond to injury/irritation by clotting. So what could be the cause of this irritation/injury leading to clots forming near

Region of shear force applied to a simulated blood vessel and calculated according to computational fluid dynamics. Note that the area 2 to 7 mm in front of the catheter is impacted Reference: The mechanistic causes of peripheral intravenous catheter failure based on a parametric computational study - PMC (nih.gov)

Too Much of a Good Thing:

Could Excessive Flushing of Vascular Access Devices Be Detrimental?

the catheter tip? We don’t think it’s the catheter itself—the clots are too far in front of the tip for local abrasion to be responsible. The chemicals infused are an unlikely culprit because, as I’ve stated, our studies show clots develop when only saline is infused. Therefore, we believe that the simple act of infusing saline could be responsible. But how could infusing saline cause blood clots?

This brings me to the garden hose analogy. Keep in mind that when we flush saline through a PICC or PIVC, we are pushing saline through the catheter tip, a very, very small tube. Depending on the catheter gauge, these tubes can have inner diameters of about 1.2 mm to 0.65 mm—only about 15 human hairs across. Now imagine trying to push fluid through that hole. Even if you flush slowly, such as 5 mL of saline in 5 seconds, that results in saline shooting out of the catheter at a very fast rate. Let’s take flushing 1mL/sec through a 22G catheter. The velocity of the saline jet that comes from the tip equals 12.5 km/hr (about 8 miles/hr). So if you are standing still, think about the speed of someone running past you at a reasonable speed (not jogging, but not sprinting). Now think about turning on a garden hose. Once you open the nozzle fully (like a wide bore catheter), think about what happens if you gently tighten the nozzle/make it narrower: water must exit faster and shoot out faster. A similar process occurs when you flush an 18G versus a 22G device. The 22G device is much narrower, meaning that when you push the same rate of saline through the two devices, fluid must exit the 22G device faster. The speed actually increases very rapidly as the gauge increases. Now let’s imagine the practical impact of water (or saline) on structures like the vein wall. Recall that water in a stream can move rocks along it. Alternatively, if you have ever been water skiing and experienced falling off at speed, the force of the water moving along your skin pulls it back and can injure/tear it. Similarly, the movement of saline along the inner

surface of blood vessels can pull the protective coating (called the glycocalyx) or endothelial cells off the surface. This instantly begins the process of clotting to protect the area.

At this stage, we don’t know what the “safe” flushing speed is to prevent injury/clotting. There are a few steps to complete before we can answer this question. First of all, we have to measure how fast clinicians are flushing devices. If you would like to know how fast you flush, I will be running a study at INS 2023 in which you can participate. Then, we will conduct a study where we program pumps to flush at low, normal, and high flushing rates (across the range of clinician flushing rates), to understand what rate thrombosis is induced in healthy volunteers. When we identify the critical rate, this information will be published and will help to inform the INS Infusion Therapy Standards of Practice and device manufacturers so that we can always practice safe flushing, prevent thrombosis, and keep precious vascular access devices working!

If you have found this article interesting, please attend my presentation at the INS 2023 annual meeting in Boston. If you have interest in volunteering in my practical, hands-on study at INS 2023, please keep a look out for the registration email in the coming weeks.

Dr. Andrew Bulmer is the colead of the AVATAR group in Australia and has been cannulating research participants for 12 years. Dr. Bulmer’s group has developed unique human cannulation experiments, coupled with blood analysis and ultrasound to track clot formation, which helps his group understand the causes of blood clot formation and catheter failure. Dr. Bulmer uses his experience in teaching and research to graphically demonstrate the causes of catheter failure using videos and pictures in his presentations, which help clinicians to improve practice and the patient experience. He looks forward to meeting you at INS 2023 in Boston!

Deborah Prinzo, MSN, RN, MEDSURG- BC, a nurse manager, was nominated by Sue Weaver, PhD, RN, CRNI, NEA-BC, a nurse scientist.

Deb Prinzo advocates for the infusion nursing specialty by ensuring organizational policies and procedures (P&P) are based on the current INS Infusion Therapy Standards of Practice, conducting research related to infusion therapy, presenting at INS conferences, and encouraging membership in INS. As chair of the organizational Vascular Access Device (VAD) Committee, Deb standardized practices at 10 hospitals, creating system-wide P&P on infusion therapy based on the INS Infusion Therapy Standards of Practice

Deb is an authentic nurse leader who is trustworthy, reliable, and has a genuine desire to serve others. Each year on IV Nurse Day, Deb recognizes her staff with gifts and a celebration of their passion for infusion therapy. A nurse on her team said that she ensures their equipment and policies are always up to the latest standards. Deb is also a resource to the nursing education team as a subject matter expert on all aspects of vascular access care.

With patient safety as her primary focus, Deb demonstrates her passion about the care and maintenance of VADs and the prevention of central line bloodstream infection (CLABSIs) throughout the organization by her dedication to the evidence-based practice. Deb is asked by all disciplines throughout the network to review their practices related to patients with VADs. At the hospital level, Deb reports daily at the safety huddle the results of the vascular access teams rounds on all patients with central lines.

Creating system-wide policy and procedures on infusion therapy from policy and procedures at 10 different hospitals was a challenge, particularly because much variation existed in the policies and equipment at these hospitals, but under Deb’s leadership, the VAD Committee created system-wide policy and procedures and standardized practices. A recent challenge was the use of an extended dwell peripheral IV catheter. Deb convened the VAD Committee to update the policy and procedures and provide education about the different peripheral IV catheters.

Deb presented a poster on infusion therapy at the Kean University Research Symposium, and also presented at the 2019 INS Annual Meeting, sharing her experience transitioning from chest radiographic confirmation of PICC placement to Sherlock 3CG® Tip Confirmation System. Most recently, Deb is conducting a study on infusion therapy during the COVID-19 pandemic and will be presenting the results at the 2023 INS Annual Meeting in Boston.

INS Leadership Award Winner

Deborah Prinzo, MSN, RN, MEDSURG- BC

Celebrate 50 Years of INS at the Annual Meeting

INS 2023 is being held at the Sheraton Boston Hotel from April 1-4. The location is not a coincidence: Boston is the home of the Infusion Nurses Society as well as where it was founded 50 years ago. In addition to the high-quality education, we will be celebrating all the successes, achievements, and patient care that the association and its members have accomplished over these 50 years.

On Sunday, April 2, a 50th Anniversary Celebration of Excellence is planned, and all meeting attendees are invited to celebrate retiring INS CEO Mary Alexander and the 50 years of INS with dinner and dancing.

As we reminisce about the past 50 years, we need input from our members. If you have any memorabilia from previous meetings, please bring it to INS 2023 in Boston. We will be giving out prizes to attendees who have the most vintage INS item. Examples include a registration bag, a shirt, a notepad, a brochure, or anything from one of our earliest meetings in the 1970s. We are looking forward to sharing all the memorable moments over the past 50 years with all of you!

If you attended or know someone who attended the very first INS Annual Meeting in 1973, please reach out to Meghan Trupiano, INS meetings manager, at meghan.trupiano@ins1.org. We would love to hear from you.

Education

The INS Education Department along with the National Council of Education (NCOE) works diligently to create the agenda for each meeting. INS 2023 is not an exception, and will provide high-quality educational content from some of the top infusion therapy experts from all over the world. This meeting will include 40 US-based speakers and 12 international speakers from Australia, Brazil, Canada, and Ireland. Each speaker will share their passion, knowledge, and expertise at INS 2023.

veINS track

We have developed sessions devoted to an important aspect of infusion therapy, the vasculature. Without diligent care of our patients’ vasculature, supported by knowledge of the evidence, clinicians cannot safely provide infusion therapy solutions or medications. These selected sessions will provide attendees with evidence from the experts pertaining to vascular access, intravascular infections, vascular access device (VAD) selection, VAD bundles, the impact of vesicant administration upon the vasculature, the significance of flushing, and much more. Speakers from around the world will share their research endeavors and disseminate their findings aimed at improving the care of our patients’ vasculature. Join us for these sessions to learn more about this important aspect of the care we provide for our patients.

Alternative Setting Track

You said it and we listened! Many of you work in alternative care settings, such as home infusion, outpatient clinics, and skilled nursing facilities. We have dedicated a track of sessions that specifically focuses on care provided in alternative care settings. While many other sessions will have integrated considerations for care of patients outside of the acute care setting, these dedicated sessions are being presented by experts in care areas outside of the hospital. Join these sessions to learn more about various disease states, vascular access care, and complication management in alternative care settings.

1973-2023

Sponsored Educational Programs

Partnership has been critical to the success of INS over the past 50 years, which is why we continue to enhance our sponsored educational offerings at the annual meeting. At INS 2023 we are offering symposia, partner presentations, and a preconference workshop.

Symposia occur each day in a general session atmosphere. The sponsor can control the speaker and the content of the presentation and there are no other meeting activities going on at this time. CRNI®s will receive 2 CRNI®s recertification units.

Partner Presentations are on Saturday, April 1 from 2:45-3:45 pm and 4:00-5:00 pm. The sponsor will present twice, which allows the presentation to occur for two different audiences. These presentations will occur simultaneously with other sponsored sessions. CRNI® will receive 2 CRNI® recertification units.

Not only will you be able to hear directly from our partners, but they will also be available in the exhibition — which is looking to be sold out for INS 2023!

Preconference Workshop

Right Line Right Now. Presented by Teleflex Clinical and Medical Affairs.

If you plan to arrive early, we welcome you to participate in the preconference workshop on Friday, March 31 from 1:00-5:00 pm. sponsored by Teleflex.

This 4-hour workshop provides small group, hands-on learning with clinical experts to advance infusion therapy practice in various care settings. During this workshop, you will explore vascular access options for patients with urgent, emergent, and long-term access needs. You will learn how to select the right device for each clinical situation using the latest innovations in both intraosseous (IO) and intravenous access. Additionally, you will explore anatomical characteristics of the vasculature using ultrasound guidance during vascular access procedures. At the conclusion of this workshop, you will be able to articulate best practices for determining infusion access choice (vascular or IO), for insertion, for care and management, and for device salvage.

This workshop requires a separate registration fee and is limited to 48 participants. Don’t delay. Secure your ticket today!

Can’t make it to Boston? We have a virtual option for you!

By registering for INS 2023: The Virtual Conference you have the ability to attend 15 select sessions virtually and on-demand from April 3-4. For CRNI®s, this adds up to 30 recertification units (RUs) and is a great alternative for those who are not able to attend the in-person event.

For more information on this option or to register, click here!

PreConference Right Line, Right Now

Friday, March 31 1:00 –5:00 PM

This 4-hour workshop provides small group, hands-on learning with clinical experts to advance infusion therapy practice in various care settings. Register at: bit.ly/3GJhxXL

Presented by Teleflex Clinical and Medical Af fairs

Welcome New Members!

DOMESTIC MEMBERS

Amber Anderson

Marianne Armil

Amy Austin

Alicia Awwiller

Verlyn Babila

Cheryl Balderson

Sharleen Bauer

Lindee Becknell

Jennifer Blackburn

Jordan Bobsin

Heather Borjan

Heidi Boyd

Lynne Brophy

Diane Buonagurio

Lynn Burkhalter

Dorothea Bushay-Marta

Eriselda Bushi

Alison Buttram

Sheryl Caddy

Sandra Campbell

John Carslake

Monica Cass

Wipaporn Chaiarm

Merlyne Chandler

Stasia Clark

Cynthia Cole

Eva Coody

Kelly Coward

Anita Crespin

Niki Crocker

Karen Cruz

Karin Csora

Brenda Cunningham

Isabella Dao

Cherie Davis

Elizabeth De la Torre

Brandie del Valle

Courtney DeTore

Afi Amen Emenyo Detti

Erin Devlin

LaDeana Diver

Maria Duenas

Terry Edwards

Martha Eitelman

Taylor Eldore

Dusty Eldridge

Barbara Elkins

Viella Evans

Alexa Evans

Melissa Feracho

Jessica Fortuna

Angela Frame

Jennifer Galvin

Michael Ganger

Kalpana Gharia

Alex Goodman

Taylor Goulding

Eric Grundmann

Ann Hadfield

Spencer Harbuck

Amanda Hardt

Andrea Harrup

Amy Harvill

Wisti Holland

Heather Holleran

Jaclyn Jackson

Lara Johns

Christine Johnson

Julie Jones

Kim Jorgenson

Francis Jose

Stacey Kelland

Donna Kenny

Barbara Keys

Anna Kinyon

Donna Knauss

Joleen Knight

Destiny Koncel

Brittani Krueger

M Eleanor Kruter

Joy Kurihara

Jennifer Latoza

Shelly Lawrence

Suhyun Lee

Hyang Ju Lee

Allison Leonard

Stephanie Lewis

Deanna Lindgren

Lori Lynn

Shauni MacLean

Karen Magatagan

Luann Majeed

Robin Malara

Rachael Mann

INFUSION NURSES SOCIETY

Mart Neil Maravillas

Gianna Marchitellli

Julie McIntire

Michelle McPherson

Caroline Meeks

Jane Miller

Joyce Miller

Kierra Moore

Danielle Morgan

Ann Murphy

Kasie Myers

Joseph Napalan

Veronica Navarro

Tresslyn Neff

Clare Nelson

Hong Nguyen

Christie Nichols

Jessica Nowoslawski

Kellie O’Flaherty

Richard Pacitti

Margie Padapat-DeMarco

Erin Palombo

Karyn Peña

Charity H Pennywell

Jamie Perrin

Ann Petcavage

Kristen Piteck

Mary Plemons

Bryan Powlus

Sarah Pruner

Tabitha Rahmann

Ann Rand

Alisha Reakoff

Kathleen Reilly

Lucinda Ridder

Herman Riggs

Robert Rivera

Katherine Robbins

Jeremy Rocha

Shekinah Roe

Katrina Rosaroso

Allison Rose

Karen Sawyer

Stephanie Schuyler

Jamicia Scott

Colleen Seeber-Combs

Cammy Sharp

Lisa Marie Silva

Charlotte Slusher

Michelle Sohol

Stephanie Speers

Kristy Stadler

Angela Sterling

Colette Stoodley

Sarah Strother

Diane Tamburro

Juan Tavera

Gina Teffeteller

Jessica Tellier

Linda Thedford

Nadine Thomas

Huibert Tjabbes

Tammy Tow

Rebecca Truesdell

Natalie Unger

Antonio Vargas

Chere Vassell

Bobbie Vaux

Ann Venable

Brenda Vires

Kelsey Walker

Lorita Waltz

Jenai Werder

Gail M Wheltle

Aaron White

Jenna Williams

Amber Wilson

Evelyn Winters

Jason Wood

Xi Wu

Leslie Young

Jamie Yurina

Kaitlyn Zilly

INTERNATIONAL MEMBERS

Socorro de Montserrat Gómez Pérez –Mexico

Michelle Nelson – Australia

Maciej Latos – Poland

Norziana Mohd Anuar – Malaysia

Karen Mueller – Canada

Sung Myoung Jung – South Korea

Kelly Sylvester – Canada

Michele Yoshimoto – Brazil

View these webinars and more on-demand: www.learningcenter.ins1.org/webinars

The Role of the Infusion Nurse in Monoclonal Antibody Administration

Listen to these podcasts and more on-demand: www.learningcenter.ins1.org/podcasts

Chat with Matt: The Importance of Hemodilution in Infusion Therapy

Beyond Burnout: Mind-Body Skills for Healing Together

Understanding Iron Deficiency Anemia

Plasma-Derived Medications: Donors Make Them Possible

Safe IV Push Medication Administration Practice

INSide Scoop

Publications

INS would like to introduce our new associate managing editor, Donna Knauss. Donna coordinates the manuscript review process of the Journal of Infusion Nursing and other publications. She corresponds with peer reviewers and authors in the request, receipt, and review of manuscripts, maintaining manuscript logging control. She copyedits all accepted manuscripts for the journal. She is also responsible for collecting accepted articles, preparing them for publication, and working with the publishing production editor and printers to meet scheduling deadlines.

Donna received her BA in communications from the University of Tennessee, Chattanooga. Prior to joining INS, Donna worked for another medical journal, first as circulation manager, then as managing editor. She began editing early in life, when she would correct the grammar and spelling on the notes friends passed to her in school (this was not usually appreciated). Donna is an avid reader and loves cats. She enjoys watching Braves baseball and college basketball and football games.

Executive

The annual INS Board of Directors’ meeting was held February 5-6 in Boston, Massachusetts. The meeting was chaired by INS president Inez Nichols, DNP, FNP-BC, CRNI®, VA-BC. Orientation was conducted for incoming board members Danielle Jenkins, MBA, BSN, RN, CRNI®, president-elect, Joan Couden, BSN, RN, CRNI®, secretary/treasurer, Jannifer Stovall, MBA, BSN, RN, IgCN, CRNI®, director-at-large, and Lisa M. Ong, CPA, PCC, public member. INCC was represented by Myra Swintz, MSN, RN, CRNI®, AGCNS-BC, chair.

The board discussed, among other items, the 2022 organizational results and 2023 strategic initiatives for each department: member services, education, meetings, publications, marketing, and certification. They also ratified the selection of the first DEI scholarship winner, whose story will be featured in the May/June INSider, and discussed the 2023-2024 nominations plan: the open positions are president elect and director-at-large.

Additionally, Gillian Ray-Barruel, PhD, RN, MACN, and Mary Alexander, MA, RN, CRNI®, CAE, FAAN, published the article “EvidenceBased Practice for Peripheral Intravenous Catheter Management: The Reasons to Reduce ‘Just in Case’ or ‘Idle PIVCs’” in the January 2023 issue of the American Journal of Nursing.

Retrospective Issue