An infusion nurse is a registered nurse who specializes in the administration of medications and fluids through an intravenous (IV) line, central line, or venous access port. They can work as a resource to a hospital by starting lines and training new nurses in obtaining and maintaining IV access. An infusion nurse must be skilled in pharmacology, laboratory tests, and sometimes even telemetry to safely monitor patients throughout infusion therapy. They also have a steady hand, keen eye, and a lot of patience.
Starting peripheral intravenous lines is a skill best learned through experience. There are many techniques that result in successful IV starts, and many "tricks" nurses learn along the way. No two patients are the same, and neither are their veins. A nurse can build upon prior experience to obtain IV access on even the most challenging patients.
What Are the Educational Requirements for Infusion Nurses?
Those looking to become infusion nurses must first complete an accredited nursing program and obtain a nursing license. They can choose to earn an ADN or BSN nursing degree. BSN nurses have a broader range of opportunities, as they can pursue supervisory roles as well as become clinical nurse educators.
Obtaining clinical experience in intravenous access and diverse types of infusion therapy is a common requirement to become an infusion nurse. Many employers require a year or more of clinical experience. Areas that may help enhance intravenous access skills can include:
- Pre- and post-operative/ surgical units
- Intensive care units
Are Any Certifications or Credentials Needed?
A practicing nurse can obtain formal infusion certification, although it is not required for some positions. The Certified Registered Nurse Infusion (CRNI) program is nationally recognized in credentialing nurses in infusion therapy. The requirements to obtain certification are:
- An active RN license in the United States
- A minimum of 1,600 hours of experience in infusion therapy within the last two years
Applicants who are approved to take the exam can schedule a date to test. There are 300 testing sites globally and the testing process takes about three hours.
Re-certification is required every three years. Nurses can either take an exam or complete 40 hours of continuing education credits to renew their certification.
As any infusion nurse will attest to, the inability to access a line can be very frustrating and, depending on the line, may require special interventions.
Peripheral IV line issues are probably the easiest to deal with. Most nurses can pop a new peripheral IV in fairly quickly, especially infusion nurses who perform IV starts frequently and are extremely skilled at finding challenging veins. Some infusion nurses even have specialized equipment (like a doppler) to help find deep or tiny veins.
PICC line access can be a bit more challenging; it may be clotted, or the line may be dislodged. Infusion nurses must first determine the cause. A clotted line won't flush or is "sluggish" when flushing. Infusion nurses can try a few techniques to try to get the line flushed, such as gentle flushing using a push-pause method, having the patient turn their head, or repositioning the arm. If those methods fail, tissue plasminogen activator (tPA) may be required.
Central venous ports are also a little more complicated. They are surgically implanted, so access issues can make even the most seasoned infusion nurse worry. The port may be clotted, requiring a de-clotting agent. It may also help to reposition patients to see if that is the reason why it is occluded. Sometimes the access needle needs to be repositioned as well.
Infusion nurses can and do make house calls. Normally, this occurs when they work for a home health agency. As more and more patients are shifted out of the inpatient setting and care is delivered in outpatient facilities or the home, infusion nurses can perform their job duties in the comfort of the patient’s home.
There are challenges to home infusions. Usually, patients have a central line for ongoing or long-term infusions, and maintaining cleanliness and sterility can be challenging. There is less environmental control than there is in an infusion clinic or inpatient setting. Infusion nurses who go out to the home must assess for potential hazards with each visit, and amp up the patient and family education on the importance of sterility/cleanliness when dealing with IV lines.
Another challenge is adverse reactions to IV therapy in the home. Since it’s usually just the infusion nurse, resources are scarce. In case of emergency, the nurse would have to call 911 and manage the patient independently until emergency techs arrive.
While there are challenges, home infusion nurses enjoy a rewarding job. Visiting patients in the home helps form bonds between the nurse and patients, leading to better patient outcomes.
Infusion nurses specialize in medication and fluid administration through IV access lines. Rheumatology nurses specialize in the care of patients with rheumatic diseases such as rheumatoid arthritis, fibromyalgia, and lupus. While the two specialties seem very different, there can be overlap in treatment that nurses should be prepared for.
One of the most significant areas of overlap is medication administration and maintenance. Some of the medications used to treat rheumatic illnesses are given via infusions. For example, the drug Remicade is used to treat rheumatoid arthritis. The infusion can take up to two hours to complete. Depending on the healthcare setting, either infusion nurses or rheumatology nurses can administer it. Both are responsible for educating the patient on the medication to include side effects, length of time of the infusion, and what to expect. Other rheumatic illnesses that may require medication infusions include:
- Psoriatic arthritis
- Ankylosing spondylitis
Occasionally, blood transfusions are needed for complications of rheumatic illnesses. Certain illnesses result in GI bleeding or anemia, and infusion nurses or rheumatology nurses may need to transfuse blood. As with medication administration, nurses must educate patients on the transfusion procedure, side effects, and what to expect during treatment.
Infusion nurses can work in the hospital setting in the following roles:
- Bedside nurse
- Resource nurse
- Peripherally Inserted Central Line (PICC) nurse
They can also work in outpatient departments such as:
- Infusion centers
- Home health
- Primary care
- Long-term care facilities
- Skilled nursing homes
Infusion nurses are responsible for initiating and maintaining intravenous lines and tubing, administering medication and fluid therapy, and educating families on line maintenance and treatment.
What Are the Roles and Duties of an Infusion Nurse?
Infusion nurses can work in many different areas. In the hospital setting, an infusion nurse may:
- Work as a resource starting intravenous lines
- Inserting and maintaining PICC or midlines
- Routine PICC/ midline dressing changes
- Teaching intravenous access and PICC insertion
Outpatient or ambulatory care infusion nurses also have a wide array of job duties. These may include:
- Intermittent chemotherapy infusion
- Blood transfusions
- Antibiotic infusions
- Steroid infusions
- Nutrition replacement/ vitamin infusions
- Fluid/ electrolyte infusions
Both inpatient and outpatient infusion nurses share the following duties:
- Patient/family education with regards to line site, tubing, and catheter management
- Patient/family education on the rationale for therapy
- Education on possible side effects/ adverse effects of therapy, and signs and symptoms of infection to report
- Collaboration and communication with the ordering physician throughout therapy
- Line maintenance and troubleshooting
- Administering medications and fluid therapy
- Reviewing pertinent lab values and drug information
- Developing a plan of care with the patient, family, and physician with regards to infusion therapy
- Monitor the patient's response to treatment throughout therapy
- Assessing line site and patency regularly, keeping infection control and prevention as a priority
Infusion nurses can be in high demand. Many patients are being discharged from the hospital still needing to continue treatment. A medically stable patient would not need a lengthy hospital stay simply to receive infusions. Outpatient infusions have become more prevalent as hospitals work to reduce costs. According to The National Home Infusion Association website,home infusion is a safe and effective alternative to inpatient infusion treatment, and allows patients to resume normal activities more timely. This results in a higher demand for infusion nurses. According to salary.com, an infusion nurse earns a median salary of $83,171.This can vary, however, based on the state and organization in which the nurse is employed.