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Exposure to hazardous materials and hazardous wastes has become a critical issue. There is now a greater awareness of the potential health risks associated with these substances. Because intravenous nurses encounter hazardous substances on a daily basis, they must adhere to appropriate precautionary measures. Mandatory compliance, however, is not enough. The I.V. nurse needs to understand the rationale for these measures and the basis for the federal and professional regulations regarding the handling of hazardous materials and wastes. This article focuses on the definitions of hazardous substances, the regulations governing these substances, and the principles concerning the handling and disposal of hazardous materials in the practice setting.

Intravenous therapy is one of the admission criteria for the geriatric patient to enter a skilled nursing facility. Because of shortened hospital stays, more and more geriatric patients are placed in this type of nursing home. These facilities are also potential alternatives to hospitalization of the nursing home resident who requires I.V. therapy. Multiple factors, such as the aging population, federal programs for the elderly, and the economic health care climate, have contributed to the emergence of the skilled nursing facility as a practice setting for I.V. therapy. As the acuity of nursing home residents continues to rise, I.V. therapy will become a more frequent treatment modality. Therefore, I.V. nurses must be aware of the impact of provision of this service in the skilled nursing facility setting.

Although adverse reactions to heparin are rare and usually quickly reversible, recent studies have reported a potentially more serious complication occurring in up to 30 percent of patients receiving heparin. This phenomenon, known as heparin-induced thrombocytopenia, is believed to be of two distinct types that differ in etiology, clinical onset, and therapeutic ramifications. The most common type is characterized by a mild, transient drop in the platelet count on the second or third day of heparin therapy that generally reverses itself with continued heparin administration. The second type is believed to be the consequence of an immune mechanism or heparin-dependent antibody and may be life-threatening because of an associated thrombosis known as white clot syndrome. This type occurs on the fourth to eighth day of heparin therapy and is signaled by declining platelet count and/or increasing resistance to heparin therapy and eventual development of a clot composed almost entirely of fibrin and platelet aggregates. Heparin-induced thrombocytopenia is significant in that it is not related to age, sex, blood type, or amount of heparin administered. Because of the absence of known risk factors, all patients receiving heparin should be considered at risk for heparin-induced thrombocytopenia.

Patient classification systems may be used to justify I.V. work load. The merits of such a system include accurate prediction of staffing requirements based on patient care needs, validation of the I.V. nursing team's productivity and cost-effectiveness, prioritization of the I.V. nursing work load, and evaluation of the quality of I.V. nursing care.