Bone Marrow Aspiration and Biopsy Performed by RNs: A Review of Clinical Practice.

: Background: At our institution, RNs have performed bone marrow aspiration and biopsy procedures for more than 10 years. A recent review of our institutional policies and practices regarding RN-performed bone marrow procedures was intended to ensure that we were using a safe and evidence-based approach and prompted this program evaluation. METHODS: We conducted a literature search and review of our institutional policies and practices regarding RN-performed bone marrow procedures. All elements of our clinical practice were reviewed and evaluated, including outcomes. RESULTS: Between 2010 and 2017, the RN team completed a total of 10,867 bone marrow procedures in our hospital-based ambulatory infusion center. The team included 15 nurses who completed up to eight patient procedures each weekday. Patient satisfaction rates were consistently high and complication rates were very low: less than 1% of all patients experienced postprocedure bleeding, and less than 2% required urgent medical care within 24 hours of the procedure. In an analysis of bone marrow procedures performed between 2016 and 2017, the quality of bone marrow samples obtained by the RN team remained high, consistently meeting or exceeding our 95% clinical adequacy goal. CONCLUSIONS: There is limited evidence in the literature supporting the practice of RN-performed bone marrow procedures. Our review revealed a robust program with excellent clinical and diagnostic outcomes that can be emulated by other institutions interested in pursuing RN-performed bone marrow procedures.

Mobilizing Education to Nurses at the Bedside.

After a survey revealed practice gaps in central venous catheter care, one organization was challenged to identify a novel approach to educate nurses. Through a search for evidence, a project workgroup discovered an existing but beneficial teaching method, using a mobile cart to deliver meaningful education at the point of care. Successful outcomes and sustained practice change were realized.

Percutaneous Nephrostomy Infusion: Nursing Considerations for Treatment of Upper Urinary Tract Urothelial Carcinoma.

An intrarenal approach using a percutaneous nephrostomy tube is a novel method to deliver chemotherapy and biotherapy to patients with upper urinary tract urothelial carcinoma. A paucity of evidence exists regarding basic nursing implications for this unique treatment option. This column will provide suggested guidelines to administer intrarenal treatment via a percutanous nephrostomy tube.
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