Intravenous immunoglobulin is a valuable therapeutic agent for many patients with primary immune deficiency disorders and for some with secondary immunodeficiency, and its use has expanded to other areas such as neurologic, hematologic, and infectious disorders. Nurses administer the majority of immunoglobulin. This article discusses indications for various immunoglobulin products available, potential adverse reactions, routes of administration, and the important role of the nurse in the administration of immunoglobulin.

Subcutaneous infusion of immunoglobulin has emerged as an alternative administration method for both children and adults. It is well tolerated, safe, clinically efficacious, and appreciated by patients. This article provides an overview of subcutaneous immunoglobulin administration advantages and disadvantages, the administration procedure, the potential side effects, patient education, and documentation.

Economic, social, and technical factors are an impetus for expressing end-of-life decisions as advance directives. Despite opportunities, nurses do not appear to be widely involved in practice and research regarding advance directives. Through an extensive literature review, this article will discuss a historical background, definitions of advance directives, positive outcomes, and several barriers to completion. Critical care nurses and advance practice nurses play a key role in educating nurses, their patients, and physicians about advance directives. The use of advance directives will likely increase if nurses can aggressively implement a plan on their unit. Specific methods of implementation are explored.

We performed a quality improvement project to decrease utilization of multilumen peripherally inserted central catheters (PICCs) in favor of single-lumen PICCs and midline catheters. Through optimization of electronic orders, education and decision support, we decreased utilization of multilumen PICCs, changed provider ordering patterns, and showed a downward trend in CLABSIs.

Studies have demonstrated that a dedicated peripherally inserted central catheter (PICC) team can reduce costs, lead to efficient use of staff time, improve patient outcomes, and improve organizational performance. A dedicated, nurse-driven PICC team at the authors' facility has demonstrated excellence through teamwork. Over the past three years, the PICC team has made significant strides in the quality of service provided to patients. The goals of the team consisted of (1) improving PICC-placement success rates; (2) developing an electronic database to track patient outcomes; (3) constructing protocols and guidelines to improve efficiency, appropriate use of PICC lines, and patient safety; and (4) pursuing collaborative research projects, publications, and presentations at the local and national level.