Central lines are any line that is placed into the larger vessels of the heart. Any catheter that is inserted and sitting in the superior or inferior vena cava is considered a central line.
Central line insertions
It is an invasive and sterile procedure that requires consent. The pt will be draped and the nurses and physicians will gown up their sterile gowns. When catheters are placed the patient is lying flat and given a numbing medication called lidocaine and pain medication. Make sure to have some sterile flushes handy in case you need to flush the line. Your job as a nurse will be to assist the person placing the line which can be an NP, MD, PA, and also monitoring vitals. Then the line is being advanced you may see some ectopy on the monitor, this usually happens when the tip of the catheter hits the right atrium (atrial tickle). If there is some ectopy let the physician know so they can pull back on the catheter. Once placed it is then sutured and anchored in place.
Some common central lines are PowerPICC, Hickman, Broviac, Groshong.
A PICC is a peripherally inserted central catheter.
PICCs are narrow flexible catheters usually inserted through a vein in the peripheral region. It is slid through until the tip reaches a large vessel in the heart called the superior vena cava. Usually placed in the upper arm.
Central lines can be inserted through:
- internal jugular vein
- common femoral vein
- subclavian veins
- basilic vein
- brachial vein
- cephalic vein
The major benefit to PICCs is that they allow for the administration of drugs that would not be able to be given through a peripheral line. They also give the patients the ability to have a long-term catheter for continuous use, for chemo, hemodialysis, etc…
Central line uses
Central lines can have multiple lumens or be single. The most common ones are a single lumen, double, and triple lumen.
- Prolonged IV antibiotic use
- Long Term medication infusions
- Multiple access was obtained with one line.
- TPN, Chemo
- Long-term inotropic therapy, vasopressors
- Home and sub-acute discharge
- Blood draws
Thicker than a PICC and temporarily used for hemodialysis or CRRT. a fistula is preferred over this method. It can be tunneled or temporary and should only be used for dialysis but can be used in emergent situations for medications.
Tunneled vs non-tunneled catheters
Tunneled catheters are placed for longer-term use and many times patients can be sent home with them. Tunneled catheters are passed under the skin and then fed into a large vein. Tunneled catheters also have something called a cuff which facilitates tissue growth to anchor it in place.
Also used for long-term treatment. It is implanted so that it sits underneath the skin usually in the upper chest. They need an occasional flush but otherwise don’t require much care. They can also be multiple.
Risks and Complications
Central lines are great; they provide critical access during critical times however there is some risk associated with central lines.
Rare but can occur during insertion and when giving medications.
Air bubbles enter the bloodstream and can travel to the brain, heart or lungs causing a MI, stroke, or respiratory failure.
Signs and Symptoms
- difficulty breathing or respiratory failure
- chest pain or heart failure
- muscle or joint pains
- mental status changes, such as confusion or loss of consciousness
- low blood pressure
- blue skin hue
Infections leading to sepsis can happen during the insertion period and after if proper maintenance isn’t done.
Signs and Symptoms
- Redness or swelling on site
- Purulent drainage
- Elevated WBCs
Inflammation of the vein where the catheter is inserted.
Signs and Symptoms
- Redness, pain, or drainage at the site
- Streak formation along the vein
Any catheter that is inserted will be at risk for thrombus formation and then embolism.
- After insertion, you will need to get an x-ray to confirm placement. Daily x-rays are not needed unless you are having problems with the catheter. One thing that can happen is catheter malposition, which will be revealed on the x-ray.
- A central line can be pulled back if it migrates but should not be pushed further in.
- Dressing changes are sterile procedures. Dressings need to be kept dry and changed if wet.
- The dressing should be changed per hospital policy, some places change them weekly and some every 72 hours. Keep in mind that every time you do a dressing change you expose the line to infection so they should not be done whenever.
- Some catheters need to be flushed with heparin.
- Keep lumens patent by flushing at least once a shift or keep a KVO going.
- Clean lumens with alcohol before using or keep caps on them.
- Using a 10 ml syringe generates the proper intra lumen pressure.
- Catheters that have clamps require heparin flushes, if clamps are not present it is a saline-only catheter.
- Avoid blood pressures on the side of the line.
- Always protect the catheter from tugging.
According to healthypeople.gov the most common HAIs include:
- Catheter-associated urinary tract infections
- Surgical site infections
- Bloodstream infections
- C. diff
CLABSI or Central Line-Associated Bloodstream Infections account for thousands of deaths a year and million dollars in added costs to the healthcare system.
The types of nursing specialties you work in can play a role in your career as a nurse. In this post, we will talk about twenty of the best areas of nursing that you can work and enjoy.
Types of Nursing Specialties to Work in as a Nurse
Nurses are the heart and backbone of healthcare. They work with patients up close and work collaboratively with other health care providers to ensure that quality care is delivered. It is why the career path a nurse chooses should be according to their passion and interests.
The good news is, there are plenty of nursing career paths to take. Others may provide more education and training, but all of these nursing specialties allow nurses to work with different groups of patients and deliver quality care at the same time. 
This post will tackle the unique nursing specialties, how to become one, the estimated income of the said position, and the requirements you need to qualify. Here are twenty of the best nursing fields you can work in as a nurse.
Types of Nursing Specialties that Works with Newborns to the Elderly
1. Neonatal Nurse
Nurses in this area work and care for infants at risk for complications or needs specialized care. Their patients include premature newborns, specifically congenital disabilities, cardiac problems, genetic conditions, or drug dependency. Neonatal nurses care for these infants until they can leave the hospital; however, in some cases, nurses provide care even after the infancy phase.
To qualify, you must have a valid license as a registered nurse. An associate degree also allows you to work in this position, but a Bachelor of Science in Nursing is needed if you want a more competitive position.
All nurses working in this field must have a Neonatal Resuscitation Program certification or credentials. These could be Low-Risk Neonatal Nursing and Neonatal Intensive Care certifications. The average income for this position is estimated to be $70,000 per year.
2. Pediatric Nurse
One of the best types of nursing specialties you can work in belongs to pediatrics. The area focuses on caring for the healthcare needs of children. It includes newborns and adolescents. However, depending on the level of training of nurses, they can provide all sorts of healthcare. Their job description includes:
- Giving primary and preventive healthcare.
- Managing chronic and acute illnesses.
- Conducting physical exams.
- Performing diagnostic tests and treatment plans as well as healthcare education to patients and their families.
How to be a pediatric nurse? First, get an RN license and certification. Nurses with a BSN degree or APRNs with a pediatric focus, MSN, or doctor of nursing degrees can find more favorable positions in this area. An RN can also qualify for a pediatric nursing certification program if they completed two years of work experience with a minimum of 2,000 hours in pediatric nursing. The average income for this position is $62,000 per year.
3. School Nurse
A school nurse is a nurse that works within a school’s clinic or health care areas. They mainly work in elementary, middle, and high schools. Their role is to provide treatment and first aid for injured or sick students. They also provide and collect health care data of students, administer health screenings, provide acute care, and help students with chronic diseases.
So, how do you become a school nurse? According to the National Association of School Nurses, you need to secure an RN license and a BSN before working in schools. In some cases, schools don’t necessarily require a specialty certification. But to further land the job, applicants must earn their credentials from the National Board for Certification of School Nurses to enhance their skills and qualifications. The average income for school nurses is estimated to be around $48,500 per year, not so bad if you ask me.
4. Family Nurse Practitioner
A family nurse works who works with patients from childhood until adulthood. It is one type of nursing specialties that is in clinical and family practice settings. Interested nurses must have an FNP certification. Nurses working as FNP usually examine, diagnose, and treat patients from birth until old age. Their practice mainly focuses on preventive care. In addition to an FNP certificate, nurses must also have an MSN as a minimum educational requirement.
You can also enter a bridge program with associate degrees in nursing or a direct entry program. These programs are for certificate holders with non-bachelor’s degrees. After graduating, FNP nurses can improve their status by earning certifications from other nurse practitioner certification boards.
The average income for this nursing specialty is estimated to be around $100,000 to $114,000 per month. It may also vary, depending on their clients. 
5. Geriatric Nurse
Working with the elderly is one of the in-demand jobs for nurses . If you like working with the elderly, geriatric nursing is perfect. Your main job is to work alongside primary healthcare givers, physicians, social workers, and families of elderly patients to ensure quality care for them. They also educate the families of patients about their conditions and the treatment options they have.
To qualify, one must be an RN with an advanced graduate degree and training in geriatrics. Having a Master’s or Doctoral level will get you better employment prospects in the future. You can get your Gerontological Specialist-Certified through the Gerontology Nursing Certification Commission.
The estimated average income of geriatric nurses is around $57,500 per year or more, depending on the facility they work.
Types of Nursing Specialties That Are Booming
1. Dialysis Nurse
Dialysis nurses work with patients who require blood cleansing due to kidney-related diseases. As a dialysis nurse, you will be working with machines and equipment that cleans the patient’s blood. You will also assess their vital signs before and after the procedure and teach them about medications and healthcare. To become a dialysis nurse, you must hold an associate or BSN degree and a registered nurse license.
Nurses with MSN degrees have the potential to earn more in advanced practice registered nurses positions. A certification in nephrology or the certified dialysis nurse credentials from the Nephrology Nursing Certification Committee also gives you higher ranks in this area. The average income for dialysis nurses is estimated to be around $71,000 per year.
2. Nurse Anesthetist
One of the best-paid jobs as a nurse is being a nurse anesthetist. These nurses administer anesthesia and pain medication to patients while observing their vital signs and monitoring them during and after surgeries. A nurse specializing in this area works with all kinds of patients scheduled for emergency or surgical procedures. Before surgery, it is their job to record patient history and teach or provide information about the anesthesia during said surgery. 
How can you become a nurse anesthetist? A BSN degree with an RN license helps, and if you have an MSN degree with a specialization in nurse anesthesiology, much better. You must also have 3,000 hours of clinical experience and a passing score from the National Examination by the National Boards of Certification and Recertification of Nurse Anesthetists.
Lastly, apply for a state license if the state you are in requires one. The estimated income for nurse anesthetists is estimated to be $175,000 annually.
3. Nurse Midwife
Nurses who specialize in pregnancy, prenatal care, childbirth, and postpartum care belong to nurse-midwives. This advanced practice in nursing work with pregnant women, caring for them from labor until delivery. They also provide postpartum assistance to new mothers. The main focus of this work is pregnancy care and offer gynecological reproductive health teaching and preventive healthcare. Working in this field is considered one of the best types of nursing specialties that you will enjoy working as a nurse.
Having an associate or bachelor’s degree in nursing and a licensed RN are the basic requirements for this position. Nurse-midwives who want to take a level up in their place can enroll in a Master of Science program or a doctor of nursing degree. Once they have completed their education, they must earn a certification as a Certified Nurse Midwife by the American Midwifery Certification Board. The average income for this position is estimated to be around $63,000 to $105,000 per year.
4. Infection Control or Prevention Nurse
One of the exciting types of nursing specialties belongs to this department. The main job of an infection control nurse is to identify, survey and manage infectious diseases and viruses. These nurses are the most influential people in the fight of Covid-19. They focus on caring for sick patients, patient case reporting, and widespread infection prevention. Infection control/prevention nurses mainly work in hospitals, but they can also work in community health centers and clinics if needed.
Interested applicants must obtain a Certification in Infection Prevention and Control (CIC) from the Certification Board of Infection Control and Epidemiology. They also require candidates with an associate or BSN and at least two years of work experience with infectious diseases. The average income for infectious control/prevention nurses is estimated to be around $71,200 per year.
5. Oncology Nurse
It is one type of nursing specialty that requires in-depth knowledge and skills since you will take care of cancer patients. They are highly trained nurses who specialize in providing cancer treatment and help educate patients about their treatment options and remission status. Oncology nurses are also the ones responsible for monitoring their patient’s progress, symptoms and prescribing medication.
If you wish to become an oncology nurse, you must have an associate’s degree or BSN and a licensed RN. You must also have 1,000 hours of training as a registered nurse to qualify. The average income for being a nurse in this area is estimated to be around $65,000 to $72,000 per year.
6. Psychiatric Mental Health Nurse
An area of nursing that helps people deal with their mental health is psychiatric mental health nursing. Here nurses help in assessing, diagnosing, and treating patients with mental health disorders. They also offer services for people with mood disorders, dementia, phobias, and depression. They administer therapy and medication, assess mental health, evaluate, intervene during a crisis, and assist patients.
Interested parties must be licensed and registered nurses with a Master’s degree. The average income for psychiatric nurses is estimated to be $65,000 to $119,000 each year.
7. Nurse Advocate
Nurse advocates are nurses who provide assessment, representation, and education to patients. They also coordinate with doctors and patients to review patient concerns and consult with doctors to deliver quality and cost-effective health care. Their other roles include treating and educating patients about their conditions and the available healthcare procedures by communicating their preferences. They also mediate conflicts with their doctors.
To become a nurse advocate, you must have a BSN degree and pass the NCLEX-RN licensure exams. Continuing education courses is also essential if you wish to be a nurse advocate and have work experience. You can also get certified by the Patient Advocate Certification Board for credentials and working in this area. The estimated average income for this nursing field is $71,700 per annum.
8. Nurse Educator
Nurses who love teaching can become nurse educators. To become one, you must be a registered (NCLEX-RN) and licensed nurse who has completed advanced graduate training. It will help you in teaching nursing students in academic institutions as well as hospital nursing training settings. In addition to that, you must also be enrolled or have a degree in continuing education and refresher courses.
Nurse educators are responsible for creating a nursing curriculum, advise students, conduct research, and write grants. You must also be an MSN holder and have additional clinical experience in the APRN practice areas. While these are all essential, some universities prefer to hire nurse educators with a Ph.D. in Nursing or a doctor of nursing practice degree. You must also pass the National League of Nursing exam to receive Certified Nurse Educator certification. The average income for this position is $68,500 to $79,300 annually.
9. Clinical Nurse
Working as a clinical nurse is like your training ground for determining the type of nursing specialties you want to work in, in the future. Clinical nurse focuses on areas of care that include pediatrics, geriatrics, emergency, or critical care. They also tackle specific disease care like cardiovascular or diabetes, mental health and rehabilitation, and pain management and wound care.
Interested nurses who want to become clinical nurses must enter an MSN program after getting their RN license. Although this field does not necessarily require special certifications to work, many nurses who want to advance their career in this area pursue specialized credentials. The average income for clinical nurses varies from $85,000 to $90,000 per year.
10. Public Health Nurse
One of the most common nursing jobs belongs to the public health nurse. They usually work with communities and help educate people on safety issues and health and assist them in getting access to healthcare. While some nursing jobs require individual patient care, community nurses focus on preventing diseases, identifying health concerns, and implementing and prioritizing safety issues within communities.
A nurse applicant must pass the NCLEX examinations and have work experience in community or public nursing. You must also have a bachelor’s degree and at least five years of work experience as a public health nurse and completing the National Board of Public Health Examiners. Becoming a public health nurse works best for nurses who don’t want to work one-on-one with patients. The average income for this position is around $56,000 to $56,000 per year.
11. Nurse Researcher
If you don’t want to work with patients, you can work as a nurse researcher. A nurse researcher’s job consists of analyzing data, conducting scientific studies, and creating reports about improving healthcare and illnesses. Nurse researchers work in research laboratories as well as hospitals. Most NRs have bachelor’s and master’s degrees with valid RN licenses. And, if you wish to boost your career in this area, earning a Certified Clinical Research Professional certification from the Society for Clinical Research Associates is a must. They can also acquire credentials through the Association of Clinical Research Professionals. The average pay for this profession is around $81,500 or more annually, but it may vary depending on the research center.
12. Informatics Nurse
An informatics nurse works in managing healthcare data and communications. They mainly work for hospitals, nursing homes, public health agencies, or insurance agencies. Nurses in this area train in computer science, information and technology, and nursing. They also manage data gathered among healthcare providers to organize and increase the efficiency of overall patient care.
Applicants interested in working as informatics nurses must be a BSN with an RN license or MSN degree in health informatics. They also hire nurses with degrees in Information Science or Computer Science, but not all employers require this. However, specialized certification in nurse informatics from the American Nurses Credentialing Center can help you go a long way in this nursing field. The average income for an informatics nurse is about $76,800 per year.
13. Orthopedic Nurse
The work of an orthopedic nurse focuses on musculoskeletal issues and diseases that include fractures, arthritis, osteoporosis, and joint replacements. They help in treating and caring for patients with physical problems and manage these conditions. They also help cast broken bones, administer pain medication, and develop a treatment plan to address pain and muscular/bone issues.
Nurses with Bachelor’s of Science in Nursing degrees who are licensed and registered nurses qualify best for this area. The average income of orthopedic nurses is around $76,200 annually.
14. Trauma Nurse
Trauma nurses work in emergency rooms and urgent care units as part of emergency medical response teams. They also received specialized training to work with other health caregivers to stabilize and treat patients. They also administer IV fluids, blood transfusion, wound care and provide emergency medications. Trauma nurses are also well-equipped in operating life-saving machines like defibrillators and monitor their vital signs.
Having an associate or BSN degree and passed the NCLEX-RN exams is a must to work as a trauma nurse. You must also have at least two years of working experience as an RN and other trauma nursing-related certifications needed. The estimated income for this job is around $65,800 per year.
15. Travel Nurse
One type of nursing specialties that works best for nurses who love adventures and traveling is travel nursing. Travel nurses can work across the states or internationally to fill the staffing needs of health care facilities for some time. They specialize in a particular practice area or perform the general nurse roles.
Travel nurses can be self-employed or placed through an agency under contracts that could last from 3 to 8 weeks or more. Applicants must have an associate or BSN degree with a valid RN license. You must also have at least two years of working experience as an RN.
The average income for travel nurses is estimated to be around $80,000 or more, depending on their contract or working areas.
Various Types of Nursing Specialties to Choose From
These are the most common types of nursing specialties you can work in as a nurse. However, there are also other areas that you can work. But whatever field of nursing you choose, be sure to pick the one you are genuinely interested in doing. This way, you don’t burn yourself out and enjoy every waking moment at work. I hope this post helped you in your decision-making, good luck!
Food labels and healthy snack options
When it comes to what snacks or even foods to eat the first thing you should always look at is the nutrition label and ingredients. There are a variety of choices in grocery stores so there is no excuse in the inability to find one that fits you. You just need to watch out for their marketing and what they actually promote.
Food labels explained
When it comes to food labels there is another label to pay attention to besides the nutrition label. That is the loss of certifications. What we have found is not all “certifications” are certified.
USDA’s National Organic Program regulates labeling requirements for organic agricultural products. Organic labels can be found on produce, dairy, meat, processed foods, condiments, and beverages. Food products labeled “organic” must contain at least 95% organic ingredients with no synthetic growth hormones, antibiotics, pesticides, biotechnology, synthetic ingredients, or irradiation used in production or processing.
Products that contain at least 70 percent organic ingredients and are produced without synthetic methods are labeled “made with organic ingredients,” though they cannot use the USDA organic seal on their packaging.
It will cost around $1,200 for an organic processor to get certified, and around $700 (or more) for a new organic farm to get certified.
Certified Naturally Grown
The food was grown using the same standards as those for organic, but not on a farm actually certified by the National Organic Program of the USDA. Some farmers have criticized the cost and process they need to go through to participate in the USDA’s organic program, so this is an alternative, non-governmental certification system where other farmers act as inspectors in a program administered by a non-profit organization called Certified Naturally Grown.
“Natural” is a term present on a lot of food products, so look closely at the label. The Certified Naturally Grown label indicates that someone is certifying that it is indeed natural, rather than just using the word “Natural” for marketing purposes.
Fairtrade standards are enforced by Fair Trade USA. Fairtrade products must be produced in accordance with the following guidelines: Workers must receive fair wages, safe and equitable working conditions, and the right to join trade unions; child or forced labor is completely prohibited. Crops must also be grown, produced, and processed in a manner that supports social development, economic development, and environmental development. Fairtrade standards have been established for coffee, tea, cocoa, honey, bananas, juices, cotton, flowers, gold, rice, spices and herbs, sports balls, wine, composite products, fresh fruit, and sugar.
Animal Welfare Approved
Started in 2006, Animal Welfare Approved (AWA) is a division of the non-profit organization Animal Welfare Institute. Its standards cover the way its participating farms raise their animals (including beef and dairy cattle, bison, sheep, goats, pigs, chickens, turkeys, ducks, geese, and rabbits). AWA states that the basic premise of their standards is that animals must be able to behave naturally and be in a state of physical and psychological well-being. They only certify family farms (charging no fees to participating farmers) and state that animals must be raised on pasture or range.
American Humane Certified
The American Humane Certified program was created by the American Humane Association in 2000 to ensure that animals raised for dairy, poultry, beef, veal, goat, swine, turkey, and bison products are raised in a humane manner. These guidelines, created with input from animal science experts, ensure that livestock has access to clean and sufficient food and water, as well as a safe, healthy living environment, and that staff and managers, are thoroughly trained to care for animals in a humane manner.
Non-GMO Project Verified
The Non-GMO Project is a non-profit organization that provides the only third-party labeling program in North America for products grown without using genetic engineering. They verify that the process products go through, from seed to shelf, are produced according to their rigorous best practices for GMO avoidance.
USDA has a grass-fed standard for ruminant animals like cows and goats, which states that these animals must be fed only grass and forage during the growing season. The American Grassfed Association is one organization that certifies beef, bison, dairy, lamb, and goat that is fed only on pasture, in addition to being raised without antibiotics, synthetic hormones, confinement, and with standards for high animal welfare. Other animals, like chicken and pigs, can be pasture-raised (and USDA organic standards require at least some access to pasture), but there are currently no specific certification standards for non-ruminant animals being grass-fed or pastured.
Non-Certified food labels
The following labels depend on farmer and processor information to support the claim that the food products were raised in compliance with each set of standards. They do not go through third-party testing or certification, they do have certain standards they must prove.
This label means that the farmer has chosen not to inject his or her cows with any artificial growth hormones, like rBGH, a genetically engineered growth hormone. The label is also used on beef and chicken products, where the animal was raised without growth hormones or steroids. However, the USDA prohibits giving hormones to chickens, so the label doesn’t mean much there — all chicken you buy will be hormone-free whether it’s labeled or not.
Hormones are not allowed in raising hogs or poultry. Therefore, the claim “no hormones added” cannot be used on the labels of pork or poultry unless it is followed by a statement that says “Federal regulations prohibit the use of hormones.
Raised without antibiotics
Chickens, pigs, and cattle raised on industrial farms are routinely fed low doses of antibiotics (the same drugs we rely on to keep ourselves and our families in good health) to make them grow faster and compensate for overcrowding and unsanitary living conditions. This label states the meat or dairy was raised without the use of antibiotics.
The following are not certified or tested by any third-party regulatory agency and do not have a set of standards.
While many products have “all-natural” labeling or packaging, there is no universal standard or definition for this claim.
Free-range poultry is defined as birds that spend part of their time outside (whether that’s 10 minutes per month or 10 hours per day) and don’t live in cages. However, the USDA doesn’t have a legal definition of free-range chicken eggs and there are also no standardized or regulated definitions for free-range beef or pork.
Healthy snack bars
There are so many varieties of snack bars it can seem impossible to choose from. With a wide variety, there will also be a variety of healthy choices. Some use marketing gimmicks that you should stay away from, just because the box looks nice does not always mean it should be your choice.
Labels to pay attention to
This is the most important place to look. You should always try to avoid ingredients like high fructose corn syrup, soy protein isolate, and inulin (“fake fiber”). The first ingredient or ingredients should be wholes foods like apples, bananas, dates, etc.
Protein and amino acids are the building blocks for your muscle and for optimal organ and bodily function. Many dieticians recommend getting snack bars with at least 5g of protein but many bars are made from fruits so they also recommend some protein to go with it. Protein is important because it supports and strengthens your cartilage, bones, and muscles, boosts your immune system, and regulates many bodily functions. It will also up the satisfaction and satiating factor of your snack.
This is something the majority of people never get enough of, we are even guilty. It is important to try and get as much of it whenever you can. It will make you feel fuller for a longer period of time. Fiber helps to regulate digestion, improve heart health, prevent type 2 diabetes, combat inflammation, and reduce your risk for cancer.
Beware of added sugar! Try to select a bar that doe not contain any added sugars. There is a difference between natural sugar and added sugar. Snack bars will always have carbs and sugar because they usually come from fruit but avoid the added ones.