RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. NAME OF THE CANDIDATE : N MARY GOLD
AND ADDRESS 1ST YEAR M.SC. NURSING
H.K.E.S. COLLEGE OF NURSING
BASVESHWAR HOSPITAL
CAMPUS GULBARGA,
KARNATAKA.
2. NAME OF THE INSTITUTION : H.K.E.S. COLLEGE OF NURSING
GULBARGA.
3. COURSE OF STUDY AND : M.Sc. NURSING 1ST YEAR
SUBJECT MEDICAL SURGICAL NURSING
4. DATE OF ADMISSION TO : 11.06.2010
COURSE
5. TITLE OF THE TOPIC : “INTRAVENOUS CANNULATION
AND ITS CARE; LEARNING NEEDS OF NURSES AND DEVELOPMENT AND EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON INTRAVENOUS CANNULATION AND ITS CARE AMONG STAFF NURSES WORKING IN SELECTED HOSPITALS AT GULBARGA.”
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“Before we create new hybrid roles we need to take stock of the example of good practice we already have”.
The Nursing profession has become an epicentric concept in the modern world with the changing lifestyle within the culture and the thinking of the people, It serves as the guiding force for service and for the peace of the society1.
Nurses do various functions in their routine work in the clinical setting and one among them is Intravenous cannulation and it is a very common therapeutic procedure in patient care1. Intravenous cannula is a little plastic tube that has been mounted on a needle for insertion into the clients vein who require frequent access to the blood stream.
Forms of intravenous injection and infusion began as early as 16702. Intravenous cannula insertion needs a sterile technique as it enters into the clients vein3 Nurses are responsible for the insertion, manipulation, infusion, intact maintenance, care of catheter and safe removal4. Nurses should be skilfull and show enough expertization in intravenous cannulation to reduce tissue damage, blood loss, frequent punctures into the vein as it enhance health, reduce complications and duration of hospitalization of the clients3.
The main advantages of using Intravenous cannula are, it allows volumes of fluids, medications, colloids, blood products, Parental nutrition and chemotherapy2.
Care of patient with intravenous access device include dressing, flushing and heparin locking. To prevent infection and intravenous cannula with related complications such as infiltration (4.54%), phlebitis (5.79%) thrombosis (6.02%), air embolism (15.08%), swelling in the area of infection site (15.54%), burning sensation (36%), pallor of the skin (41%), catheter related bacteremia (43%) are major and common clinical problem particularly in critically ill patients5.
The study report shows that patients with intravenous cannula for more than 72 hours are more prone or vulnerable to develop intravenous cannulation with related complication such as infection, burning sensation, redness, swelling, phlebitis etc6.
As Intravenous Cannula is common and routine procedure for patients, nurses responsibility in taking care of these patients begins with preparing the material, selecting the vein, selecting proper gauzed catheter, cleaning and disinfecting the area, insertion of catheters, placement of catheter, restoring intravenous therapy and safe withdrawing of inserted intravenous catheter7.
Hence Nurses should be aware of recent changes in intravenous cannulation procedure, care of the patient by updating their knowledge to provide high quality of care for individual that reduces on instrumental complications. Nurses are also responsible for teaching patients about device care and how to handle trouble shoot complications. Failure to provide proper instruction may resort in the omission of vital steps which may create problems with any type of device.
6.1 NEED FOR THE STUDY
“Intravenous cannulation has evolved to form a fundamental corner stone of modern health care.”
At present context the nursing profession succeeds not only in helping the sick live longer but to have a higher quality of life if possible inside their family environment8.
Intravenous cannulation refers to the technique of venipuncture to insert an intracath or needle, whole interlip lies in a vein for people who frequently require access to the blood stream9. Intravenous catheter placement is an extremely common, painful procedure performed in all the ages and health care settings10. Peripheral intravenous cannulation is a common practice, frequently used and crucial in an emergency care11.
The cannulation is associated with risk to nearby structures, especially in the hands of inexperienced operator. Veins commonly lie close to arteries and nerves both of which can potentially be damaged by a misplaced needle. The nurse must be able to recognize the indications, advantages and disadvantages associated with each device9.
Intravenous catheters become more widely used in today’s healthcare environment, nurse require expert knowledge in relation to venous catheter maintenance to prevent complications and maximize efforts to optimize the individual’s health status. Nurses should be aware of these safety Peripheral intravenous cannulation to implement in the clinical setting to improve the health status of the client and to minimize the complications12.
The patients who undergo Peripheral Intravenous Cannulation procedure are more vulnerable for infection as procedure involves breaching the integrity of the skin and exposing patients to the risk of infection. The most identified contributing factors for the development of infection and complication among intravenous patients are poor cannulation skills, lack of adequate knowledge, noncompliance with standard policies of cannulation etc13.
A study was conducted to determine the rate of infection associated with long term intravenous catheter, insertion of catheter by an unexperienced persons and maintenance. The investigator found that extending the scheduled catheter replacement interval from 48-72 hrs to 72-96 hours was not a risk factors for local catheter infection, but catheter insertion by poor skilled personnel and the use of continuous infusion to maintain catheter patency were two independent identified risk factors for infection14.
The complications associated with intravenous cannulation are thrombophlebitis, thrombosis, air embolism infections (Methicillin – resistant staphylococcus aureus, health care acquired infection). These complications increases the duration of hospitalization, cost of the treatment and even morbidity significantly15.
Registered nurse require specific education and training to attain the knowledge assessment skills and technical expertise required to manage the care of patients who have Intravenous Cannula and catheter related complications that patients may experience. The Nursing role includes, educating the patient and the family about the device, its care, management of complications and the ability to advocate the patient when necessary.
Education of staff to use of correct insertion site, skin preparation, use of maximum barrier precautions during catheter insertion and catheter maintenance. The best treatment for catheter related blood stream infections is prevention of infection and complications.
Ongoing Educational Programme for nurses are necessary to update their knowledge, skill and competence in intravenous cannulation and its care. Approved policies, education, clinical skills, procedures based on current evidence can be implemented and evaluated for the change in practice. The research study and working area created insight in investigator mind and felt the need to design a study to conduct structured teaching programme for nurses who are working in selected hospital on Intravenous Cannulation and its care. This will help to learn and improve knowledge of nurses regarding Intravenous Cannulation and its care.
6.2 REVIEW OF LITERATURE:
An observational survey was carried out to identify position of peripheral Intravenous cannulae and the incidence of thrombophlebitis among 427 patients in one Italian hospital in 2007. The data were collected by using observation protocol. The result shows that, thrombophlebitis was higher in females (OR:1.91; CI:1.20-3.03; P<0.006) and highest incidence was found the patient with cannulae inserted in the dorsal side of the hand veins compared to those with cannulae inserted in cubital fossa veins (OR:3.33; CI:1.37-8.07; P<0.001). 16
The study was conducted to identify choosing the right intravenous catheter for safe and effective care. The result identified that some of the important factors to be considered while choosing right intravenous catheter such as physician order, patient preference, length of therapy, PH and Osmolality of the drugs as well as it is potential vesicant properties. The study also recommended that nurse need to act as a patient advocate, patient educator in identification of appropriate catheter in order to prevent immediate interventions to avoid problem. 17
Randomized controlled trial was carried out to compare routine replacement of intravenous peripheral catheters with replacement only when clinically indicated among 755 medical and surgical patients in Tertiary hospital in Australia. Among 755 patient 379 allowed for clinically indicated catheter replacement and 379 for routine replacement of intravenous catheter. The study result shows that, catheter were removed because of phlebitis or infiltration from 123 of 376 (33%) patients in control group compared with 143 of 379 (38%) in intervention group. Infusion related costs were higher in the control group (mean $A4102; Pound 19.71; Euro 24.80, $38.55) than intervention group ($A36.40). 18
A prospective sequential clinical trial was conducted to compare among three (Non sterile tape, stat lock and Hub guard) methods of peripheral intravenous catheter. The result shows that stat lock had highest peripheral intravenous survival rate (52%) followed by Hub Guard, Non sterile tape got 9% and 8% peripheral intravenous survival rate respectively. 19
A randomized controlled trial was carried out to assess the safety of changing peripheral venous cannulas when clinically indicated (for every 3 days control group) compared with only when complication occurred (intervention group) among 206 hospitalized patients in tertiary referral hospital in Brisbane, Australia. The study result shows that 46 patients had unplanned removals in the intervention group compared with 41 in the control group (relative risk 1.12, 95% confidence interval 0.81-1.55 (P=0.286), an non significant difference. Total duration of peripheral cannulation was similar in both groups (mean 132.3h in the intervention group and 125.9h in the control group: P=0.82) but significantly more resites occurred in the control group (167 in intervention group, 202 in the control group=0.022). The result concluded resisting peripheral venous cannulas changing routinely for every 3 days does not lead to more complications. 20
Prospective, placebo control, double blind study was conducted on use of topical anesthesia during intravenous cannulation in adults to evaluate pain experience. The data was collected among 43 subjects who receives LMX-4 on one hand and hand cream on other. The result shows that LMX-4 hand was 3.2 (SD=2.25, range, 0.85cm), while the placebo hand was 4.67 (SD=2.25, range, 0.25-10mm), The mean paired difference between LMX-4 and placebo hands was -1.37 (95% CI; -2.2, -0.49); subjects receiving LMX-4 reported clinically as statistically significant pain reductions (t=-3.17, P=0.003) when adjusted for difficulty of stick, pain scores continued to remain lower in the LMX-4 hand. 10
STATEMENT OF THE PROBLEM:
“Intravenous cannulation and its care; learning needs of nurses and development and effectiveness of structured teaching programme on intravenous cannulation and its care among staff nurses working in selected hospitals at Gulbarga”.
6.3 OBJECTIVES OF THE STUDY:
i) To identify the learning needs of nurses regarding intravenous cannulation and its care in terms of pre-test scores, among staff nurses working in selected hospital at Gulbarga.
ii) To develop and implement the structured teaching programme on intravenous cannulation and its care among staff nurses working in selected hospitals at Gulbarga.
iii) To determine the effectiveness of structured teaching programme on intravenous cannulation and its care among staff nurses in terms of gaining knowledge by post-test scores.
iv) To determine the association between intravenous cannulation and its care, learning needs with selected demographic variables.
Operational Definitions:
Intravenous Cannulation : Intravenous Cannulation refers to the technique of venipuncture to insert
an intracath or needle whose interlip lies in a vein for people who
frequently require access to the blood stream.
Care : It refers to selecting vein, device, safe insertion , intact of cannula,
infusion, prevention of complication and safe removal of Intravenous
Cannula.
Learning needs : It refers to educative information regarding Intravenous Cannulation such
as selecting vein, device, safe insertion , intact of cannula, infusion,
prevention of complication and safe removal of Intravenous Cannula
Nurses : Refers as registered nurses working in the clinical setting and having
experience of Intravenous Cannulation and its care.
Effectiveness : It refers to gain knowledge as determined by significant difference in post
test Score among staff nurses on Intravenous Cannulation and its care.
Structured Teaching : It refers to a planned instruction to impart knowledge among staff nurses Programme on Intravenous Cannulation and its care.
7. MATERIALS AND METHODS
7.1 SOURCE OF DATA : Staff Nurses working in selected hospitals, at
Gulbarga.
7.2 METHOD OF COLLECTION : Interview Schedule
OF DATA
7.2.1 SAMPLING CRITERIA
INCLUSION CRITERIA : Staff Nurses working
i) In selected hospitals, at Gulbarga.
ii) In clinical setting and having experience
of Intravenous Cannulation and its care.
iii) Who are willing to participate in the
study.
iv) Who are available during the study.
EXCLUSION CRITERIA : Staff Nurses
i) who have undergone education
programme regarding intravenous
cannulation and its care.
ii) Who does not have enough experience of
Intravenous Cannulation and its care.
iii) Not available at the time of Data collection.
iv) Who are not willing to participate in the
study.
7.2.2 Research Design : Quasi-Experimental one group pre and Post
test design
7.2.3 VARIABLES UNDER STUDY:
Independent variable : Structured Teaching Programme on
Intravenous Cannulation and its care
Dependent Variable : Knowledge level of staff nurses regarding
Intravenous Cannulation and its care
Demographic Variable : Age, Gender, Educational status, Marietal
status, Area of working, Year of Experience
in hospital, Exposure to Education.
7.2.4 Setting : Selected hospitals in Gulbarga
7.2.5 SAMPLING TECHNIQUE : Random sampling technique
7.2.6 SAMPLE SIZE : The sample size for the present study is 50.
7.2.7 Tool of RESEARCH : Structured knowledge questionnaire will be
constructed in 2 parts.
Part 1 : Demographic data
Part 2 : Knowledge based questions regarding
Intravenous Cannulation and its care
7.2.8 DATA COLLECTION
TECHNIQUE : The investigator will collect the pre-test and
post test data from sample by using
structured knowledge questionnaire to assess the knowledge of staff nurses regarding Intravenous Cannulation and its care.