Aswi Editted Copy Project
Aswi Editted Copy Project
Aswi Editted Copy Project
BY
ASWINI. S
KALITHEERTHALKUPPAM,PUDUCHERRY
July 2014
A STUDY TO EVALUATE THE EFFECTIVENESS OF NURSING
INTERVENTION ON PREVENTION OF INTRAVENOUS
THERAPY RELATED COMPLICATIONS AMONG NEONATES
ADMITTED IN NICU AT SMVMCH PUDUCHERRY.
i
A STUDY TO EVALUATE THE EFFECTIVENESS OF NURSING
INTERVENTION ON PREVENTION OF INTRAVENOUS
THERAPY RELATED COMPLICATIONS AMONG NEONATES
ADMITTED IN NICU AT SMVMCH PUDUCHERRY.
JULY 2014
ii
SRI MANAKULA VINAYAGAR NURSING COLLEGE,
KALITHEERTHALKUPPAM,
PUDUCHERRY
DATE:
PLACE: Puducherry.
iii
SRI MANAKULA VINAYAGAR NURSING COLLEGE,
KALITHEERTHALKUPPAM,
PUDUCHERRY
MRS.L.SARASWATHI
PUDUCHERRY.
DATE:
PLACE: Puducherry
iv
PONDICHERRY UNIVERSITY, PUDUCHERRY
Miss. ASWINI.S
DATE:
PLACE: Puducherry.
v
COPYRIGHT
the rights to preserve, use and disseminate this dissertation/ thesis in print or
Miss. ASWINI.S
DATE:
PLACE: Puducherry.
vi
ACKNOWLEDGEMENT
esteemed Institution.
Institution.
the foundation of the project and her direction and support given to me which
vii
I would like to extend my hearty thank to pediatrics HOD
conducted the study in successful manner in NICU and also express my lovable
I would like to thank all our Lecturer and Assistants Lecturer for their
I would like to thank all my Lecturers and Assistants Lecturers for their
A special thanks to our classmates and friends for their support in times of
need, and those who helped me directly or indirectly towards the completion of
the study.
viii
I extended my heartfelt thanks to the librarians, office staff, computer
operators, printers and binders for their help in converting this manuscript into
printed matter.
SIGNATURE
Miss.ASWINI.S
DATE:
PLACE:
ix
ABSTRACT
INTRODUCTION
Nurses who are able to plan and carry out nursing care with knowledge,
skill and confidence are better ambassadors for their specialty. Nurses practice
within a changing and evolving health care environment and therefore they are
supported by knowledge that is continuously evolving and therefore must use the
best available evidence to guide their practice. Nurses who are performing
practice and therefore will deliver a more responsive timely service that will
For nurses working with children and young people, this is usually regarded as
The nurse has the important role and responsibility in monitoring this
type of therapy. All nurses are likely to be responsible for the administration and
x
management of some form of intravenous therapy. The important responsibility
of the nurse is to protect the child from infection during the intravenous infusion.
Infiltration of fluid is common in children nurse has to make sure that the needle
is in place and patent in the basis of scientific principle the protocol using
at SMVMCH, puducherry.”
among neonates.
xi
HYPOTHESES:
CONCEPTUAL FRAMEWORK:
The conceptual framework for the study was based on Lydia Hall, Core,
METHODOLOGY:
The design adopted was pre experimental one group post-test only design.
The main study was conducted in SMVMC Hospital, Puducherry. The period of
data collection was six weeks. Totally 60 Neonates were selected by using
method and interpretations was made on the basis of the objectives of the study.
xii
RESULT OF THE STUDY:
The over all mean value is 10.47% and SD level of 0.947 there is
selected demographic variable, such as age in day, sex, term of birth, weight of
RECOMMENDATIONS
been made,
design.
generalization.
xiii
The study can be done as a longitudinal study.
CONCLUSION:
are affected with moderate and sever complications. So the standardized protocol
intravenous injection with and without antibiotic. It shows that highly significant
xiv
TABLE OF CONTENTS
xv
IV DATA ANALYSIS AND INTERPRETATION 2 34-47
V DISCUSSION, SUMMARY, CONCLUSION,
NURSING IMPLICATIONS, AND 48-58
RECOMMENDATIONS
Discussion
Summary
Conclusion
Nursing Implication
Limitations
Recommendations
BIBLIOGRAPHY 59-61
APPENDICES 62-91
xvi
LIST OF TABLES
TABLE TABLE NAME PAGE
NO. NO.
1. Distribution of selected demographic variable of neonates 35
2. Distribution of mean, SD post test scores of standardized 43
protocol among neonates.
3. Distribution of level of complications related to intravenous 44
therapy for neonates.
4. Association between the levels of complications of intravenous 46
therapy among neonates with selected demographic variable.
xvii
LIST OF FIGURES
FIGURES FIGURE NAME PAGE NO.
1. Conceptual frame work 23
xviii
LIST OF APPENDICES
APPENDIX
NO. CONTENT
Tool:
VI
Informant consent
xix
CHAPTER-I
INTRODUCTION
“An ounce of prevention is better than a pound cure”
Medication administration is a basic nursing function that involves skillful
The nurse needs knowledge base about drugs including drug name, preparation,
classification, adverse effect and physiologic factors that affect the drug action.
modality in the care of neonates. The nurse has the important role and
quickest and most effective means of administering fluid or medicine to the ill
neonates, infant and child, as much as, is a relative common pediatric therapy.
Intravenous fluid may be infused into a peripheral vein, a central access device,
principles of intravenous therapy, including the fluid and caloric needs of the
intensive care unit patients were examined to determine complications rates and
1
associated risk factors. Phlebitis13%, extravasation 28%, and bacterial
ill children every 72 hours would not decrease phlebitis, bacterial colonization,
ill children.
Neonatal Intensive Care Unit (NICU) will undergo the insertion of a peripheral
be approximately 4%, with 70% of such injuries occurring in infants. The study
report shows that children with intravenous cannula for more than 72 hours are
etc.
concern in today’s medical care. There are two major sources of blood stream
catheter may be used if therapy is expected to last less than 5 days. The length of
2
the catheter may be directly related to infection and embolus formation. The
shorter the catheter, the fewer the complications. Determining the best catheter
for the patient early in the therapy provides the best chance of avoiding catheter
related complications.
extravasations are next to a major artery in the forearm or leg, vascular flow can
volume and type of the fluid in filtered. Infiltration is the most common
the dorsum of the hands, the anticubital fosse and the ankle. Serious
using observation check list the signs & symptoms were assessed which reveals
that, the type of infusion, duration of cannulation more than 3 days (50%), IV
antibiotics (12%), female sex(12%), catheter material PEO - vialon and Teflon
3
An article on prevention of infection in peripheral intravenous devices
stated that the possible uses of the catheters that are available in different sizes.
14-16G are used for major trauma/surgery, epidural, massive fluid replacement.
18G for routine blood transfusions, rapid infusion, 20G for routine infusions,
bolus drug administration, 22G for small, fragile veins, short-term access and
chemotherapy.
nurses responsibility in taking care of these children begins with preparing the
material, selecting the vein, selecting proper gauzed catheter, cleaning and
4
NEED FOR THE STUDY
The requirements for fluids and electrolytes of the newborn are unique. At
birth, there is an excess of extra-cellular water, and this decreases. Over the first
few days after birth Furthermore, extra- cellular water at birth and insensible
water loss decrease as birth weight and gestational age increase. Several days
after birth, fluid and electrolyte requirements increase as the infant starts to grow.
intoxication.
infants in a neonatal intensive care unit require intravenous fluids and have shifts
inappropriate fluids are administered, serious morbidity may result from fluid
complications.
5
WHO (2010) A study was conducted to evaluate the effect of nurse
have high knowledge levels, but their practices were not suitable to their
knowledge levels. Of the patients who participated in the study, 67.24% showed
.05) between the selection of the vein and the occurrence of phlebitis in patients
who had an intravenous catheter. We also found that the relationships between
the age groups of the patients and phlebitis and the relationships between the
stated that the possible uses of the catheters that are available in different sizes.
14-16G are used for major trauma/surgery, epidural, massive fluid replacement.
18G for routine blood transfusions, rapid infusion, 20G for routine infusions,
bolus drug administration, 22G for small, fragile veins, short-term access and
over a 3-year period .There were 56 minor and 11 major complications. More
than 50% of minor complications occurred in the hand and wrist, and more than
6
hematomas resulting in skin necrosis in 2%, and infiltration related
in 13%.Risk factors for phlebitis were skin lesions, active infection unrelated to
peripheral venous catheter, "poor quality" peripheral vein and > 72 hour-of
peripheral venous catheters are frequent but remain benign. They could probably
different guidelines.
occur with prolonged use. A study findings revealed that phlebitis occur most
commonly and the frequency is from 2.5 to 45% or more and the chance for
7
MGR university of health and science Tamil Nadu (2010).A study was
intensive care unit patients were examined to determine complication rates and
ill children every 72 hours would not decrease phlebitis, bacterial colonization,
ill children.
venous catheter .
8
therapy. They studied 3094 patients with 5161 total episodes of peripheral
intravenous therapy(PIVT) from the day of admission until the day of discharge.
The results showed that the overall rate of phlebitis was 2.3% and the rate of
experience and competence on the length of time and the number of attempts to
using observation check list the signs & symptoms were assessed which reveals
that, the type of infusion, duration of cannulation more than 3 days (50%),
and Teflon (6%), anatomic site - forearm related (12%) and wrist(8%).
of the nurse is to protect the child from infection during the intravenous infusion.
9
Infiltration of fluid is common in children nurse has to make sure that the needle
is in place and patent in the basis of scientific principle the protocol using
evidence based resources .The overall focus was on raising awareness, providing
cannula care among staff nurse technique may reduce the complications, so the
10
STATEMENT OF THE PROBLEM:
among neonates.
ASSUMPTION:
11
HYPOTHESIS:
OPERATIONAL DEFINITION:
among neonates.
12
Intravenous therapy: It refers to administration of fluid substance and
redness,tenderness,pain,swelling,phlebitis,thrompophlebitis,infiltration,ex
Neonate: It refers to the new born from birth to 28 days after delivery.
DELIMITATIONS:
The study was limited the neonates only admitted in NICU at SMVMCH.
13
CHAPTER II
REVIEW OF LITERATURE
Review of literature is a key step in research process. Review of literature
relevant to the research project. A review of research and non research literature
relevant to the study was undertaken which helped the investigator to develop
deeper insight into the problem and gain information what has been done in the
past.
complications.
therapy.
complications.
compare the rates of phlebitis of peripheral intravenous lines left in place for 72
hours versus rates of those left in place 96 hours. Design was a prospective,
nonrandomized study. Setting was a university teaching hospital with 375 beds.
and were admitted to the wards. Results were a total of 2503 peripheral lines
were evaluable. The overall phlebitis rate was 6.8%. It was estimated that in 1
14
month approximately 300 intravenous lines potentially could be prolonged
inflammation, 61 lines were kept till 96 hours, and 19 lines were kept beyond 96
hours. The study concluded that the Phlebitis rate for peripheral intravenous
infection and catheter material are the important risk factors while the neonates
catheter colonization were calculated. They studied 642 Teflon catheters in place
for 525 neonates. There were no cases of catheter sepsis, 1% possible insertion-
15
recommendations are made for children. Findings and those of others indicate
replacement.
hundred fifty-four peripheral Teflon catheters in 303 pediatric intensive care unit
and could increase extravasations risk. Catheters can be safely maintained with
with 954 cannula insertions. The risk of phlebitis was significantly greater with
Teflon catheters (18.8 % with Teflon catheters, 8.8 % with steel needles), steel
catheters, 40.1% with steel needles). The overall rate of complications was
significantly greater for the group in which steel needles were used (53.8 %
versus 64.0 %), basically due to the increased risk of infiltration with steel
needles.
16
Halvorsommerfelt. E et. al., (2009) had conducted descriptive study on
the IV related complication. The samples were 650 neonates with IV cannula
from Nice University Hospital. The Chi-square findings show that 54(13.6%)
had thrombophlebitis, 50(13.2%) had Infiltration and 9 (2.3%) had swelling and
local infection.
observation check list the signs & symptoms were assessed which reveals that,
antibiotics (12%), female sex(12%), catheter material PEO - vialon and Teflon
2515 neonates (25%) received a peripheral venous cannulation, Indication for the
arrival at the emergency department, and 33.8% upon leaving the emergency
department. Out of 318 neonates, the peripheral venous cannula was left in place
followed until the time of their removal. Among these 390 neonates, 62 (15.9%)
17
Wilkinson .R et. al., (1989) had conducted study on “Randomized
and splints. Prospective data was collected regarding duration of patency and
complications. Both univariate and multivariate analysis were done. There was a
statistically significant increase in the duration of patency with the use of heparin
flushes and splints. Shorter patency duration and increased complications were
associated with younger age, wrist and scalp insertions, and 24-gauge catheters.
therapy” there were 503,300 hospital stays with IV cannulated noted an increase
of nearly 80% since. More than 90% of the neonates had intravenous cannula in
NICU and general ward 100 % of neonates had IV cannula line. In comparison
56.5% of male neonates and rest of them were female neonates. The cross
sectional study results shows that complication are phlebitis rates reported for
neonates receiving intravenous therapy have been as high as 80%, with the rates
in most hospitals ranging between 20% and 80%. Other complications resulting
infection.
18
2. Review of Literature related to protocol for intravenous therapy.
The use of 0.8mm size cannula had increased by 22% (p<0.001). The study also
Zealand. The survey received a 96% response rate. Approximately two thirds of
Australian and New Zealand NICUs have written protocols for prevention and
for both prevention and treatment of EI. 92% of units had experienced cases of
ensuring that guidelines for the prevention and treatment of EI are available, and
was used by 69% (18/26) of units. A further 23% (6/26) had no written policy
19
standard practice. Broken down by country, 83% (5/6) of the New Zealand units
intravenous therapy with their nursing experience and their level of educational
Statistical analysis model was used for statistical analysis. To find the association
Results showed that patients demographic variables (age, gender, first language,
and day, impatient status of patient) did not significantly predict overall rating of
observational survey carried out with 427 neonates in one Italian hospital. A
20
variables evaluated were age, gender, term of birth, weight of baby, therapy size
and site of therapy location. The study shows that the frequency of peripheral
(P < 0·006). The highest incidence was found in neonates with therapy inserted
in the dorsal side of the hand veins compared to those with therapy inserted in
cubital fossa veins (P < 0·001). The use of cubital fossa veins rather than forearm
whether intravenous care conformed to the hospital policy”. The study was done
Pennsylvania. The peripheral line assessment revealed those 87 sites (56%) < 72
hours old, 4 sites (3%) > 72 hours old and 64 sites (41%) that were not recorded.
The researcher suggested need for improvements which included the need to date
all dressings/ infusion tubing, proper labeling of all bottled/bags and efforts to
infectious complications from this device. 376 out of 830 patients had
signs of infection. The study concluded that the health workers require ongoing
21
education to ensure prompt removal of devices that are not required for patient
care.
improvement were distributed among the staff. During the surveys, 40% ± 8% of
1998 to 2.6% (5/189) in 2003 (P < .01) throughout the study period.
devices placed by infusion nurses with complication rates in neonates who had
significance was not achieved with pain complication rates between the two
groups.
22
CONCEPTUAL FRAMEWORK
that are assembled together in some rationale scheme by virtue of their relevance
to a common.
- Polit&hungler(2006)
THEORY OVERVIEW:
CORE CIRCLE:
According to the theory ,the core refers to patient care is based on social
sciences Therapeutic use of self Helps patient learn their role is in the healing
process Patient is able to maintain who they are Patient able to develop a
maturity level when nurse listens to them and acts as sounding board Patient able
in the NICU. Not only do the babies need gentle care but nurses have to be
prepared to work with the parents and families, who are scored and worried and
23
In this study, the core circle refers to staff nurse, investigator, student
nurses having therapeutic relationship with each other for discussing about the
CARE CIRCLE :
Nurses goal is to “comfort” the patient patient may explore and share feelings
complications. Before start intravenous therapy proper hand wash, strict aseptic
technique when starting intravenous therapy, clean the site before insertion
intravenous infusion using an alcohol swab( wipe and allow to dry), avoid joints
when selecting a site, Avoid veins over joint flexion, Proper supportive measured
use in splint, Assess the intravenous site frequently, intravenous site with sterile
dressing, utilizes single –use intermittent medication tubing, inspect access site
patient care, maintain prescribed flow rate with regular patient assessment,
24
CURE CIRCLE:
According to the theory, the cure refers to Care based on pathological and
phase of care Nurse is patient advocate in this area Nurses role changes from
25
CHAPTER III
RESEARCH METHODOLOGY
indicates the general pattern of organizing the procedures for gathering the valid
of the tool, data collection techniques and plan for data analysis.
RESEARCH APPROACH:
A research approach tell the researcher, what data to collect and how to
RESEARCH DESIGN:
The research design refers to the researcher’s overall plan for testing the
research hypothesis. The research design helps the researchers in the selection of
Research Approach
Quantitative Approach
Research Design
Quasi experimental post test only design
Target Population
All neonates admitted in NICU
Accessible
theD.T.Ed students studying Population
in District Institute of Education and
Neonates admitted in NICU inSMVMCHwith intravenous infusion
Training at Puducherry
Sampling Technique
Conveniente Sampling Technique
-
Data Analysis
Descriptive Statistics: Frequency distribution, Mean, Standard Deviation
Inferential Statistics: Chi Square test, Paired‘t’ test
Result
Positive outcome of nursing intervention in terms of
prevention of intravenous related complications
25
POPULATION:
The term population refers to the aggregate (or) totality of all subject (or)
Setting is the physical location and condition in which data collected takes
place.
SAMPLE:
Sample refers to the Subject of the population that is selected for a study.
In this study, sample consists of neonates who fulfill the inclusion criteria.
SAMPLE SIZE:
SAMPLING TECHNIQUES:
at the right time, with addition of available subjects until the desired sample size
is reached.
26
CRITERIA FORSAMPLE SELECTION:
Inclusion criteria:
Exclusion criteria:
VARIABLES:
The term variables are concepts at different level of abstraction that are
study.
intervention
27
INFLVENCE ING VARIABL
Age of days
Sex
DEPENDANT VARIABLE
INDEPENDENT
Term of birth VARIABLE
Prevention of intravenous
Type of delivery
therapy related -Standardized
Wight of the baby protocol for nursing
complications
intervention
Duration of IV therapy
Site of IV cannula
Type of IV fluid
antibiotic
EXTRANEOUS VARIABLE
-catheter material
-duration of catheter
-mechanical complications
-GDM
24
DESCRIPTION OF THE TOOL:
experiences and with the extensive review of literature and discussion with
intravenous therapy.
Section C: observational check list for staff nurse which is 10 items not
1-10- no complications.
25
CONTENT VALIDITY
The contents of the tool were evaluated by five experts from Child Health
Nursing Department. A criterion rating scale for validation of the tool was
developed experts were asked to give opinion and suggestion about the content
RELIABILITY:
The reliability of the tool was established by using split of method (r=0.5).
PILOT STUDY:
A pilot study is a trail run for the main study to test the practicability,
obtained permission to conduct the study. After a formal approval from the HOD
feasibility and practicability. The investigator approach the NICU staff nurses
and informed regarding the objectives of the study and obtained the consent from
26
For 10 neonates investigator assessed for intravenous therapy
result of the pilot study revealed that the study was feasible and practicable and
modification was made in the tool after pilot study in the aspect of protocol. And
observational checklist was prepared for staff nurses. Suggested by the experts.
permission were obtained from the hospital authority. Sample was selected based
day 4 babies were selected at the end of the 7thdaylevel of intravenous therapy
27
PLAN FOR DATA ANALYSIS:
The data obtained was analyzed in terms of the objective of the study
using descriptive and inferential statistics. The plan of data analysis was as
follows.
28
CHAPTER IV
using inferential statistics. Analyzed and interpreted data are based on the
Table 2:Distribution of mean, SD, post tests core on standardized protocol for
neonates.
neonates.
demographic variable.
29
Table 1: Distribution of selected demographic variable of neonates
30
Inference:
(3.33%) of them were born in preterm 5 (8.33%) of them were post term baby.
forceps delivery.
the (hypertonic fluid), 35 (58.33%) of them were received the (isotonic fluid).
31
Considering the Intravenous injection with and without antibiotic of
32
Term baby
Pre term baby
Post term baby
88.33%
100
80
60
40
20 3.33% 3.33%
0
Term baby
Pre term
Post term
baby
baby
33
6-10 days
>10 days
25%
75%
34
Digital vein
Basicila vein
66.67%
Cephalic vein
70
60
50
40 25%
30 8.33%
20
10
0
Digital vein Basicila vein Cephalic vein
35
Yes
No
58.33% 41.67%
36
Table-2: Distribution of mean post test score of standardized protocol among
neonates.
score
Inference:
Table 2: the above table shows that mean post test score for
intravenous therapy mean value is 10.47 and the standard deviation is 0.947.
37
Table -3: Distribution of level of complications related to intravenous
complications F %
No 44 73.33
complications
Mild 16 6.67
Moderate - -
Severe - -
Total 60 100
Inference:
related to intravenous therapy among neonates are classified as four level such as
16 neonates (26.67%) had mild complications and no neonates are affected with
38
73.33%
80 No Complications
70 Mild
60 Moderate
50 Severe
Percentage
40 26.67%
30
20
10 0% 0%
0
No Complications Mild Moderate Severe
Level of complications
39
Table 4: Association between the level of complications of intravenous therapy
among neonates with selected demographic variable.
S. No No complications Mild
Demographic variables complications χ2 p-value
F % F %
1. Age in days:
1-6 days 25 41.67 9 15
7-15 days 8 13.3 2 3.3 0.39 0.001**
16-28 days 11 18.3 5 8.3 (df=2)
2. Sex :
Male 26 43.3 8 13.3 0.39 0.001**
Female 18 30 8 13.3 (df=1)
3. Religion:
Hindu 28 46.7 11 18.3 1.37 0.468
Muslim 11 18.3 2 3.3 (df=2)
Christian 5 8.3 3 5
4. Term of Birth:
Term baby 39 65 14 23.3
Pre term baby 2 3.3 0 0 1.18 0.01*
Post term baby 3 5 2 3.3 (df=2)
5. Type of delivery :
Vaginal delivery 35 58.3 10 16.7 3.35
Elective LSCS delivery 7 11.7 3 5 (df=2) 0.187
Forceps delivery 2 3.3 3 5
6. Weight of baby :
1.3-2.3kg 2 3.3 0 0
2.4-3.3kg 20 33.3 7 11.7 0.82 0.001**
>3.3kg 22 36.7 9 15 (df=2)
7. Duration of IV therapy:
6-10days 32 53.3 13 21.7 0.45 0.001**
>10 days 12 20 3 5 (df=1)
8. Site of IV Cannula:
Digital vein 32 53.3 8 13.3 0.256
Basilic vein 9 15 6 10 2.73
Cephalic vein 3 5 2 3.3 (df=2)
9. Type of IV fluid :
Hypertonic 21 35 4 6.7 2.49 0.146
Isotonic 23 38.3 12 20 (df=1)
40
Indication of IV
therapy:
11. Respiratory disorders 13 21.7 3 5
Neonatal infection 9 15 3 5 3.51 0.476
Electrolyte imbalance 5 8.3 5 8.3 (df=4)
Baby with physiological 13 21.7 4 6.7
and pathological
jaundice
Metabolic disorders 4 6.7 1 1.7
*-p<0.05 significant, ** -p<0.01 & ***-p<0.001 highly significant
41
Inference:
(p<0.001), intravenous injection with and without antibiotic (p<0.06). It all shows
42
V. CHAPTER
DISCUSSION
The goal of the study was “A study to evaluate the effectiveness of
the present study is based on the findings obtained from statistical analysis of
collected data.
observation check list and observation check list for staff nurse to assess the
level complications among neonates. According to the score, I have assessed the
therapy. In that result shows that 44 neonates (73. 33%) had no complications of
related complications and no neonates are affected with moderate and sever
complications.
in NICU were mostly lies between the age group of 1-6 days (56.67%).when
coming to the gender male neonates are more common 34(56.67%) .Most of the
43
neonates belong to Hindu religion 39 (65%). Most of the babies term of birth 53
pathological jaundice.
(p<0.001). The use of 0.8mm size cannula had increased by 22% (p<0.001). The
study also showed that the documentation had increased (p<0.001) after
that most of the neonates admitted in NICU are prompt to get intravenous
44
Batten.Ret.al. (1996) In this study was supported by an For most IV
therapy is expected to last less than 5 days. The length of the catheter may be
directly related to infection and embolus formation. The shorter the catheter, the
fewer the complications. Determining the best catheter for the patient early in the
survey carried out with 427 neonates in one Italian hospital. A standardized
evaluated were age, gender, term of birth, weight of baby, therapy size and site
of therapy location. The study shows that the frequency of peripheral intravenous
therapy thrombophlebitis was higher in weight of the baby(P < 0·006). The
highest incidence was found in neonates with therapy inserted in the dorsal side
of the hand veins compared to those with therapy inserted in cubitalfossa veins
(P < 0·001). The use of cubital fossa veins rather than forearm and hand veins
peripheral.
Table 4:Association was found by using chi-square test indicate that there
was an association between the age of child term of birth duration of intravenous
the level of complication of intravenous therapy finding revels that neonates with
less age and duration of intravenous therapy causes a complications due to any
delicate vein.
46
Wilkinson. Ret.al.LadyHardinge Medical College and Associated
and splints. Prospective data was collected regarding duration of patency and
complications. Both univariate and multivariate analysis were done. There was a
patency with the use of heparin flushes and splints. Shorter patency duration and
increased complications were associated with younger age, wrist and scalp
infusion nurses with complication rates in neonates who had devices placed by
generalist nurses. The data demonstrated that peripheral infusion devices placed
complications and remained in the vein significantly longer than those placed by
47
SUMMARY
extensive review of literature, professional experience and expert guided lead the
The conceptual frame work developed for the study was based on the
Convenient samples techniques was adopted one group post test only
The data was collected by using VIP complications scale which includes
validity of tool. The pilot study was conducted with 10 neonates at SMVMCH,
puducherry.
The ethical aspect of research was maintained throughout the period from
48
standardized protocol and assessed for intravenous complications based on the
The over all mean value is 10.47% and SD level of 0.947 there is
selected demographic variable, such as age in day, sex, term of birth, weight of
49
CONCLUSION
are affected with moderate and sever complications. So the standardized protocol
intravenous injection with and without antibiotic. It shows that highly significant
NURSING IMPLICATIONS
1. The present study can help nurses to enrich their knowledge skill, practice
prevent infection).
infection.
50
d) In order to maintain proper position splint should be used because it is
appropriate manner.
practice this standardized protocol daily in their clinical setup she’s become well
NURSING EDUCATION
therapy.
handling such clients and how to identify their difficulties and help them to
51
4. As nursing educator, need to strengthen the evidence based nursing practices
NURSING PRACTICE
1. Nurses working in NICU should have enough knowledge and special skills
NURSING ADMINISTRATION
3. Nurse Administrator should select the staff nurses with good knowledge,
neonates.
52
5. The nursing administrator should take initiative in organizing the continuing
NURSING RESEARCH
1. The findings of the study help the nurses and students to develop the inquiry
by providing baseline. The general aspect of the study result can be made by
LIMITATIONS
The study was limited the neonates only admitted in NICU at SMVMCH.
53
RECOMMENDATION
been made,
design.
generalization.
54
VI.BIBLIOGRAPHY
BOOKS REFERENCE
(2008)P.no:80.
Nursing”, 5th edition, published by Jud. (2010) Page. No: 95, 124 -128.
emmess. (2012)P:no:56-62.
55
12. Nitis.Dr.k. shar, “Indian academy of pediatrics, pediatric infectious disease”,
Jaypee brothers medical publishers (p) ltd, new delhi. (2005) P.no: 602-605,
14. Parul data, “pediatric nursing”, 2nd edition, published by jaypee. (2011) P:
15. Ross and Wilson,” anatomy and physiology”, published by evalove, new
publishers. (2001)P:no:34.
56
22. DattaParul, “pediatric nursing”, 2nd edition, published by jaypee. (2010) P:
25. Gupta Suraj, ”The short text book of pediatrics”, 11th edition, published
(2003)P:no:56-62.
31. Manojyarav, ”A text book of child health nursing with procedures”, edited
9, 259-261.
57
33. Moralo. “Text book of pediatric nursing”, 2nd edition, published by
Jaypee brothers medical publishers (p) ltd, new delhi.(2008) P.no: 602-
128.
39. Wilson and Ross,” anatomy and physiology”, published by evalove, new
58
42. BibudhaB . “American Academy of Pediatrics Report of the Committee
43. Pillitteri Adele. “Child health nursing” 8th edition , published by Elsevier
44. Masoorli, Sue. “Nerve Injuries Related to Vascular Access Insertion and
P:no49.
59
51. Mathew K V, “Clinical nursing procedure manual” 7th edition,
Publications Pvt Ltd, 2004, Page 40.
52. Irwin E, “Text book of pediatric Nursing, volume-II, 1st edition published
by Kumar publishing House, New Delhi. 2003, p: no: 20-35
55. Shives, “Basic concept of Child Health Nursing, 7th edition, published by
wolterskluever. (2010),p:no: 124-135
56. Mary C. Townsend, “Child health Health Nursing,” 6th edition, published
by Jaypee publication.(2012) p:no: 155-176.
60. Perry Griffin Anne., “Basic Nursing Theory and Practice”., Third
edition., published by St. Louis Mosby Company., (1998), p:no: 231-232.
60
JOURNAL REFERENCE
3(5):230-240.
Aug:18(4) : 211-5.
– 6.
61
9. Lundgren Anna, Wahren Karin Lis. Effect of education on evidenced-
11. Lerma, Ung, Lerma, Cook, Sara, Edwards, et al. Peripheral Intravenous
14. Paulson PR, Miller KM, “Neonatal peripherally inserted central catheters:
84.
62
17. PalefskiSSandStoddard GJ, “The infusion nurse and patient complication
100.
20. Chandravasu O et al., “A New Method for the prevention of Skin Sloughs
NET REFERENCE:
http://www.rcn.org.uk
http://www.wisegeek.com
2002;113(2):146-151 http://www.amjmed.com.
63
5. DalalSS,Chawla D, Singh J, Agarwal RK, Deorari AK, Paul VK.Limb
6. http://27/photobucket.com/album/jj158/derive/IVpic.jpghttp://www.nursi
ngcentre.com
7. http://www.Elitemedical.com
8. http://www.Karolinska.com
9. http://www.medtexx.com
10. http://www.nursingtimes.net
64
APPENDIX-I
RESEARCH TOOLS
SECTION:A-DEMOGRAPHIC DATA
Sample no:
1.AGE IN DAYS:
A. 1-6 days
B. 7-15 days
C. 16-28 days
2.SEX :
A. Male
B. Female
3.RELIGION:
A. Hindu
B. Muslim
C. Christian
4.TERM OF BIRTH:
A. Term baby
B. Pre term baby
C. Post term baby
5.TYPE OF DELIVERY:
A. Vaginal delivery
B. Elective LSCS delivery
C. Forceps delivery
6.WEIGHT OF BABY :
A. 1.3-2.3kg
B.4-3.3kg
C.>3.3kg
7.DURATION OF IV THERAPY:
A. 6-10days
B. >10 days
65
8.SITE OF IV CANNULA:
A. Digital vein
B. Basicilic vein
C. Cephalic vein
9.TYPE OF IV FLUID :
A. Hypertonic
B. Isotonic
11.INDICATION OF IV THERAPY:
A. Respiratory disorders
B. Neonatal infection
C. Electrolyte imbalance
D. Baby with physiological and pathological
E. Jaundice
F. Metabolic disorders
66
SECTION: B-MODIFIED VISUAL COMPLICATIONS SCORE
SCALE
COMPLICATIONS:
a. No pain(1)
c. Moderate(3)
d. Sever(4)
2.Infiltration:
a. Absent(1)
c. Skin blanched(3)
3. Hematoma:
a. Absent(1)
b. Edema(2)
c. Redness(3)
d. Skin discoloration(4)
4. Thrombosis:
a. Absent(1)
b. Swelling (2)
c. Tenderness(3)
67
d. Obstruction of flow(4)
5.Thrombophlebitis:
a. Absent(1)
b. Erythematic(2)
c. Palpable cords(4)
6.Pulmonaryemboliusm:
a. Absent (1)
b. Dyspnea(2)
c. Cough(3)
d. Hemoptysis(4)
7.Air embolism:
a. Absent(1)
b. Pain(2)
c. Dizziness(3)
d. cardiac arrest(4)
8. Septicemia:
a. Absent(1)
c. Flushed skin(3)
d. Tachycardia(4)
68
9.Pulmonary edema:
a. Absent(1)
b. Restlessness(2)
c. Shortness of breath(3)
c. Hypoxia(4)
10.Speed shock:
a. Absent(1)
b. Hypotension(2)
COMPLICATIONS SCORE:
1. 1-10-No complications
69
SECTION: C-OBSERVATIONAL CHICK LIST FOR
STAFF NURSE
2. Infiltration:
Absent/inflammation near the insertion site/skin
blanched slowed (or)stopped infusion.
3 Hematoma:
absent /edema/redness/skin discoloration.
4 . Thrombosis:
Absent/swelling /tenderness/obstruction of flow.
5 Thrombophlebitis:
Absent/erythema/low grade fever/palpable cords.
6 Pulmonary emboliusm:
absent /dyspnea/cough/ hemoptysis.
7 air embolism:
absent/pain/dizziness/ cardiac arrest.
8 septicemia:
absent/general malaise and high greade
fever/flushed skin/tachycardia.
9 pulmonary edema:
absent/restlessness/shortness of breath/hypoxia.
10 speed shock:
absent/hypotension/ weak (or) absent pluse/cold
(or) blue extremities.
70
APPENDIX-II
FROM:
S.ASWINI
MSC, NURSING (II-YEAR),
SRI MANAKULA VINAYAGAR NURSING COLLEGE,
KALITHEERTHALKUPPAM,
TO:
Respected sir,
sub: Request to accord permission for conducting research project
Thanking you
Yours Faithfully
S.ASWINI
71
LETTER SEEKING PERMISSION FOR CONDUCTING THE
STUDY
Date: 27.09.2013
TO:
Puducherry.
Sir,
Regarding this project data collection she is in need of your esteemed help
and co-operation. I request you to kindly permit her to conduct proposed data
collection. Kindly do the needful.
Thanking you,
Yours sincerely,
PRINCIPAL.
72
APPENDIX – III
LIST OF EXPERTS
1. MRS.SUMATHI,
PROFESSOR IN CHILD HEALTH NURSING,
KGCON,
PUDUCHERRY.
2. MRS.ROSE RAJESH,
PROFESSOR IN CHILD HEALTH NURSING,
PIMS,
PUDUCHERRY.
3. MRS.V.SASI,
PROFESSOR IN CHILD HEALTH NURSING,
VMCON,
PUDUCHERRY.
4. MRS.SUJATHA,
PROFESSOR IN CHILD HEALTH NURSING,
PIMS,
PUDUCHERRY.
5. MRS.BARANI,
HOD IN CHILD HEALTH NURSING,
RAAK,
PUDUCHERRY.
73
APPENDIX – IV
LETTER FOR VALIDATION OF TOOL
From
Ms.ASWINI.S ,
Kalitheerthalkuppam.
To
Respected Sir/Madam,
Sub: Requesting the Experts opinion and suggestions for establishing the content
validity.
Thanking You,
Yours faithfully.
(ASWINI.S)
Enclosures:
1. Research tool
2. Certificate of validation
3. Evaluation check list
74
CHECK LIST FOR VALIDATION OF TOOL
Introduction
The expert is requested to go through the following criteria for evaluation
of check list. Three columns are given for response and a column for remarks.
Kindly place tick mark in the appropriate column and give remark,
Interpretations of columns
Column I - Meets the criteria
Signature :
Name, Designation :
Address :
75
CERTIFICATE OF VALIDATION
Vinayagar Nursing College, Puducherry who has undertaken study field title of
Name :
Designation :
Date :
76
APPENDIX-V
SIGNATURE
DATE :
PLACE :
77
APPENDIX-VI
INFORMANT CONSENT
SIGNATURE
78
APPENDIX-VII
DATE COLLECTION SCHEDULE
DATE OF T
DATA TIME ACTIVITIES/ PROCEDURE
COLLECTION
25/9/2013 to 7am to 7pm -First day I assessed the child condition and then I
1/10/2013 Checked the physician order.
-Before injecting hand washing done.
- Selected the site by avoiding the joint areas.
-Clean the site with alcohol swab (wipe and allow
to dry).
- Select the appropriate size of venflon ,prepare
few Strip of adhesive tapes and keep ready for use.
- Apply tourniquet firmly 6 to 8 inches proximal
to the venipuncture site.
-Inserted needle into the vein by holding the
needle at a 30 degree angle with the bevel, pierce
the skin lateral to the vein, when back flow of
blood occurs into the needle and tubing, insert the
needle further up into the vein about ¾ or 1 inch,
release the tourniquet.
-Secured venflon H method or crises cross
method.
-Supportive the site with splint.
-Then connected with the intravenous tubing.
-The pattern of tubing maintaining still 7am to
7pm.Then after that 7pm to 7am hand over to the
staff nurse to maintain patency.
-Observational check list was given to the staff
nurse.
-To was assess the complications among neonates.
79
7am to7pm -Second day I assessed the intravenous line.
-Check for flow rate overload or inadequacy is
beassessed.
-Check for the movement of hand, assessed the
baby activity assessed intravenous site.
-Secured with sterile dressing.
-Change intravenous site dressing if necessary,
then monitored the vital signs.
7am to 7pm -In third day I assessed the intravenous site.
-If any other complications occurs means I was
removed intravenous line.
-Again restart the new intravenous line therapy
by using standardized protocol infusion.
7am to 7pm -In fourth day I assessed the intravenous line.
-If the child condition is good recovered means,
safely removed the intravenous therapy.
7amto7pm -In fifth and six days I followed same routine
standardized protocol for nursing intervention for
neonates.
80
APPENDIX- VIII
INTRAVENOUS PROTOCOL MODULES
PROTOCOL FOLLOWED FOR NURSING INTERVENTION ON
PREVENTION INTRAVENOUS THERAPY COMPLICATIONS
Step-1
Proper hand washing
Step-2
Step-3
Step-4
81
Step-5
Step-6
Step-7
Joint flexion Avoid veins over
82
S.NO FOLLOWED PROTOCOL FOR NURSING INTERVENTION ON
PREVENTION OF INTRAVENOUS THERAPY COMPLICATIONS
3. Clean the site before insertion iv infusion using an alcohol swab (wipe and allow to
dry)
4. Strict aseptic technique when starting iv
83
PROTOCOL FOLLOWED NURSING INTERVENTION ON
PREVENTION OF INTRAVENOUS THERAPY RELATED
COMPLICATIONS AMONG NEONATES
INTRODUCTION:
AIM OF PROTOCOL:
Administer drugs
Maintain correct hydration
Transfuse blood and blood products
Keep vein patent
PRINCIPLES TO ADOPT PRIOR TO INTRAVENOUS LINE
CANNULATION:
cannulate veins in the lower arm and hand first, if no success, select legs
No more than 3 attempts at cannulation shall be made by one individual.
After 3 unsuccessful attempts additional attempts shall be made by some
one with more experience
use sterile equipment and apply principles of asepsis
ensure correct identification of patient prior to procedure
decontaminate hands prior to procedure
cleanse babies skin using surgical spirit swabs and allow 30 second to dry
prior to insertion of cannula
the volume of intravenous fluid for administration should be calculated
accurate labeling of additives to the intravenous fluid is essential
2
the cannula length should correspond approximately to the length of
straight vein to be used
expected duration (short length and small gauge permit better blood flow)
infusion rate
18G Green 45 76
20G Pink 33 54
22G Blue 25 31
24G Lime(yellow) 19 14
3
SELECTION OF SITE INTRAVENOUS LINE CANNULATION:
PROCEDURE:
Preliminary assessment:
Preparation of articles
4
Sterile tray contains
a. Intravenous line cannula kit containing stainless steel bowl (1) sterile
cotton swabs (3) sterile towel(1)
b. Sterile gloves
I.V stand
1. Wash hands
5
2. Arrange all articles in nurse station
3. Check the intravenous solution (color, clarity, expiry date, leakage)
4. Open the infusion set, maintaining sterility of both ends of tubings
5. Clean the top of the solution bottle with a spirit swab
6. Insert infusion set in the fluid bottle and close the roller clam fill
drip chamber
7. Release slowly the roller clamp to allow the fluid travel from drip
chamber to tubing with out air bubble
8. Replace the tubing cap at the end of the tube
6
Insertion of intravenous line cannula:
1. Collect all used articles washed, cleaned and replaced and dispose the
waste appropriately
2. Wash hands
3. Observe the client for adverse reaction at the site of cannula insertion,
such as pain, infliltration, allergic reaction etc.
4. Ask the baby mother (or) relatives to report if any unfavorable signs such
as fever, chills, etc. occur
5. Document the procedure with date, time, type of intravenous fluid and
drops per minute, with signature
7
DAILY CARE OF INTRAVENOUS LINE CANNULA:
8
8. Inspect the site of cannula insertion for adverse reaction such as pain,
thrombophlebitis etc,
9. Take 2 ml of normal saline (0.9%) from the IV bottle in aseptic manner in a
sterile 5 ml syringe
10. Flush the intravenous line cannula with 2 ml normal saline (0.9%) twice
(morning & evening ) within a minute (except for intravenous normal saline)
11. Instruct the patient (or) caretaker to report if any chills, fever, edema, etc.
12. Collect all the used articles, replaced properly and dispose the waste
appropriately.
13. Wash hands.
14. Document the procedure (date, time, condition of vein) with signature.
1. Provide the information to the baby mother about the removal of cannula
2. Wash hands
3. Prepare and then arrange all the articles for the intravenous cannula removal
nearby baby bedside in a clean stool.
9
a.Intravenous line cannula care kit containing
Steel bowl – 1
Swabs – 2
Sterile towel – 1
Sterile gloves
10
COMPLICATIONS OF INTRAVENOUS LINE CANNULATION
Local complications
11
SYSTEMIC COMPLICATIONS:
fluid over load : due to on non adjustment of fluid rate (or) drops
air embolism : a possible hazard during all forms of intravenous therapy
due to careless administration without expelling air in tube
infection:
nerve damage : due to improve placement of arm (or) too tight tying of
arm board (or) splint
CONCLUSION:
12
13
Neonates admitted in NICU. Arrange all articles in nurse station
14
Assessment and identification of vein Administering intravenous cannula
15
Observation of any complications. Proper replacement of articles
16
Adjust the flow rate
17
18