DOI: 10.

21276/sjmps

Saudi Journal of Medical and Pharmaceutical Sciences ISSN 2413-4929 (Print)

Scholars Middle East Publishers ISSN 2413-4910 (Online)
Dubai, United Arab Emirates
Website: http://scholarsmepub.com/

Original Research Article

Assess Nurses Knowledge and Practices towards Care and Maintenance of

Peripheral Intravenous Cannulation in Services Hospital Lahore, Pakistan
Zonobia Qamar1, Muhammad Afzal2, Robina Kousar3, Ali Waqas4, Dr. Syed Amir Gilani5
1
Posr RN Student, Lahore School of Nursing, The University of Lahore, Pakistan
2
Principal, Lahore School of Nursing, The University of Lahore, Pakistan
3
Assistant Professor, Lahore School of Nursing, The University of Lahore, Pakistan
4
Visiting Lecturer, Lahore School of Nursing, The University of Lahore, Pakistan
5
Dean, Faculty of Allied Health Sciences, The University of Lahore, Pakistan

*Corresponding Author:
Zonobia Qamar
Email: [email protected]

Abstract: The current study assesses the knowledge and practices towards maintenance and care of the peripheral
intravenous cannulation among the nurses of public hospitals of Lahore, Pakistan. The data was collected from 240
nurses of Services hospital Lahore, Pakistan through convenient sampling. The results of the current study depict that
nurses of Services hospital, Lahore, Pakistan have good knowledge regarding care and IV cannula but lack the practices.
Therefore, healthcare provider should train the nurses to improve the practices in the public hospitals especially. SPSS 21
used to analyze the data. Limitations and recommendations are given in the end of this study.
Keywords: Knowledge, Nurses, Practice, Peripheral intravenous (I/V) cannulation

INTRODUCTION cannula with outer surface of catheter [4]. Due to high

This study is to assess the knowledge and risk of infection and embolism, superficial veins of the
practices of nurses regarding care and maintenance of lower limbs are avoided. If the cannula is placed in the
intravenous cannula. Peripheral venous Cannulation is lower limbs it may resisted soon [5].
the insertion of a vascular access device into a
peripheral vein. This procedure needs manual skills, Blood stream infections are also associated
professional competency, knowledge about the anatomy with peripheral or intravenous catheters through
and physiology of vascular system. Intravenous contamination of microorganisms on the venous
cannulas are small hollow advance device over a needle puncture site. Organisms include staphylococcus
which penetrates into vein and it is used more epidermidis, staphylococcus aureus, candida species
frequently for administration of different drugs, fluids, and enterococci which introduced within contaminated
blood, nutrition, for sampling and other purposes [1]. infusion fluids [6].

However, the incidences of local or blood In today’s world of health care, nurses must
stream infections are related to IV therapy. A possess up to date knowledge while practicing
considerable number of deaths occur due to blood intravenous therapy for safe nursing practice as well as
stream infections like every 10th person is suffering excellent quality of care. Nurses are responsible for
from one type of hepatitis which is life threatening. This provision of safe, patient centered and effective care to
problem occurs due to the poor practices of intravenous the patients. To minimize the severity of complications,
cannulation or therapy [2]. Moreover, may cause the puncture site must be constantly monitored for early
universal infection which can be mechanical or identification of signs. In addition, hands should be
infectious like Occlusion, thrombosis, dislodgment, decontaminated properly before gathering equipment,
infiltration, leakage, phlebitis and scar formation are the palpation of the veins, cannulation and placing gloves
mechanical complication while fungal and bacterial on hand, repeat it after removing gloves and before and
sepsis are included in infectious complication [3]. after the contact with patients [7]. Likewise, American
National Guidelines emphasizes on the cleansing of the
Peripheral intravenous cannulation is the most port as it is important for the patency of I/V line [4].
common source of infection due to the migration of skin However, documentation plays a vital role in the
flora on the site of insertion into the cutaneous tract of generation of real time data and the improvement of

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Zonobia Qamar et al.; Saudi J. Med. Pharm. Sci.; Vol-3, Iss-6B (Jun, 2017):608-614
staff abidance with care guidelines that helps to provide The study noted that 53.8% nurses had poor
the quality care with peripheral venous cannula [1]. knowledge, 39.3% average and 5.9% had good
knowledge about the indications and contraindications
Furthermore, majority of nurses know how to of I/V lines in Dhaka [10]. On the other hand, practices
care and maintain peripheral intravenous line but still were excellent among 2.67% nurses and 12% had poor
there is some gap in this basic nursing skill. The aim of practices which is an alarming sign for health care
this study is to determine and assess the knowledge and organizations and health care providers.
practice of nurses towards care and maintenance of
peripheral intravenous line among the public hospitals The study noted the factors which may be
of Lahore, Pakistan. helpful to reduce the phlebitis like diameter of cannula
can affect the complications and awareness of nurses
Problem Statement has significant importance for the maintenance of
Peripheral intravenous cannulation related peripheral intravenous cannulation [12]. In addition,
infections are very common problem among necessary documentation plays a key role for safe
hospitalized patients. Such infection is dangerous for handling of patients with peripheral venous catheters
the patients and decreases the quality of care. The study [13]. Priority should be given to the education of nurses
noted that intravenous infection rate is 20% in Pakistan on proper documentation for maintenance of
[8]. Intravenous associated infections are present in intravenous lines.
different health care settings but have not enough
baseline/electronic data available. Almost same The study accessed the knowledge and
condition is in every public hospital of Lahore, practices among nurses of Celal Bayar University
Pakistan. Therefore, it should be investigated among the Hospital regarding patients with intravenous catheter
public hospitals especially, so that the infection rate can and phlebitis interventions [14]. The result depicts that
be controlled and solution for this high rate of IV-line nurses have enough knowledge but their practices were
infection can be controlled. comparatively low and 67.24% patients developed signs
of phlebitis that indicate the poor practices [14].
Objectives
 To assess the nurse’s knowledge towards Furthermore, peripheral intravenous
maintenance and care of the peripheral I/V catheterization has numerous effects on patients in
Cannulation. health care that might lead to various complications like
 To determine the practices of nurses thrombophlebitis or sepsis. Several standard guidelines
regarding insertion, removing and care of developed to assist nurses for care of peripheral
I/V Cannulation. intravenous lines. The study determines the nurse’s
bonding to national and local guidelines on peripheral
Study Significance intravenous catheters and results depict that nurses
The following study will help to reveal the partially follow the national and local guidelines. [15].
understanding and practices of nurses regarding care
and maintenance of peripheral intravenous cannulation. The study results show that 62.7% patients had
Factors would be identified might lead to practice colony and the amount of time influences colonization
modification through education, in-service training, and with risk of infection through the nursing care provided
equipment / procedure changes according to the to the patients [15]. Moreover, there is lack of
standards for quality of care. This study would help to standardized nursing practices and uniformity in
control the efficiency of the interventions and prevent handling the intravenous Cannulation [15].
patients from trouble, reduce hospital stay and quality
of care will be improved. This study will be helpful for After reviewing the literature, I/V therapy is an
the authorities of the hospital to increase the knowledge integral part of job of health care providers. Standard
regarding infections related to peripheral intravenous aseptic measures and correct practices of health care
cannulations. professionals according to the standard guidelines can
reduce the risk of infection related to intravenous
Literature Review therapy.
Peripheral intravenous cannulation is an
invasive procedure in which skin is punctured with a METHODOLOGY
needle of short temporary device [9]. Intravenous Study Design
cannulation and therapy are always associated with This study is of descriptive study design. The
infections either skin around the site of insertion and adopted questionnaire was distributed to 240 nurses of
may need the control measures [10]. The study noted Services hospital Lahore, Pakistan. The questionnaire
that traumatic phlebitis develops when catheter inserted consists of study purpose and consent as well. The
on the high mobility areas [11]. questionnaire composed three Section A (demographic

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Zonobia Qamar et al.; Saudi J. Med. Pharm. Sci.; Vol-3, Iss-6B (Jun, 2017):608-614
information) and section B was about section C
questions. All Head Nurses, paramedic staff, student RESULTS
nurses who are not participating in delivering Demographic Information
medication system and other health care professionals
were excluded. The data security was ensured to the Gender of the subject
study participants. SPSS 21 was used to analyze the
data.

Table-1.1: Gender of the subject

Frequency Percent Valid Percent Cumulative Percent
Valid male 14 5.8 5.8 5.8
female 226 94.2 94.2 100.0
Total 240 100.0 100.0

Table no.1,1 shows the frequency distribution 94.2% (n=226) were female nurses while 5.8% (n=14)
of gender of the study participants. the results show that male nurses participated.

Marital status
Table-1.2: Marital status
Frequency Percent Valid Percent Cumulative Percent

Valid Married 83 34.6 34.6 34.6

Unmarried 157 65.4 65.4 100.0
Total 240 100.0 100.0

Table 1.2 show that show that 65.4% (n=157)

study participant were unmarried nurses and 34.6%
(n=83) married were married.

Age of the subject

Table-1. 3: Age of the subject
Frequency Percent Valid Percent Cumulative Percent
Valid 21-25yrs 81 33.8 33.8 33.8
26-30yrs 105 43.8 43.8 77.5
31-35yrs 33 13.8 13.8 91.3
36-40yrs or above 21 8.8 8.8 100.0
Total 240 100.0 100.0

Table no. 1.3 shows the participant’s age. The 21-25 years, 13.8% (33) nurses were from age group
results show that 43.8% (n=105) were young nurses 31-35 years and only 8.8% (n=21) nurses were above
under age group of 26-30years, 33.8% (n=81) were in 36-40years and above group.

Qualification

Table-1.4: Qualification
Frequency Percent Valid Percent Cumulative
Percent
Valid Diploma in G nursing and midwifery 116 48.3 48.3 48.3
Specialization 62 25.8 25.8 74.2
Post RN 58 24.2 24.2 98.3
Others 4 1.7 1.7 100.0
Total 240 100.0 100.0

Table no.1.4 show the qualification level of the nurses did just diploma holder, Specialized nurses were
study participants. The results show that 48.3% (n=116) 25.83% (n=62) and 24.2% (n=58) did Post RN

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Stay in Organization

Table-1.5: Stay in Organization

Frequency Percent Valid Percent Cumulative Percent
Valid < 1 year 30 12.5 12.5 12.5
1-5 yrs 119 49.6 49.6 62.1
6-10yrs 63 26.3 26.3 88.3
Above 10yrs 28 11.7 11.7 100.0
Total 240 100.0 100.0

Table 1.5 show the job experience of nurses (n=119) have 1-5 years of experience, 28.2% (n=63)
participated. The results show that 12.5% (n=30) nurses had 6-10years of experience and only 11.7%
respondents have less than 1 year of experience, 49.6% (n=28) nurses had above 10 years of experience.

Knowledge Towards Care and Maintenance of Peripheral IV Cannula.

Table- 2.1: Knowledge towards Care and Maintenance of Peripheral IV Cannula.

Sr. Variables Strongly Disagree Neutral Agree Strongly Mean S. D
# Disagree Agree
1 The cannula gauge 14G, 16G, 18G and n=10 n=28 n=43 n=113 n=46 3.65 1.048
20G are suitable to use for peripheral 4.2% 11.7% 17.9% 47.1% 19.2%
intravenous Cannulation.
2 Veins use for intravenous cannulation n=12 n=24 n=47 n=121 n=36 3.60 1.022
normally located at dorsal) and ventral 5.0% 10.0% 19.6% 50.4% 15.0%
surface of the upper extremities right and
left hand/arm (metacarpal, cephalic and
basilic)
3 Peripheral IV cannula must be removed n=4 n=6 n=48 n=102 n=80 4.03 .886
every 12-72 hours from insertion time. 1.7% 2.5% 20.0% 42.5% 33.3%
4 Based on Universal Infection Control n=6 n=14 n=38 n=134 n=48 3.85 .893
Guidelines, IV cannula can be used 48-72 2.5% 5.8% 15.8% 55.8% 20.0%
hours if no signs and symptoms of
complication
5 Phlebitis is the most identifiable infection n=4 n=10 n=21 n=120 n=58 4.13 .862
related to IV cannulation. 1.7% 4.2% 8.8% 50.0% 35.4%
6 The environment situation (e.g. n=5 n=17 n=35 n=133 n=50 .899
cleanliness) will influent the risk of 2.1% 7.1% 14.6% 55.4% 20.8% 3.86
infection related to IV cannulation.
7 Hand hygiene before procedure IV n=5 n=3 n=28 n=98 n=106 4.24 .862
insertion is important in order to prevent 2.1% 1.3% 11.7% 40.8% 44.2%
infection.
8 Maintaining aseptic technique only during n=12 n=20 n=36 n=114 n=58 1.063
insertion of IV cannula will help to prevent 5.0% 8.3% 15.0% 47.5% 24.2% 3.78
infection occur
9 Wearing non-sterile gloves during insertion n=54 n=29 n=32 n=92 n=33 3.09 1.398
of IV cannula are advisable. 22.5% 12.1% 13.3% 38.3% 13.8%
10 Skin preparations at insertion site are n=10 n=15 n=35 n=119 n=61 1.005
require before IV cannula inserted. 4.2% 6.3% 14.6% 49.6% 25.4% 3.86
11 Increase attempts for cannulation will n=9 n=10 n=22 n=142 n=57 3.95 .
increase the risk of infection. 3.8% 4.2% 9.2% 59.2% 23.8% 913
12 Using transparent dressing will help to n=8 n=7 n=52 n=110 n=63 3.89
recognize early signs and symptoms of 3.3% 2.9 21.7 45.8 26.3% .942
infection
13 Removing IV cannula immediately if not n=3 n=7 n=44 n=117 n=69 4.01
in use, will help to reduce risk of infection 1.3% 2.9 18.3 48.8 28.8% .838
occur.
14 Giving intravenous therapy will increase n=10 n=54 n=126 n=34 3.66 .946

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risk of infection through peripheral IV 4.2% n=16 22.5% 52.5% 14.2%
catheter. 6.7%
15 Patient educations on how to care IV n=4 n=7 n=31 n=130 n=68 4.05 .825
cannula is important as it do help to reduce 1.7% 2.9% 12.9% 54.2% 28.3%
risk of infection.

Table 2.1 show he results of the nurses’ were agree and strongly agree regarding the questions
knowledge care and maintenance of peripheral IV of knowledge which means that nurses of Services
cannula. In table 2.1, 15 question analyzes the nurses’ hospital have knowledge regarding care and peripheral
knowledge and it depicts that majority of the nurses IV cannula safe usage.

Nurses’ Practices towards Care and Maintenance of Peripheral IV Cannulation

Table-3.1: Nurses Practices towards Care and Maintenance of Peripheral IV Cannulation.

Sr. Practice Variables Strongly Disagree Neutral Agree Mean S. D
# Disagree Strongly
Agree
1 I always change IV cannula after 72 hours n=38 n=43 n=29 n=145 N=100
inserted. 15.8% 17.9% 12.9% 60.4% 41.7% 3.17 1.307
2 When I saw there is a sign of phlebitis I n=25 n=34 n=22 n=98 n=61 1.29
immediately change the IV cannula to 10.4% 14.2% 9.2% 40.8% 25.4% 3.57
non-affected part.
3 I always use transparent dressing when n=33 n=57 n=37 n=81 n=32
securing IV cannula. 13.8% 23.8% 15.4% 33.8% 13.3% 3.09 .961
4 I always write date, time, site, size, due n=37 n=56 n=28 n=70 n=49
date change and name of person 15.4% 23.3% 11.7% 29.4% 20.4% 3.16 .905
cannulated
5 I use administration set for IV cannula n=18 n=63 n=35 n=77 n=47
within 72 hours. 7.5% 26.3% 14.6% 32.1% 19.6% 3.30 .894
6 I aware of complications of IV n=7 n=37 n=29 n=104 n=63
cannulation for instance infiltration, 2.9% 15.4% 12.1% 14.3% 30.0% 3.75 .835
phlebitis and extravasation
7 I always maintain aseptic technique n=8 n=27 n=37 n=104 n=64 3.79
during preparing, inserting and removing 3.3% 11.4% 15.4% 49.3% 26.7% .818
of IV cannula.
8 I always change the dressing when it wet n=11 n=34 n=34 n=99 n=62 3.70
or dislodge. 4.6% 14.2% 14.2% 41.3% 25.8% .863
9 I always educate my patient how to care n=11 n=36 n=20 n=119 n=54
the IV cannula. 4.6% 15% 8.3% 49.6% 22.5% 3.55 .835
10 I always educate my patient how to n=13 n=42 n=40 n=93 n=52
recognize the signs and symptoms of IV 5.4% 17.5% 16.7% 38.8% 21.7% 3.75 .868
cannulation infection.
11 I aware the important of hand hygiene n=11 n=33 n=29 n=99 n=68
before IV cannulation being carried out. 4.6% 13.8% 12.1% 41.3% 28.3% 3.69 .819
12 I aware the important of doing skin n=14 n=21 n=44 n=108 n=53
preparation before the procedure insertion 5.8% 8.8% 13.3% 53.3% 22.55% 3.83 .860
of IV cannula.
13 I aware the factors that influence the risk n=33 n=57 n=37 n=81 n=32
of infection occur. 13.8% 23.8% 15.4% 33.8% 13.3% 3.09 .810
14 I always follow guidelines that given by n=37 n=56 n=28 n=70 n=49
my management when carried out IV 15.4% 23.3% 11.7% 29.4% 20.4% 3.16 .898
cannulation.
15 I am confident enough to carry out this n=5 n=79 n=30 n=121 n=5
procedure (IV cannulation) because I have 2.1% 32.9% 12.5% 50.4% 2.1% 4.10 .847
enough knowledge and experience.

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