CHAPTER I
INTRODUCTION
“To do what nobody else will do, a way that nobody else can do, inspite of all we go through; is to be a nurse.”
– Rawsi Williams.RN.
The first principle to enunciate in a hospital is “do the sick no harm” (Florence Nightingale, 1859). Curing is a part of doctors and caring is in nurses’ domain. The intravenous (IV) cannulation is a very common procedure which is performed by nurses to save the lives of the patients. Though IV therapy saves the life if it is not handled well it will result in many complications.
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Carson.D. et al, stated in 2012 that the history of IV therapy was trailed during the Middle Ages. The first experiments using IV therapy were carried out in the 17th century using quills and animals bladder. In 1831-1832, Dr. Thomas Latta pioneered the use of the IV saline infusion for the cholera epidemic. It was then established as a routine medical practice during World War II. By the 1990s, it was estimated that 85% of hospitalized patients in the US received IV therapy.A nursing survey in 1990 found that 75% of a nurse’s hospital time was spent providing IV therapy related services. The most frequent complication of peripheral intravenous (PIV) infusion is phlebitis, which may occur at rates as high as 50%,or even 75% for patients with infectious diseases; however, the incidence rate of urgent catheter insertion is approximately 20%. Although the incidence of IV infusion-related infections is difficult to determine, studies have shown that between 5% and 25% of peripheral catheters are colonized by skin organisms at the time of removal.(Aston 1990).
Ortega, et.al, (2008) observed that the ability to obtain PIV access is an essential skill for all nurses. Although this technique is considered as a simple invasive procedure, mastering the skill requires experience and is of substantial significance in life-saving intervention. According to Waitt ,C. and Waitt, P., approximately 80% of patients are receiving IV therapy during their hospitalisation. The IV therapy is commonly used to correct fluid and electrolyte imbalance, for medication administration, for blood transfusion, etc. When comparing with other routes, the IV route is faster for fluid resuscitation and medication administration.
In 2003, Macklin found that IV therapy has some common complications like phlebitis, infiltration, hematoma, extravasations, embolism, catheter related blood stream infections, etc. Drug induced thrombophlebitis is 25% to 70% comparatively higher in clinical setting for patients who are receiving IV therapy.
Luer Access Split Septum (LASS) eliminates the internal complexities of mechanical valves, and with them the places that may harbour microorganisms. Studies found that patients are on average three times more likely to develop a Catheter Related Blood Stream Infection (CRBSI) with the use of mechanical valves vs. a split-septum needless access system.
NEED FOR THE STUDY
PIV cannulation is a very common invasive procedure performed by nurses throughout their duty schedule. The IV cannulation procedure is simple but it requires a lot of skills. If the cannulised site is disturbed or not maintained properly it may result in many other complications which increase the number of days in hospital as well as the cost of treatment. The intravenous catheter related infections (CRI) come under the quality indicators of a hospital. As nurses we should therefore follow our ethics and improve the quality of our nursing care by implementing evidence based innovative principles.
In 2001, Reineck observed that maintenance of IV cannula patency is important to reduce the patient discomforts like visible scaring and CRI. Black et al., in 1997, found that blood clots may form in the IV line as a result of kinked IV tubing, very slow infusion rate, solution administration, etc.
The CDC recommends according to 2011 guidelines, that when needleless systems are used, a split septum valve may be preferred over some mechanical valves due to an increased risk of infection with the latter ones. Recently, updated guidelines from the CDC provide a critical new evidence based intervention of Q-Syte which helps to overcome the challenges of CRBSI. When compared to the other connectors, the Q-Syte or the mechanical valve split–septum devices have 64% to 70% lower CRBSI rates.
Salgado, D.C., et al , conducted a study to determine whether needleless mechanical valve device have any influence on catheter related blood stream infection among patients with a central venous catheter . He found that there was a marked decrease in the incidence of CRBSI .
The investigator during her clinical experience observed that many patients who received intermittent IV drug therapy suffered from thrombophlebitis, being thus the primary cause of infection. Some studies as well as the CDC recommend to use of luer lock access along with the IV cannula. This motivated the researcher to study and to found more alternatives for preventing thrombophlebitis.
STATEMENT OF THE PROBLEM
Effectiveness of Q-Syte Connector on Prevention of thrombophlebitis , IV Line Patency and Ease of Administration of Medication Among the Patients with Peripheral IV Cannula in KMCH, Coimbatore.
OBJECTIVES
The objectives of the study are to:
- assess the magnitude of occurrence of thrombophlebitis and IV line patency among patients with a Q-Syte connector;
- compare the occurrence of thrombophlebitis and IV line patency among patients with a Q-Syte connector and those who do not have a Q-Syte connector;
- compare the ease of administration of medication for patients connected with Q-Syte and those without Q-Syte connector;
- associate the occurrence of thrombophlebitis and peripheral line occlusion with demographic variables.
OPERATIONAL DEFINITION
Q- SYTE:
A Luer Access Split Septum device connector which can be connected to the peripheral IV line.
PATENCY:
An absence of blockage in PIV line as observed by the flow of fluid without resistance.
THROMBOPHLEBITIS:
An inflammation of blood vessel due to blood clot.
HYPOTHESIS
H1 – There is a significant difference in the occurance of thrombophlebitis between the patients with Q-Syte and those who are without Q-Syte in preventing of thrombophlebitis.
H2 – There is a significant difference in maintaining the IV line patency between the patients with Q-Syte and patients without Q-Syte.
H3- There is a significant difference in easing the administration of medication between the patients with Q-Syte and patients without Q-Syte .
ASSUMPTION
- Occlusion of a PIV line may result in the development of thrombophlebitis.
- Q-Syte prevents the occlusion of PIV line by preventing air entry and backflow.
CONCEPTUAL FRAMEWORK
The conceptual framework of this study was based on the modified Kolcaba comfort model. This theory was developed by Katharine Kolcaba in1990 and modified again by her in 2010.
- HEALTH CARE NEEDS
Health care needs are those identified by the patient or its family in a particular practice setting.
In the present study, the health care needs were the prevention from thrombophlebitis and the maintenance of IV line patency among the patients receiving IV drugs.
- HEALTH SEEKING BEHAVIOUR
When patients and families are accustomed to the actions of the health care personnel (i.e. nurses), they can involve better in the health seeking behaviour which can be internal or external.
In the present study, health seeking behaviours were internal when about the prevention of thrombophlebitis and external behaviour when about the functional outcome.
- INTERVENING VARIABLES
Intervening variables are those which are not likely to change and over which the providers have a very little control such as prognosis, financial situations, the extent of social support, etc.
In the present study, the intervening variables were prognosis and the extent of the social support system around the patient.
- COMFORT INTERVENTION
Comfort is an immediate desirable outcome of nursing care. Nurses traditionally provide comfort to patients and their families through interventions that can be called comfort measures. The intentional comforting nursing actions strengthen the patients and their family.
In the present study, the comfort measure was the setting of Q-Syte connector along with the IV cannula in the experimental group and not in the control group.
- ENHANCED COMFORT
Enhanced comfort is an immediate desirable outcome of nursing care.
In the present study, the enhanced comfort was the relief from thrombophlebitis by maintaining the IV patency.
- INSTITUTIONAL INTEGRITY
Institutional integrity is defined as the values, the financial stability and the wholeness of health care organisations at local, regional, state and national levels.
In the present study, the institutional integrity was the financial stability and the wholeness of the health care organisation.
7. BEST PRACTICE
Best practices are the protocols and the procedures developed by an institution after collecting evidence on specific applications on the patient.
In the present study, the best practice was the setting of Q-Syte connectors along with IV cannula for patients receiving such injections.
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