Peripheral intravenous cannulation Research

According to Delahanty and Myers (2009), Intravenous (IV) cannulation is a technique in which a cannula is placed inside a vein to provide venous access, which allows sampling of blood, administration of fluids, medications, etc. PIVC is important in delivering desired fluids, and medications directly into the patient’s circulatory system. But, it is always having the potential risk for the complications such as phlebitis, cannula occlusion, thrombophlebitis, infiltration etc. However, a lot of complications occur as a result of PIVC’s, and it is the responsibility of nurses to minimize such complications. Patients under IV cannulation are at risk of infections that pose serious health issues to them. The procedure for PIVC involves puncturing the skin and leaving a foreign item there; the patients are vulnerable to infections and other risks.

The most common complications associated with a peripheral venous catheter are infections and thrombophlebitis, and their use should be stopped because of leakage or occlusion. One of the common nursing activity/ roles is the insertion, monitoring, and assessment of the PIVC. To avoid complications such as thrombophlebitis, guidelines recommend removal or changing or the peripheral venous catheter every 12-72 hours (Feldman, 2004). In the patient's chart, there should be documentation with date, size, location and time as one of the basic peripheral procedure requirements. The intravenous therapy is a significant part of professional nursing practice and all medical institutions in Klang Valley. A nurse is expected to possess sufficient knowledge and skills for administering intravenous therapy, patient’s venous system, setting up and maintaining IV equipment and all related physicochemical features of the medications (Kadium, 2015).

The complications that accompany PIVC’s are the responsibility of the nurse to mitigate them and also ensure the patients receive appropriate treatment (Stonecypher, 2009). The nurses, therefore, require adequate knowledge to handle intravenous therapy effectively and also deal with any complications that may arise. It will improve the quality of care patients receive their safety and also reduce the length of time patients stay in the hospital. Competent nursing practitioners are needed to perform intravenous cannulation to deliver more timely and responsive service that will improve patient’s journey towards recovery. PIVC’s are clinical skills performed by either professional nurses or doctors. Assessing the patients’ needs and distending the patient’s veins by selecting the correct site and device are the keys to successful intravenous insertion (Dougherty, 2008).

It is essential for professional doctors or nurses to have this knowledge to make important decisions regarding the patient’s care needs like where to site intravenous, what type of intravenous accessed is best used and care for the patient receiving intravenous therapy. There’s a need of having adequate knowledge and practices regarding peripheral intravenous cannulation to prevent and manage complications. The cannulation is associated with a high risk to nearby structures, especially in the hands of the inexperienced operator. Veins commonly lie close to arteries and nerves both of which can potentially be damaged by a misplaced needle (Kadium, 2015). The nurse must be able to recognize the indications, advantages, and disadvantages associated with each device. Intravenous catheters are widely used in today’s healthcare environment; nurses require expert knowledge about venous catheter maintenance to prevent complications and maximize efforts to optimize the individual’s health status (Bonnici,1996).

Nurses should be aware of the safety measures that regard Peripheral intravenous cannulation to implement in a clinical setting to improve the health statuses of patients and to minimize the complications. Ongoing Educational Programme for nurses is 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 a change in practice (Kadium, 2015). This research is therefore necessary for assessing nurses’ knowledge towards care and maintenance of PIVC’s and the measures that can be taken to minimize infections or complications. Objectives of the research General objectives: To determine the nurse’s knowledge level and practice towards care and prevention on phlebitis of peripheral intravenous cannulation.

Specific objectives: 1) To determine the nurse’s knowledge level towards care and prevention on phlebitis of peripheral intravenous cannulation. In this research gender, age, marital status, education background and years of experiences are included in the research data collection. The exclusion will be operating theatre and pediatric ward because the criteria are not fulfilled with the objective of the research. Head nurses, student nurses who are not involved in indirect nursing care are excluded. Staffs nurses who are on leave or maternity leave are also excluded from this research. Limitations of the study This study is mainly focused only on the one selected hospital in Klang Valley. Nurses: Refers as registered nurses working in the clinical setting and having experience of Intravenous Cannulation and its care.

v. Effectiveness: It refers to gain knowledge as determined by the significant difference in post-test Score among staff nurses on Intravenous Cannulation and its care. vi. Phlebitis- Phlebitis is the most common complication results from PIVC where vein at the cannula access site is inflamed. Therefore, specific precautions need to be put in place when undertaking the peripheral intravenous cannulation. Care and Maintenance of PIVCS The intravenous peripheral catheter requires extremely high care and maintenance which starts by educating the patients and health professionals for effective use. There is importance in training the nurses on the preparation, how to administer and manage the intravenous cannulation. To prevent infections and be successful in the procedure, nurses are required to put in place the process that minimizes all risks (Trim, 2005).

The necessary skills should be taught to all people that are involved with the administration of the intravenous therapy. Decontamination of hands is required before the start of the procedure and gloves are a necessity to put on the hands, these gloves should be taken off immediately at the end of the procedure. The healthcare team, patients, and visitors should be encouraged to use alcohol hand rubs for hand sanitation. Wristwatches, rings, long sleeved and long nails are discouraged I the clinical areas as they contaminate the hands. Adherence to the proper procedures of keeping the hands clean and away from germs is basic in any cannula care (Trim, 2005). When the health practitioners challenge poor hand hygiene in the areas of practice, it does improve the compliance with keeping hands clean.

One can now work on the insertion site back and forth; the antiseptics should, therefore, be left on the site of insertion for it dry according to the recommended time by the manufacturer. Catheter Insertion A lot of care should be observed when it comes to the insertion of the catheter. On occasion, one should do a thorough assessment, plan and careful insertion of the external device into the vein, this should be accompanied by periodic examination and monitoring of the device to ensure that all is okay and that there are no infections on the sitre. During insertion, the attending should avoid the lower extremities and the joints or even the nerves to site the cannula (Ingram and Lavery, 2005). The number of attempts on the site for cannulation should be reduced since the more the punctured sites, the better the chances of having infections.

The packages to be used in the procedure should be intact and up to date at the time of use, health practitioners should comply with the aseptic technique when opening the packages and during the preparation of the medication. Replacement of Catheters Phlebitis can be prevented by scheduling the replacement of catheters; the replacement is important in that it reduces the discomfort that patients would experience and the site could be examined in a more detailed manner (Mirza, 2012). The catheters should be replaced at a time interval of approximately 72 hours; other scholars state that replacing the catheters at an interval of 72 to 96 hours is a more economical and effective way of monitoring the patients (Damani, 2004). For adults, it can be done less frequently as compared to the young ones.

For the medical team to be able to monitor the replacement of catheters in a more effective way it is recommended that they are labeled with the date and time when they are administered. The niduses formed normally acts as a pathway of protection and also provide a conducive environment for the inbreeding of microorganisms. Research shows that a bacterium affects at least three people out of one thousand that are admitted to the acute hospitals (Damani, 2004). The most common infecting microorganisms include the Escherichia coli, Enterococcus faecalis, and the Staphylococcus aureus but those that commonly associated with the cannula infection are Staphylococcus aureus, Candida albicans and S. Epidermidis (Duval, 2010). Peripheral therapy is a quite risky procedure however it is considered to have minimal risks by nurses as compared to other procedures such as Carew of the pressure area since there are a few factors that contribute to patient’s infection on the catheter site (Hindley, 2004).

Endogenous agents are those that do practically originate from within the patient while the exogenous ones are from a different source that is like visitors, medical personnel the equipment and the surrounding (Ingram and Lavery, 2005). On the other hand, just as the agents are endogenous and exogenous, the risk factors are categorized to be patient related and hospital related (Lathe very, 2010). When it is hospital related, it is all about the mode of insertion, the period of the catheter insertion, the health practitioners skills in the field and the the care that the patient is offered in the hospital. Patient-related has to include the susceptibility of the patient, their age, and severity of other diseases that the patient may be experiencing at the moment (Lobdell, Stamou & Sanchez, 2012).

Further, the IV therapy infections have been classified into intrinsic and extrinsic, whereby contamination of equipment causes the intrinsic occurring during manufacturing, and contamination causes the extrinsic during insertion and administration of the medicine the patient (Mirza, 2012). Two types of asepsis are medical and surgical asepsis (WHO, 2011). Medical asepsis refers to the practices that reduce transfers of infection firm one person to the other, usually the clean techniques (Cousins et al. On the other hand, surgical asepsis aims at keeping objects and surfaces free of any microorganisms normally called the sterile technique. Ascetic techniques are applied to prevent the patient from being infected by the microorganisms (Fry and Johnstone, 2002). The aseptic technique is also described as those practices performed under controlled conditions to minimize any contamination by the bacteria causing agents.

In the nursing profession, the nurses are allowed to administer the intravenous therapy, but with limited powers, this is because for a nurse to administer he or she requires knowledge and the experience about the intravenous therapy (Rowley et al. Such knowledge includes all the types of devices required for the procedure on how to administer and manage any problems that may occur in the course of the procedure. For example, nurses that are qualified to administer should pass a particular exam and gain the certificate of registered nurse intravenous. These qualifications have to be maintained by attending national IV conferences and other enlightening workshops, and there is a rectification which is done every three years (Hand Hygiene in Health Care, 2009).

Some other places a person has to pass a workshop to acquire a license for the same. Conceptual Framework usually considered as getting them to the point where they are most helpful. The objective of this review is to examine conceptual frameworks that are relevant to nurse practitioner education. RESEARCH METHODOLOGY Introduction. Research methodology is about how the researcher carried out their work of describing, explaining and predicting the variables. It is a systematic way to solve a problem and also a science of studying how research will be carried out (Morris and Tay, 2008). Departments that available in the hospital such as the Emergency unit, Outpatient department, ICU, Medical Ward, Surgical Ward, Maternity ward, Operation theatre, Pediatric ward, daycare/scope room.

To get the most accurate data, the researcher had chosen some of the departments in which the nurses are involved directly in intravenous cannulation. Questionnaire was distributed to the nurses working in the Emergency unit (16 staff nurses with 6 total bed and patient ratio 1:2), maternity ward (16 staff nurses with 21 total beds and patient ratio 1:4), surgical ward (21 staff nurses with 22 total beds and patient ratio 1:4), medical ward (23 staff nurses with 24 total beds and patient ratio 1:4), ICU (13 staff nurses 7 total beds and patient ratio 1:1). Samples Population 123 nurses are working at the private Hospital in Klang. The researchers only choose the nurses from the Emergency unit, medical ward, surgical ward, ICU, and maternity ward. Pilot Study Pilot testing of the survey questionnaire was conducted using a convenience sample of Intensive Care Unit staffs in the hospital to investigate its validity and reliability.

The pilot interview gave me a perspective on whether to change my questions structure, the specific areas I needed to pay attention in during study, and whether the range of my question is broad, or short and specific to give me realistic data. Data collection and Instrumentation Data collection began with distributing the questionnaires through the nursing manager of the selected department on the first week of April during weekdays. The study instrument was the use of self-administered questionnaires. The questionnaires came with the consent and the purpose of the study on the cover page; the questionnaire was randomly given to the participants that were working during that period. The knowledge of nurses about care and maintenance of the insertion procedure was analyzed; nursing practices and challenges were also analyzed.

Ethical Consideration To achieve the objective of being ethically objective we do away with our basic interpretation and views about the study after analysis. Instead, the only data used is the original reports (Fry and Johnstone, 2002). All queries that came up during the research were reported; the researcher made the necessary efforts to ensure that the data collected was in line with the scientific guidelines. The researcher avoided anything to do with plagiarism, second-guessing of work and fabricating the work based on the authors of the original works. 3% of respondents were categorized as Chinese, 10% Indians and only 6. 7% were Malay. Demographic data like a year of service, educational level, area of practice (department) and their position will influence their understanding and knowledge towards care and maintenance of peripheral intravenous cannulation.

Fig 1. 0: A chart showing the distributions of races. Majority of respondents, 57. 4% were aware that phlebitis is the most identifiable infection related to IV cannulation. About 9. 5% are unaware of phlebitis being quite prevalent with catheters while the rest were aware but not quite sure. Meanwhile, more than 90% of the respondents comprising of those agreed and those agreed strongly were aware those environment situations will influent the risk of infection related to IV cannulation, while about 10% were not aware of such environment situations. Fig 1. 1: Those aware that phlebitis is the most identifiable infection with cannula iii. Nursing practice on care and maintenance of peripheral IV cannulation (Section C) Section C about respondents’ practice on care and maintenance of IV cannula. 8% of the respondents agreed that they always used transparent dressing, and 20.

2% strongly agree to be doing so. 8% strongly disagreed. The majority of them were not aware of the complications that were associated with the IV cannula while about 44. 7% were aware and practiced control measures to mitigate such complications. About 40% of respondents always educate their patient. 9% did not educate their patients at all. From the study, it revealed that staff experience in the field and administration of catheters highly influences how effective the intravenous cannulation procedure could be, and the way of maintenance (Hadaway and Millam, 2005). Therefore, the longer one status in the field the more the experience they gain. Among the respondents only 17% of them knew the duration of redressing the catheters (72 hours). Also the greater number of them did not know when and when not to remove the catheter.

Such kind of a finding is disturbing because with such ignorance the patients are more likely to get the cannula related infections. 8% of those that respondents knew very well that the aseptic technique was of importance not only during the insertion phase but also in preparing and removing the catheter device. However, the rest of the population had no idea about the aseptic technique and its importance in the intravenous cannulation. According to Ingram and Murdoch (2009), using the aseptic technique in the preparation, administration and any further manipulation with the catheter is of importance because it prevents any further complications such as the catheter-related infections. The aseptic nontouch technique helps keep the part sterile such that germs and other infection causative agents do not attack.

A nontouch technique is preferred whether the health practitioner wears gloves or not, it is safer (Milutinović, Simin & Zec, 2015). In conclusion, out of the 94 respondents, 55 of them had a lot of challenge in caring and maintaining the intravenous cannulation because of doctor’s prescriptions that lead to vein depletion. Many factors lead to vein depletion according to studies like increasing the prevalence of the methicillin-resistant Staphylococcus aureus and the preferred drug of choice to combat the disease-causing microorganisms (Kanerva, at, al. 37% of the nurses had a challenge in care and maintenance of the intravenous cannulation because of unresponsive patients; most patients are uncooperative because they do not know about the catheter and maintenance that such procedures do require. Other factors that make patients be uncooperative include the status of the patient about alertness and the willingness to be taught and have a new experience, Unwillingness to do a self-evaluation and discover some signs of the infections.

Recommendations The peripheral intravenous cannulation procedure is a very important one, and nurses should learn more about its care and maintenance to carry out a successful procedure effectively. In casa e of incompetence by the nurses or any medical practitioner, they need to address it with the necessary training to avoid any mistakes. The other recommendation is that patients should be educated and encouraged to give the nurses all details about their progress on the catheter site, any uncomfortable signs should be reported to the nurse. The patients should be empowered and made aware to take responsibility for themselves because once an infection is discovered at an early stage, it is easier to manage (Lyytikäinen, at al. Nurses also have a responsibility to give full details about the procedure including the side effects, repercussions if any and contraindications.

Most times the patients are taught not to take off the catheter device bit less is taught about how to care and maintain it; this should take a course to ensure that fewer infections are reported in future days. The nurses have a good attitude towards the procedure however they lack the appropriate knowledge required. The challenges that make the nurses have a difficult time in caring for the patients are factors such as, uncooperative patients and strong doctor’s prescription that eventually cause the veins of the patients to deplete hence increasing the risk of the infection (Milutinović, Simin & Zec, 2015). Nurses should have the necessary skills and techniques of caring for the patient to not risk the life of the patients which would be very dangerous.

For the nurses to improve on the same, they need to attend special training and courses I order to enhance their knowledge and confidence levels. In other words, the management of the hospital around the Klang area should take the right measures and actions to implement new strategies that will be beneficial to both the patients and the nurses. Barnett-Page, E. , Thomas, J. (2009) Methods for the synthesis of qualitative research: a critical review. BMC Medical Research Methodology 9(59). doi:10. Safer patient care through better peripheral intravenous catheter management, 1–7. https://doi. org/10. 3396/ijic. v8i2. British Journal of Nursing 20 (SUPPL. 14), S4-S8. Damani, N. N. ( 2004) Manual of infection control Procedures. Dougherty L. Peripheral cannulation. Nurs Stand. 2008 Sep 3-9. 22(52): pg. and Benefield, P. (2001) Systematic reviews of educational research: does the medical model fit? British Educational Research Journal 27(5), 527-541.

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World Health Organization, Geneva: World Health Organization, Accessed February 14, 2013, http://whqlibdoc. 0% Female 18 60. 0% Age 21-30 1 3. 0% Race Chinese 25 83. 3% Malay 2 6. 7% Indian 3 10. 0% 1 to below 3 years 9 30. 0% 3 to below 5 years 5 16. 7% >5 years 4 13. 3% Work Status Employed 14 46. 7% Unemployed 4 13. 0 Total 94 100. 0 period to discard cannula Frequency Percent Valid Percent Cumulative Percent Valid strongly disagree 4 4. 3 disagree 23 24. 7 Agree 43 45. 5 strongly agree 24 25. 0 Total 94 100. 0 enviroment situation Frequency Percent Valid Percent Cumulative Percent Valid disagree 2 2. 1 Agree 26 27. 8 strongly agree 66 70. 0 Total 94 100. 7 disagree 27 28. 4 Agree 39 41. 9 strongly agree 17 18. 0 Total 94 100. 0 skin preparation Frequency Percent Valid Percent Cumulative Percent Valid disagree 2 2. 0 Agree 19 20. 2 strongly agree 28 29. 0 Total 94 100. 0 removing cannula immediately Frequency Percent Valid Percent Cumulative Percent Valid strongly disagree 17 18. 1 disagree 29 30. 0 Agree 29 30. 9 strongly agree 18 19. 0 Total 94 100. 0 always change IV cannula after 72 hours insertion Frequency Percent Valid Percent Cumulative Percent Valid strongly disagree 15 16. 0 disagree 30 31. 3 Agree 30 31. 2 strongly agree 28 29. 0 Total 94 100. 0 Label Frequency Percent Valid Percent Cumulative Percent Valid strongly disagree 10 10.