http://doi.org/10.33698/NRF0301-Maninder Kaur, Sunita Sharma, Sanjay Jain
Abstract:A Quasi Experimental study was conducted in Nehru Hospital to evaluate patency of I.V cannula with Normal Saline Lock in the control and experimental groups. Patients having I.V. cannulae inserted in peripheral veins of hand and forearm for the administration of Bid I.V. medication were included in the study. Simple Random Sampling Method was used to allocate the subjects in control and experimental group. The study was conducted on 60 I.V. cannulae. Data was collected by assessing the patency of I.V. cannula twice a day, before giving medication for three consecutive days. A standardized assessment tool (standardized by Intravenous Infusion Society) was used for assessing patency of I.V. cannula. The data revealed that, majority (96.7%) of the subjects received antibiotics in the both groups. Up to the day III evening, 96.7% cannulae remained patent in the experimental group and 56.7% cannulae were patent in the control group. The Binomial Distribution and chi square test with Yates correction was applied to find the p value and two proportions were found to be statistical significant. Normal Saline Lock is found to be highly effective for maintaining patency of I.V. cannula.
Key Words:Patency, Intravenous cannula, Normal Saline Lock, Intermittent medication.
Introduction:Millions of patients require vascular access for the administration of medications, fluids, nutritional solutions and blood products.1 The first peripheral I.V. device was developed in 1945, it had a plastic catheter over a steel needle.2 A variety of complications associated with the insertion and utilization of venous access devices generally can be considered either local or systemic in nature. The non – patency of I.V. cannula found to be the major complication that can cause the other local and systemic complications i.e. thrombosis, thrombophlebitis, extravasations, infiltration, pulmonary embolism and bloodstream infections. Diverse practises are followed for maintaining the patency of I.V. cannula with different solutions.1Various studies have been conducted in different countries to evaluate the effectiveness of the heparin lock with the normal saline lock. In US, since 1985, daily saline flushes (8 hourly) are used as a standard protocol for intermittent infusion. The use of sodium chloride (0.9%) for intravenous lock was recommended by American Society of Health System Pharmacists and Infusion Nurses Society.4 It is evidently proved that saline lock reduces the incidences of phlebitis, infiltration and blockage of I.V. cannula.5,6 Studies have shown that 82% cannulas are found patent when saline lock is used (8 hourly).3 In India, no study is available of regarding use of standardized flushing solution for patency of I.V. cannula. Investigator has observed the blockage of the I.V. cannula (6-8 per day) in different units of PGI and no standard protocol is adopted for maintaining patency of I.V. cannula. Investigator has observed the blockage of I.V cannula (6-8 per day) in different units of PGI and no standard protocol is adopted for maintaining patency of I.V. cannula. Great need is felt to maintain patency of I.V. cannula hence the investigator has taken up the study. There is also a lack of research evidence about present practices of maintaining patency of I.V. cannula hence the investigator has taken up the study. There is also a lack of research evidence about present practices of maintaining patency of I.V. cannula with ‘Normal Saline Lock’ for patients on intermittent medication at Nehru Hospital, Post Graduate Institute of Medical Education And Research, Chandigarh, was undertaken with the objective to evaluate the patency of intravenous cannula with Normal Saline Lock.
Materials and methods:A Quasi Experimental design was adopted to carry out study on two group i.e. experimental group and control group. The study was conducted in Nehru Hospital, PGIMER, Chandigarh, which is a primer Institution of Medical Education and Research in India. This institute was established in 1962 and has been functioning as an autonomous body under the Ministry of Health and Family Welfare, Govt. of India since April 1967. It is a tertiary care hospital of Northern India with total bed strength of about 1359 beds. The specialized quality service of the Institute is well-known not only availed by the residents of Chandigarh, but also by people hailing from the neighbouring states like Haryana, Punjab, Himachal Pradesh, J &K, Rajasthan, U.P. & Uttaranchal. Hospital has five-storyed building. Each floor has 4 blocks & numerous wards (critical care units, private wards, emergency wards). The study was conducted in the Male & Female Medical Wards. The patients of Internal Medicine Unit-I were included in the study.The Procedure for assessing patency of I.V. cannula, administration of I.V. medication and Normal Saline Lock was prepared through the extensive search of literature and consultation with experts in field of medicine and nursing. A standardized assessment tool by intravenous infusion society for assessing patency of I.V cannula was used. A Record Performa for the use of I.V. cannula for administering medication to study subjects was also prepared. The validity was established by seeking opinion of eight experts from the field of nursing and medicine.Permission to conduct the study was obtained from competent authority. An informed consent was obtained from each study subject. Anonymity and confidentiality of subjects were maintained while carrying out intervention. It was ensured that prescribed treatment of patients is not affected. They were given full autonomy to participate in research and withdraw at any time. No costs were borne by the subjects during the study. It was ensured that the nursing interventions performed during research will not cause any harm or discomfort to the subjects.The clients were taken from the Male and Female Medical Wards who were receiving intermittent I.V. medication. A total number of patients with I.V. cannula during the study period were 90. Out of them 60 were receiving Bid medication which met the criteria for sample selection were selected as the study sample. Criteria used for sample selection were all patients on BID I.V. medication with newly inserted vein flow of 18 or 20 gauze, inserted in the basilic, cephalic and meta tarsal drugs, receiving stat ordered I.V. drug, I.V. fluid, platelet and blood transfusion within three days of the study and who refused to be the part of the study were excluded from the study. The 60 I.V. cannulae were randomly assigned to control and experimental group using even and odd method in the control and experimental group.Clients were informed about the purposes, objectives and benefits of the study. Verbal consent was obtained from each subjects, identification profile of patients was filled in the record Performa. Patency was assessed by the ability to irrigate the I.V. cannula with 1 ml distilled water without resistance in the morning and evening before administering BID I.V. medication, 2ml normal saline was administered by using push/pause method for three consecutive days. In the control group, patency was assessed for three consecutive days before administering medication.
Results
As per description of the subjects, 50% of the subjects in the control group, were male. The mean age was 44.2 ± 16.60 years, ranging from 13 to 70 years whereas in the experimental group, 56.7% subjects were male and 43.3% subjects were female with mean age of 41.5± 18.29 years, ranging from 13 to 75 years. Majority (96.7%) of the patients in both the groups were administered Antibiotics. One (3.3%) subjects in control group received corticosteroid while one (3.3%) subjects in experimental group received Anti- secretory (Table 1). This shows that the control and experimental groups were administered almost the similar type of medication. About 1/4th of subjects in the control group, were diagnosed to have tubercular meningitis whereas in the experimental group,1/3rd had acute lymphocytic leukaemia & chronic myelocytic leukaemia. The other diagnosis distribution is also depicted in the table 2
Table 1: Distribution of study subjects as per I.V. medication
| I.V. Medication Control Group (n=30) Expt. Group (n=30)
f(%) f (%) |
Antibiotics 23 (76.7) 27 (90)
Anti- Secretory (Pantop) – 1 (3.3)
Corticosteroid 1 (3.3) –
Combined
|
Table 2: Distribution of subjects as per diagnosis
|
Anti-biotic+ Anti- secretory 6 (20.0) 2 (6.7)
ALL & CML 6 (20.0) 10 (33.3)
Tubercle meningitis 7 (23.3) 6 (20.0)
Multiple Myeloma 4 (13.3) 4 (13.3)
HTN and DM 1 (3.3) 3 (10.0)
Hodgkin’s disease 2 (6.7) 3 (10.0)
PUO – 2 (6.7)
Sacroidosis 2 (6.7) 1 (3.3)
Nephrotic Syndrome – 1 (3.3)
Aplastic Anaemia 2 (6.7) –
Community acquired pneumonia 2 (6.7) –
Liver abscess 1 (3.3) –
Cor- pulmonale 1 (3.3) –
Ulcerative Colitis 1 (3.3) –
CAD 1 (3.3) –
|
Findings revealed that (Fig.1), all the cannulae in the morning and evening on day I, were found patent in both the group, 96.7% and 76.7% cannulae were found patent in the morning and evening respectively, whereas in the experimental Group, 100% cannulae were found to be patent. On the third day, in the experimental group, all cannulae were patent in the evening while in the control group 60% cannulae were patent in the morning and 56.7 % cannulae were patent in the evening.To compare the patency of I.V. cannula on Day I, II &III in the Morning and Evening, in the study groups, the Binomial Distribution was used to find the p value. (Table 3). No significant difference between the proportion of non-patency of I.V. cannula in the control and in the experimental group was seen until the morning of day II.On the evening of day II, 7 out of 30 cannulae were found non-patent in the control group, whereas in the experimental group, all the cannulae were found patent. These two proportions (control and experimental group) were found to be statistically significant (p<0.01). The proportion of patients who developed non-patency of I.V. cannula in the control group was significantly higher than the proportion in the experimental group.On the day III, in the morning and evening these proportions became higher and were found to be statistically significant (p<0.01).The chi square test with Yates correction was applied at one degree of freedom. The calculated value was found higher than tabulated (p<0.05). So there was a significant difference in the patency of the I.V. cannula between the experimental and control groups. Table 3: Comparison of patency of I.V. cannula on Day I,II &III in the Morning and Evening in the study groups.
n=30 n=30 n=30 n=30 |
|
| Day I
Patent 30 30 30 30 Non- patent – – NS – – NS Day II Patent 29 30 23 30 Non- patent 1 – NS 7 – p<0.05 Day III Patent 18 30 17 29 Non-patent 12 – p<0.01 13 1 p<0.01
Note :1. NS= Not Significant 2. The non-patent cannula of Day III evening also includes the non-patent cannula shown against Day III morning and Day II evening & morning respectively. Discussion The present study revealed that 100% cannulae were found patent up to the morning of day III in experimental group. On the evening of day III, 3.3% (I) cannulae were found non patent. On the other hand, in control group, 100% cannulae were patent only ob day I, whereas 96.7%& 76.6% cannulae were patent in morning & evening of day II respectively. By the evening of day III, only 56.7% cannulae were patent. Almost similar type of findings were reported by Dunn and Lenihan (1987)3 i.e; 82% cannulas were patent when saline lock is used 8 hourly. Ashton and Gibson, in 1990,6 conducted study on patency of I.V. cannula and found that patency was successfully maintained with a flush of 1 ml sodium chloride solution every 12 hours. Binomial distribution was applied to compare the patency of I.V. cannulae between the control and experimental groups. It was found significant at the level of 5% and 1 %. So, the null hypothesis was rejected and it was concluded that there was significant difference in the patency of I.V. cannula with Normal Saline Lock. Thus, Use of Normal Saline Lock in the I.V. cannula following administration of intermittent I.V. medication is highly recommended. A study of patency of different sizes of I.V. cannula with Normal Saline Lock should be conducted and also a study on patency of I.V. cannula on different sites with Normal Saline Lock in different veins of upper extremity should be conducted. References 1. Complications with the venous access device [Online]. 2006 January; Available from URL: http:// www.uspharmacist.com/oldformat.asp? Ur/= newlook/flies/feat/act2fg.htm. 2. Gabriel J. An intravenous alternative. Nursing Times 1993;90 (31): 39-41. 3. Dunn DL, Lenihan SF. The case of saline flush. American Journal pf Nursing 1987;6:698-9. 4. ASHP therapeutic position statement on the institutional use of 0.9% sodium chloride injection to maintain patency of peripheral indwelling intermittent infusion devices. American Society of Health-System Pharmacists. [Online];2005october.Available from URL:http://www.ashp.org/orn.onlinejournal. 5. Sandy H,Xuan S.Best practice: Heparin/saline lock of PIVs. [Online];2005 October Available from URL: http//www.childrenofMinnesota-Nursing News-j. 6. Ashton J,Gibson V, Summers S. Effects of heparin versus solutions on intermittent infusion device irrigation. Heart and Lung 1990;19:608-12.
|
|