A Study to assess the effectiveness of Intermittent Flushing of Normal Saline to maintain A Patency of Intravenous Cannulation among Hospitalized patient in Saveetha Medical College and Hospital

 

Ms. Varalakshmi¹. E, Ms.Usharani. S²

¹Assistant Professor, Department of Medical Surgical Nursing, Saveetha College of Nursing,

SIMATS, Chennai-602105

 

ABSTRACT:

INTRODUCTION: Peripheral venous catheters are most frequently used invasive devices in the hospital and up to 70percent of patients require a peripheral venous line during their hospital stay. Phlebitis is still a common complication of peripheral venous catheter. Blockage of intravenous cannula is one of the major discomforts faced by the patients. Nurses not only directly administer the medication to the patient but also experience the difficulty while administering the medication through non patent intravenous cannula. It is one of the major role of a nurse to maintain the patency of intravenous cannula by just following a flushing techniques. STATEMENT OF THE PROBLEM: Assess the effectiveness of intermittent flushing of normal saline to maintain a patency of continuous intravenous cannulation among patient with intravenous medication admitted in Saveetha Medical College and Hospital. OBJECTIVE: To assess patency of intravenous cannula after intermittent normal saline flushing in experimental group and control group among hospitalized patients. To find out the association between patency of intravenous cannula (type of medication, size of cannula, site of cannula). To assess the association between the level of experimental group patency of intravenous cannulation with the demographic variables. METHODS: A Quasi-experimental study was conducted among 60 patient on intermittent intravenous medication, 30each in experimental and control group who met the inclusive criteria. Purposive sampling technique was used for selecting the sample. Data where collected from the subject using patency checklist. From the first day of intravenous cannulation, normal saline flushing with 2ml of normal saline was administered intermittently twice daily after administering intravenous medication for 72 hours to experimental group and no saline flushing given to control group. The patency was observed twice daily for both the groups until 72 hours through the observational checklist. RESULT: The findings revealed that in the experimental group, after the intervention of saline flushing ,(96.6%) patients had patent intravenous cannula for 72 hours. There was a significant difference in the patency status of intravenous cannula between the experimental and control group (t = 2.278 at 0.05 level of significance). There was statistically no significant association found between the patency of intravenous cannula with the selected extraneous variables like type of medication, size of cannula and site of cannulation. CONCLUSION: It was conducted that normal saline flushing could be used in maintaining the patency of intravenous cannula.

 

 

 

 

INTRODUCTION:

Hospitalization is a period beginning the hospital the patient immediately receiving the intravenous for the good treatment and managing the disease symptoms. The World Health Organization(WHO) describes the hospitalized period as the most critical and yet the most neglected phase in the lives of patient; most of the problem araising during the hospitalization.

 

Peripheral venous catheters are most frequently used invasive devices in the hospital and up to 70percent of patients require a peripheral venous line during their hospital stay. Phlebitis is still a common complication of peripheral venous catheter. Finding an appropriate solution to prevent and reduce the incidence of this complication remains challenging.A special care to the hospitalized client to facilitate the patency of intravenous cannula. Normal saline lock was found to be highly effective for maintaining patency of intravenous cannula. The patient with intravenous medication face difficulties due to loss of patency of intravenous cannula and it lead to infiltration, redness edema phlebitis and causes of pain. So the care giver(nurses) want to frequently  change the intravenous cannula because of it may cause a complication and associated problem related to failure of intravenous cannulation. maintaining of patency of intravenous cannula is very important and needed. Therefore the researcher identified the need for conducting research regarding the maintenance of patency of  intravenous cannula by using a normal saline.

 

Lei zhong, Hai –Li Wang, Bo Xu, Yao Yuan, Zhan sheng Hu (2017) are conducted a study an ‘’Normal saline versus heparin for patency of central venous catheters in adult patient – a systematic review and meta-analysis’’. Whether in terms of pooled or local analysis, normal saline can be equally, if not more effective, in keeping the central venous catheters open. Of studies reporting secondary outcomes (maneuver needed, heparin-induced thrombocytopenia, haemorrhage, central venous thrombosis and catheter-related bloodstream infection),heparinised saline was shown not to be superior to non-heparinised solution. Subgroup analysis in patients with short vs longterm CVC placement was consistent with the main outcome partly (n=1286, p=0.041). based on the results of this meta-analysis, HS is not superior to normal saline in reducing CVCs occlusion. But in the short term, the use of HS is slightly superior to normal saline for flushing catheters from a statistical point of view.

 

Understanding such mechanism (normal saline lock) that promote or hinder health and survival is central to developing strategies to ensure positive outcomes for patient and medical professional for example a study in Uganda showed strong care takers beliefs that intermitten flushing of normal saline to maintain a patency of intravenous cannula. Initiation of intravenous cannula lock by normal saline is important because of maintaining good health and preventing hospital associated complication(philibitis).

 

MATERIALS AND METHOD:

Research approach:

Quantitative research approach.

 

Research design:

Quasi experimental research  design was chosen to assess the effectiveness of intermittent flushing of normal saline to maintaining a patency of intravenous cannulation among hospitalized patients.

 

Setting:

The  study was conducted at Saveetha Medical College and Hospital.

 

Population:

The population included in this study are 16-70 years,  both  male and female who are admitted in medical and surgical ward in Saveetha Medical College and Hospital.

 

Sample size:

The study consist of 60 patient, who admitted in Saveetha Medical College and Hospital.

 

Technique:

Purposive random sampling  technique.

 

Criteria for sample selection:

Inclusive criteria

·        patient with intravenous medication.

·        Patient willing to participate in this study.

·        Both male and female.

 

Exclusive criteria:

·        who receiving continuous infusion, blood transfusion, anticoagulation medication

·        patient who are not willing to participate in this study.

·        Patient with insufficiency(renal failure)

 

Tools and scoring process:

Tool - 1 (patency chick list):

 It was used for assessing the patency status of intravenous cannula. It as tow section

 

Section – A

It consist of seven criteria regarding patence of iv cannula. i.e., resistance, leaking, infiltration, hardening of tissue, erythema at the assess site changes in colour and pain.

 

The scoring was: yes - o score, No – 1 score: maximum score=7, minimum score=0. presence of any criteria indicated that the cannula was not patent.

 

Section - B

3 criteria regarding i.e., type of medication, size of cannula and site of cannulation

 

Tool - 2

Pain scale ( universal pain assessment scale)

 

RESULT:

The study reported that intermittent normal saline flushing twice daily was effective maintain the patency of intravenous cannula, there was no association between the selected extraneous variable such as type of medication, size of cannula and site of cannulation.

 

Table – 1 Frequency and percentage distribution of level of patency of intravenous cannulation experimental and control group of hospitalized patients.

Group	Patent		Non patent
	No	%	No	%
Experimental group	29	96.6%	01	3.04%
Control group	00	00%	30	100%

 

 

Table-1 Represent in experimental group after intermittent flushing of normal saline to maintain the patency of intravenous cannulation. A majority 29(96.6%) had a patency of IV cannulation and 1(3.04%) had a non patent of intravenous cannulation among hospitalized experimental group.

 

Where in the control group, 30(100%) had a non patent of intravenous cannulation among hospitalized experimental group.

 

Table – 2 Patency of intravenous cannulation after intermetten flushing of normal saline for experimental group and control group among hospitalized patients.

Group		Mean	SD	Unpaired t-Test value
Experimental group	Pre test	6.6	0.6633	2.278
	Post test	6.4	0.757
Control group	Pre test	2.43	1.806
	Post test	3.03	1.473

 

 

Table- 2 Represents in experimental group, pre test mean is 6.6 and SD is 0.6633, thepost test mean is 6.4 and SD is 0.757. the control group, pre test mean is 2.43 and SD is 1.806,the post test mean is 3.03 and SD is 1.473. the unpaired t-value for post test of experimental and control group is 2.278 which is significant at P<0.05 level, and hypothesis(H1) is retained.

 

 

 

 

Table– 3 Association between the level of experimental group patency of intravenous cannulation with the demographic variables.

S. NO	Demographic Variables	Level of Experimental Group Patency of Intravenous Cannula		Chi-Squre and P – Value
		Patent	Non patent
1.	Age a)15 – 30 b)31 – 40 c)41 – 50 d)above 60	06 02 10 03	02 00 06 01	X2=1.4282 P = 7.82 Df=3 Significant
2.	Sex a)male b)female	02 07	06 05	X2=0.21516 P = 3.85 Df=1 Significant
3.	Education a)illiterate b)primary c)secondary d)graduate	04 07 06 04	02 04 03 00	X2=2.0053 P = 7.82 Df=3 Significant
4.	Income a)less than 5000 b)5000-8000 c)9000-12000 d)greater than 12000	02 14 06 02	00 04 01 01	X2=1.0314 P = 7.82 Df=3 Significant
5.	Days of hospitalization a)<7 days b)7-14 days c)15-20 days d)>4weeks	18 05 03 00	03 01 00 00	X2=1.183 P = 7.82 Df=3 Significant
6.	Type of medication a)antibiotic b)other	20 03	06 01	X2=0.0070 P = 3.84 Df=1 Significant
7.	Colour of cannula(size) a)pink(20 gauge) b)green(18 gauge) c)grey(16gaug)	15 05 03	05 02 00	X2=1.7529 P = 5.99 Df=2 Significant

 

Table 3 Represents that the study significant association between the demographic variables of age, sex, education, income, number of hospitalization, type of medication and colour of cannula in an experimental group at P<0.05 and the non-significant associated between the demographic variable of years of experience with patency of intravenous cannulation in an experimental group at P>0.05.

 

Natalie K Bradford, Rachel M Edwards, Raymond J chan. Editorial group: Cochrane Vascular group (2013). They are conduct a study on ‘Heparin versus 0.9 % sodium chloride intermittent flushing for the prevention of occlusion in long term central venous catheters in infant and children’ in the year of 2013. Randomized controlled trials in adults 18 year of age and older with a central venous catheter in witch intermittent flushing with heparin was compare with 0.9% normal saline were included. Data collection and analyses: two review authors independently selected trials, assessed trial quality and extracted data. Trial authors were contacted to retrieve additional information, when necessary. As heparin is more expensive than normal saline, our finding challenge its continued use in central venous catheter flushing outside the context of clinical trials.

 

Figure – 1

Frequency and percentage of level of patency of intravenous cannulation among hospitalized patient in Saveetha Medical College and Hospital.

 

Patency of Experimental group – 96.60%

Non patency of experimental group – 3.40%

Patency of control group – 0.00%

Non patency of control group – 100%

 

DISCUSSION:

The aim of the study was to assess the effectiveness of intermittent flushing of normal saline to maintain the patency of intravenous cannulation among hospitalized patient. This current research helped us to understand the effectiveness of normal saline lock. If the intervention is cost effective and at the same time if gives faster result, then it becomes boon for the client or patients. Advanced education in nursing prepares a nurse to take independent discussion and function independently to advocate patient right for health care which is appropriate. The nursing administration can improve knowledge among staff nurses through development program like in service education and continuing education program.

 

ACKNOWLEGDEMENT:

The authors are grateful to the authorities of Saveetha College of Nursing, Saveetha Medical college and Hospital.

 

CONFLICT OF INTEREST:

The Authors declare no conflict of interest.

 

REFERENCES:

1.       Taylor, “ Fundamental of Nursing- The Art and Science of Nursing Care”, Bangalore, 2015.

2.       Ignatavieius, Workman, Mishler. “Medical-Surgical Nursing (A Nursing Process Approach)”, Saunders Publication,2011.

3.       Kaur, M., Sharma, S., and Jain, S. Patency of intracenous (I.V) cannula with normal saline lock for patients on intermittent medication. Nursing and Midwifery Research Journal, 2(4); 2006: 132-138.

4.       Kaur, P., Thakur, R., Kaur, S., and Bhalla, A.. Assessment of risk factors of phelebitis amongst intravenous cannulated patients. Nursing and Midwifery Research Journal, 7(3);2011: 106-114.

5.       Sucheta, P. A comparative study of heparinised solution versus nonheparinised solution for the maintenance of patency of peripheral intracath line among the patients admitted in the medical and surgical wards. Nightingale Nursing Times, 185(10); 2005: 28-30.

6.       Moclair A Bates I. the efficacy of heparin in maintaining peripheral infusions in neonates. European Journal of Pediatrics. 1995; 154(7): 567-70.

 

 

 

 

Accepted on 28.05.2018        © RJPT All right reserved

Research J. Pharm. and Tech 2018; 11(10): 4211-4214.