Introduction/ Back Ground:

Intravenous catheters represent the most common parenteral site for medication delivery. Loss of peripheral intravenous (PIV) catheter patency is a common problem in the clinical setting. Maintenance of the PIVC patency gives rise to a significant problem in everyday clinical practice. Maintenance of the patency is important for minimizing client’s discomfort and the expense associated with replacement.²

Demir and Dramali (2003) and Le Duc (1997) suggest that normal saline is more efficacious than heparin for maintaining the patency of peripheral IV lines.¹²

Need for the study:

Patient safety is always a top priority in any nursing intervention. Several studies (Demir and Dramali, 2006; Goode, Titler, Rakel, Ones, Kleiber, Small et al, 1991 and Ranze Magnani and Greinacher, 2003) indicate that quality of care can be enhanced by using normal saline as the flush solution as it eliminates the severe complications associated with heparin such as heparin induced thrombocytopenia (HIT), thrombus and hemorrhage.⁹

More than five million clients require central venous access each year in USA. Central venous access can be associated with adverse events that are hazardous to clients and expensive to treat. Infection remains the main complication of intravascular catheters in critically ill clients. About 150 million intravascular devices were purchased in the United States each year for intravenous therapy for approximately 30 million patients.¹²

No such information available regarding purchasing and utilizing of intravascular devices every year in India. Above mentioned information and researcher own clinical experience motivated to conduct the research study on this topic.

STATEMENT OF THE PROBLEM:

Impact of intermittent saline flushing in the patency of peripheral venous catheter among clients in selected hospitals of district Muktsar, Punjab

OBJECTIVES:

1) Determine patency of peripheral venous catheter after intermittent saline flushing in experimental group.

2) Compare the patency of peripheral venous catheter between control group and experimental group.

3) Find the association between patency of peripheral venous catheter with the selected background variables.

OPERATIONAL DEFINITION:

• Intermittent Saline Flushing- it refers to flushing with 2ml of 0.9% normal saline every two hourly in patient with peripheral venous catheter.

• Patency– it refers to free flow of parenteral fluid through a peripheral venous catheter.

RESEARCH HYPOTHESES:

There is a significant difference in the patency of the peripheral venous catheter among patients who get intermittent saline flushing than those who do not.

REVIEW OF LITERATURE:

Review of literature selected under the following titles-

• Efficacy of Normal saline in Patency of peripheral venous catheter.(12)

• Safety of the patients (8)

• Cost effectiveness (8)

CONCEPTUAL FRAMEWORK:

Modified Ernestine Weidenbach's Helping Art of Clinical Nursing. Here the investigator develops a prescription based on a central purpose and implements it according to the realities of the situation.⁵

Statistical analysis – descriptive and inferential statistics use to assess the sample characteristics and variable and find out the relationship demographic and clinical variables.

Analysis and interpretation-

Table-2 Aspect wise compare the patency of PIVC among Control and Exp. Group

S/N	Aspect	Category	Control group	Exp. group	Chi-Square value	df	p value
			N=500 (%)	N=500(%)
1	Resistance Present	Yes	51	1.8	311.450	1	0.00
		No	49	98.2
2	Fluid leaking from cannula	Yes	4	0.4	15.059	1	0.00
		No	96	99.6
3	Hardening of surrounding tissues	Yes	92	1.2	828.294	1	0.00
		No	8	98.8
4	Redness or changing in character surrounding skin	Yes	75.6	1.2	585.024	1	0.00
		No	24.4	98.8
5	Discomfort for patient due to cannulation	Yes	72.2	1	546.172	1	0.00
		No	27.8	99
6	Blanched skin	Yes	41.4	0.4	254.206	1	0.00
		No	58.6	99.6
7	Swelling on cannulation site	Yes	64.2	2	476.784	1	0.00
		No	35.8	98
8	Edema surrounding the cannula	Yes	63.6	2.4	422.09	1	0.00
		No	36.4	97.6
9	Skin cool to touch	Yes	23.4	1.2	113.983	1	0.00
		No	76.6	98.8
10	Erythema on cannula access site	Yes	59.6	0.8	408.715	1	0.00
		No	40.4	99.2
11	Possible numbness	Yes	27.6	0.4	153.039	1	0.00
		No	72.4	99.6
12	Pain	Yes	68.4	3.6	454.112	1	0.00
		No	31.6	96.4
13	Infiltration of any amount of blood from cannula site	Yes	10.8	0.8	45.551	1	0.00
		No	89.2	99.2
14	Bruised skin	Yes	40.2	0	251.564	1	0.00
		No	59.8	100
15	Palpable venous cord	Yes	29	0	169.591	1	0.00
		No	71	100

Table -3 Shows the Association with the background variable

S/N	Aspect	Category	Control group	Exp. group	Chi-Square Test
			N=500(%)	N=500(%)	Chi –Square value	df	p value
1	Site of catheter insertion	Dorsum of hand	47	17.80	97.32	1	0.00
		Forearm	53	82.2
2	Solution used for flushing	Normal saline	0	100	1000	1	0.00
		None of the above.	100	0
3	Gap between fluid changes	Half an hour	53.60	7	286.99	2	0.00
		One hour	27.40	33.40
		More than one hour	19	59.60

There is no association with remaining background variables

Demographic findings:

• Present study maximum (65.2%) patient of control group and(76%) in experimental group are male. Remaining was female. In control group (37%) and (23%) in Experimental group had the history of previous hospitalization. In control group (49.2%) patients hospitalize for the 2 days and (49.2%) patients in experimental group hospitalize for 3 days.

• All the 1000 patients in (500 in control group and 500 in experimental group) cannulated by staff nurses, avoid previous puncture mark and joint, most distal portion of the vein was used for cannulation.

• Data showed that the patient who received the intermittent saline for flushing the cannula every 2 hourly found to be effective in experimental group. In the present study the calculate p value was 0.00 which is highly significant at p<0.01 level and hence the research hypothesis is accepted.

The findings of this study were supported by Shoaf J, Oliver S who examined an efficacy of normal saline injection with and without heparin for maintaining intermittent intravenous site. This study evaluated the effectiveness of normal saline versus normal saline containing 10 units per 1ml heparin preventing loss of an intermittent intravenous site (heparin lock). The sample consists of 260 surgical patients from a general surgery and a cardio vascular surgery nursing unit at a tertiary care hospital. Results indicated that heparinized saline is not needed to maintain the patency of an intermittent intravenous site and the use of saline solution is less irritating, causes less phlebitis, is less expensive to patients and save nursing time. ²⁴

IMPLICATION:

Nursing Practice:

Nursing practice is shifting from a traditional practice into an Evidence-Based Practice. Extra precautionary measures must be taken when heparin therapy in instituted. Nurses and other healthcare professionals need to be reeducated on the side effects and complications of heparin therapy in order to prevent unnecessary complications and to provide safe and effective care.

Saline flush is an important for clients, to reduce the need for the potentially painful process of placing vascular lines and also helps to control costs by reducing the number of devices used for each clients and the development of phlebitis, decrease platelet count, and cause of iatrogenic hemorrhage due to heparin flushing. ¹⁸

Nursing Education:

The findings of the study is useful for nursing educators to educate nursing students, which help them to learn more about the importance of maintaining the patency of peripheral venous catheters in patients. While doing procedure demonstrations, teachers can focus on the correct technique of the IV cannulation, proper injection technique and nursing care that will help in improving quality of health care.²⁴

Nursing Administration:

Being a nurse administrator, one can instructs all nursing staff regarding the principle to be followed for the procedure of I.V cannulation, proper methods of administrating I.V injection and the nursing care. In-service education can be organized on the same and develop the protocol for I.V flushing with normal saline to reduce the nurses work due to frequently removal of I.V catheter and minimizing the complication associated with repeated insertion of I.V cannulation.²⁹

Nursing Research:

The research findings will useful for a nurse administrator in changing the attitude of staff nurses, nursing practices to improve the quality of nursing care and instructing the staff nurses to minimize health hazards associated with intra venous cannulation, administrating intra venous medications and establish quality assurance in nursing practice

The various research studies have indicated that flushing with normal saline prevents local tissue damage, drug incompatibilities, iatrogenic hemorrhage and it can also reduce the cost of maintaining peripheral devices.²²

LIMITATION:

• Study participants were selected from private hospitals only.

• Had difficulty in controlling the contamination due to hospital policy on flushing of I.V catheters.

• Emergency and ICU patients are not included in the study

FUTURE DIRECTION:

• Study will conducted in Government Hospitals.

• Emergency and ICU patient will be included in the study who have IV catheter for long duration.

• Comparative study between patient receiving heparin and Normal saline to evaluate the effectiveness and safety of the patient.

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Received on 24.01.2014 Modified on 08.02.2014

Int. J. Nur. Edu. and Research 2(1): Jan.-March, 2014; Page 29-35

Group	Intervention	Posttest
E	X	O₁
C		O₂