EFFECTIVENESS OF NURSING INTERVENTION ON

PREVENTION OF INTRAVENOUS THERAPY RELATED

COMPLICATIONS AMONG NEONATES ADMITTED IN NICU AT
SMVMCH PUDUCHERRY.

BY

ASWINI. S

Dissertation submitted to the Pondicherry University, Pondicherry in

Partial fulfillment of requirement for the degree of

Master of Science in Nursing

Under the guidance of

Mrs .SARASWATHI.L. Msc, NURSING

HOD (cum) Professor

Department of Child Health Nursing

SRI MANAKULA VINAYAGAR NURSING COLLEGE,

KALITHEERTHALKUPPAM,PUDUCHERRY

July 2014
 A STUDY TO EVALUATE THE EFFECTIVENESS OF NURSING
INTERVENTION ON PREVENTION OF INTRAVENOUS
THERAPY RELATED COMPLICATIONS AMONG NEONATES
ADMITTED IN NICU AT SMVMCH PUDUCHERRY.

NAME OF THE CANDIDATE : ASWINI.S

REGISTER NUMBER : 12MSN302

NAME OF THE GUIDE :Mrs.L.SARASWATHI, MSC(N)

Head of the Department

NAME OF THE CO-GUIDE :Mrs.D.VASANTHAKUMARI, MSC(N)

Lecturer

DEPARTMENT : CHILD HEALTH NURSING

Signature of the Signature of the

Internal Examiner External Examiner
Date: Date:

i
 A STUDY TO EVALUATE THE EFFECTIVENESS OF NURSING
INTERVENTION ON PREVENTION OF INTRAVENOUS
THERAPY RELATED COMPLICATIONS AMONG NEONATES
ADMITTED IN NICU AT SMVMCH PUDUCHERRY.

Approved By Dissertation Committee in July 2014

PROFESSOR IN NURSING RESEARCH:

DR.R. DANASU, M.Sc. (N) MA (Socio), M.Phil., Ph.D.(N)

Principal, College of Nursing

Sri ManakulaVinayagar Nursing College,

Kalitheerthalkuppam,
Puducherry

PROFESSOR IN CLINICAL SPECIALITY AND GUIDE:

Mrs.L, SARASWATHI. M.Sc. (N),

Head of the Department,

Child Health Nursing,
Sri ManakulaVinayagar Nursing College,
Kalitheerthalkuppam,
Puducherry.

A DISSERTATION SUBMITTED TO THE PONDICHERRY

UNIVERSITY, PUDUCHERRY IN PARTIAL FULFILMENT OF
REQUIREMENT FOR THE DEGREE OF MASTER OF SCIENCE
IN NURSING

JULY 2014

ii
 SRI MANAKULA VINAYAGAR NURSING COLLEGE,

KALITHEERTHALKUPPAM,

PUDUCHERRY

ENDORSEMENT BY THE PRINCIPAL/ HEAD OF THE

INSTITUTION

This is to certify that the dissertation titled “ASTUDY TO

EVALUATE THE EFECTIVENESS OF NURSING INTERVENTION ON
PREVENTION OF INTRAVENOUS THERAPY RELATED
COMPLICATIONS AMONG NEONATES ADMITTED IN NICU AT
SMVMCH PUDUCHERRY.”Is a bonafide research work done by
MS.ASWINI.Sunder the guidance of Dr.R.DANASU, Principal
SriManakulaVinayagar Nursing College, Kalitheerthalkuppam, Puducherry.

SIGNATURE OF HEAD OF THE INSTITUTION

DR.R. DANASU, M.Sc. (N) MA (Socio), M.Phil., Ph.D.(N)

PRINCIPAL,
SRI MANAKULA VINAYAGAR NURSING COLLEGE,
KALITHEERTHALKUPPAM,
PUDUCHERRY.

DATE:

PLACE: Puducherry.

iii
 SRI MANAKULA VINAYAGAR NURSING COLLEGE,

KALITHEERTHALKUPPAM,

PUDUCHERRY

CERTIFICATION BY THE GUIDE

This is to certify that the dissertation titled “A STUDY TO EVALUATE

THE EFFECTIVENESS OF NURSING INTERVENTION ON

PREVENTION OF INTRAVENOUS THERAPY RELATED

COMPLICATIONS AMONG NEONATES ADMITTED IN NICU AT

SMVMCH PUDUCHERRY” in partial fulfillment of the requirement for the

degree of Master of science in Nursing in Child Health Nursing.

SIGNATURE OF THE GUIDE

MRS.L.SARASWATHI

HODCHILD HEALTH NURSING,

SRI MANAKULA VINAYAGAR NURSING COLLEGE,

PUDUCHERRY.

DATE:

PLACE: Puducherry

iv
 PONDICHERRY UNIVERSITY, PUDUCHERRY

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation/thesis titled “A STUDY TO

EVALUATE THE EFFECTIVENESS OF NURSING INTERVENTION

ON PREVENTION OF INTRAVENOUS THERAPY RELATED

COMPLICATIONS AMONG NEONATES ADMITTED IN NICU AT

SMVMCH PUDUCHERRY.” is a bonafide and genuine research work carried

out by me under the guidance of Dr.R. DANASU, Principal Sri Manakula

Vinayagar Nursing College, Kalitheerthalkuppam, Puducherry.

SIGNATURE OF THE CANDIDATE

Miss. ASWINI.S

DATE:

PLACE: Puducherry.

v
 COPYRIGHT

DECLARATION BY THE CANDIDATE

I hereby declare that the Pondicherry University, Puducherry shall have

the rights to preserve, use and disseminate this dissertation/ thesis in print or

electronic format for academic/ research purpose.

SIGNATURE OF THE CANDIDATE

Miss. ASWINI.S

DATE:

PLACE: Puducherry.

vi
 ACKNOWLEDGEMENT

I extremely thankful to the Sri Manakula Vinayagar Medical College and

Hospital for giving me an opportunity to accomplish this project work in their

esteemed Institution.

I am grateful to Shri.N.Kesavan, (Late)former Chairman and founder

of Sri ManakulaVinayagar educational trust, for the facilities offered in this

Institution.

I express my appreciation to Shri. M.Dhanasekaran, chairman cum

Managing Director, who extended the opportunity for this endeavor.

I wish to extend my heartfelt thanks to Shri.S.V.Sugumaran,Vice

chairman , Sri Manakula Vinayagar educational trust for his support.

I express my sincere thanks and heartiest gratitude to principal

Dr.R. Danasu, Principal, of Sri ManakulaVinayagar Nursing College, for lay

the foundation of the project and her direction and support given to me which

helped me to accomplish this study.

It is my great pleasure and privilege to express my deep sense of gratitude

to my esteemed guide Mrs.L.Saraswathi,HOD in child health

nursing,Mrs.D.Vasanthakumari, and Miss.P.Suganyasweetlin, lecturer in

child health nursing and Mrs.R.Sridevi, Department of Medical Surgical

Nursing for their consistent guidance, highly interactive suggestions, precious

advice, inspiration and encouragement.

vii
 I would like to extend my hearty thank to pediatrics HOD

Mr.Ragavendiran, Mr.Chandankumarshaw for given permission to

conducted the study in successful manner in NICU and also express my lovable

thanks to Staff nurses, Mother of neonates for this valuable support.

I would like to thank all our Lecturer and Assistants Lecturer for their

guidance and support.

I would like to thank all my Lecturers and Assistants Lecturers for their

guidance and support. I extent my sincere thanks to Mr.Mani.V, Dept of

Biostatistics, Meenatchi Medical Mission Hospital, Madurai for his valuable

suggestions to do this research successfully.

I also wish to extend my thanks to Mrs.D.VIJI, Lecturer, in

krishnaswamy arts and science college cuddalore, for her interactive

suggestions regarding grammar and spelling checking in this study.

I am deeply indebted to the subjects for their kind co-operation for

without them the study could not have been done.

A special thanks to our classmates and friends for their support in times of

need, and those who helped me directly or indirectly towards the completion of

the study.

viii
 I extended my heartfelt thanks to the librarians, office staff, computer

operators, printers and binders for their help in converting this manuscript into

printed matter.

SIGNATURE

Miss.ASWINI.S

DATE:

PLACE:

ix
 ABSTRACT

INTRODUCTION

“An ounce of prevention is better than a pound cure”

Nurses who are able to plan and carry out nursing care with knowledge,

skill and confidence are better ambassadors for their specialty. Nurses practice

within a changing and evolving health care environment and therefore they are

required to develop their knowledge, skill and attitude. Nurses’ practice is

supported by knowledge that is continuously evolving and therefore must use the

best available evidence to guide their practice. Nurses who are performing

intravenous annulations will be competent practitioners in the expanded area of

practice and therefore will deliver a more responsive timely service that will

improve the patient’s journey within the health services.

To facilitate holistic and timely treatment for neonates, nurses

increasingly need to develop their competence in inserting intravenous cannula.

For nurses working with children and young people, this is usually regarded as

an expanded role. Before starting programmers of education and training, in

most cases practitioners will need to demonstrate competence and experience in

venipuncture and administering medicines intravenously to children and young

people. Intravenous infusion of fluids has become widely used as a therapeutic

modality in the care of neonates.

The nurse has the important role and responsibility in monitoring this

type of therapy. All nurses are likely to be responsible for the administration and

x
management of some form of intravenous therapy. The important responsibility

of the nurse is to protect the child from infection during the intravenous infusion.

Infiltration of fluid is common in children nurse has to make sure that the needle

is in place and patent in the basis of scientific principle the protocol using

evidence based resources .

STATEMENT OF THE PROBLEM

“A study to evaluate the effectiveness of nursing intervention on prevention

of intravenous therapy related complications among neonates admitted in NICU

at SMVMCH, puducherry.”

OBJECTIVES OF THE STUDY

 To prepare a standardized protocol for nursing intervention on prevention

of intravenous therapy related complications among neonates.

 To evaluate the effectiveness of standardized protocol for nursing

intervention on prevention of intravenous therapy related complications

among neonates.

 To associate the effectiveness of standardized protocol for nursing

intervention on prevention of intravenous therapy related complications

among neonates with their selected demographic variable.

xi
HYPOTHESES:

1. H1-there will be a significant relationship between the standardized

protocol for nursing intervention and intravenous therapy related

complications among neonates.

2. H2- there will be a significant association between the effectiveness of

nursing intervention on prevention of intravenous therapy related

complications among neonates with their selected demographic variable.

CONCEPTUAL FRAMEWORK:

 The conceptual framework for the study was based on Lydia Hall, Core,

Care, Cure, theory, 1960.

METHODOLOGY:

The design adopted was pre experimental one group post-test only design.

The main study was conducted in SMVMC Hospital, Puducherry. The period of

data collection was six weeks. Totally 60 Neonates were selected by using

convenient sampling technique. Standardized protocol for intravenous therapy

administration among Neonates to assess the level of complications with

Modified visual infusion complications scale score.

The gathered data analyzed by using descriptive and inferential statistical

method and interpretations was made on the basis of the objectives of the study.

xii
RESULT OF THE STUDY:

The major findings of the study were;

The post test assessment of intravenous therapy related complications

based on standardized protocol reveals that distribution of level of complications

44 neonates (73.33%) had no complications of intravenous therapy, 16 neonates

(26.67%) had mild level of complications of intravenous therapy and no

neonates are affected with moderate and sever complications.

The over all mean value is 10.47% and SD level of 0.947 there is

association at 1% level of significant of post test level of complications with

selected demographic variable, such as age in day, sex, term of birth, weight of

baby, duration of intravenous therapy, intravenous injection with and without

antibiotic. It shows that highly significa433nt.

RECOMMENDATIONS

Based on findings of the present study, the following recommendations have

been made,

 Similar study can be conducted in other areas with a large sample.

 The same study can be conducted in different settings.

 The same study can be conducted with true experimental research

design.

 The study can be replicated with larger samples for better

generalization.

xiii
  The study can be done as a longitudinal study.

 The study can be replicated with bio-physical parameters.

 A comparative study can be conducted between pharmacological and

non pharmacological intervention.

 The standardized protocol should be used for the adult also.

CONCLUSION:

The study was conducted among60 neonates to find the effectiveness of

standardized protocol for nursing intervention on intravenous therapy related

complications at puducherry. The result shows there is 44 neonates did not

develop no complications, 16 neonates have mild complications and no neonates

are affected with moderate and sever complications. So the standardized protocol

is effectiveness there is association of selected demographic variable like, Age in

days, sex, term of birth, weight of baby, duration of intravenous therapy,

intravenous injection with and without antibiotic. It shows that highly significant

with post test score of level of complications.

xiv
 TABLE OF CONTENTS

CHAPTER CONTENT PAGE NO.

I INTRODUCTION 1-4
 Need for the study 5-9
 Statement of the problem 10
 Objectives of the study 10
 Assumptions 10
 Hypothesis 11
 Operational definitions 11
 Delimitations 12
II REVIEW OF LITERATURE 13-20
 conceptual framework 21-23
III RESEARCH METHODOLOGY 24
 Research Approach 24
 Research Design
24-25
 Population
26
 Setting of the study
26
 Sample
 Sample size
26
 Sampling technique 26
 Criteria for sample selection 27
- Inclusion criteria 27
- Exclusion criteria 27
 Study variables
27-28
 Development and description of data
29
collection tool
29
 Content Validity
 Reliability 29
 Pilot Study 30
 Data collection procedure 31
 Plan for data analysis

xv
IV DATA ANALYSIS AND INTERPRETATION 2 34-47
V DISCUSSION, SUMMARY, CONCLUSION,
NURSING IMPLICATIONS, AND 48-58
RECOMMENDATIONS
 Discussion
 Summary
 Conclusion
 Nursing Implication
 Limitations
 Recommendations
BIBLIOGRAPHY 59-61
APPENDICES 62-91

xvi
 LIST OF TABLES
TABLE TABLE NAME PAGE
NO. NO.
1. Distribution of selected demographic variable of neonates 35
2. Distribution of mean, SD post test scores of standardized 43
protocol among neonates.
3. Distribution of level of complications related to intravenous 44
therapy for neonates.
4. Association between the levels of complications of intravenous 46
therapy among neonates with selected demographic variable.

xvii
 LIST OF FIGURES
FIGURES FIGURE NAME PAGE NO.
1. Conceptual frame work 23

2. Schematic representation of research design 25

3. Relationship of the variables 28

4. Distribution of term of birth of neonates 38

5. Distribution of duration of intravenous cannula of 40

neonates.

6. Distribution of site of intravenous cannula of 41

neonates.

7. Distribution of intravenous injection with antibiotic 42

and without antibiotic of neonates.

8. Distribution of level of complications related to 45

intravenous therapy among neonates.

xviii
 LIST OF APPENDICES
APPENDIX
NO. CONTENT
Tool:

Section A:Demographic data

I Section B:Modified visual infusion complications score scale

Section C: Observational Check list for staff nurse

II Letter seeking permission for conducting the study

III List of experts

IV Letter for validation of tool

V Certificate for English Editing

VI
Informant consent

VIII Schedule for data collection

IX Intravenous protocol modules

X Data Collection Photos

xix
 CHAPTER-I
INTRODUCTION
“An ounce of prevention is better than a pound cure”
Medication administration is a basic nursing function that involves skillful

techniques and consideration of children’s development, health status and safety.

The nurse needs knowledge base about drugs including drug name, preparation,

classification, adverse effect and physiologic factors that affect the drug action.

Among all method of drug administration, intravenous administration of fluids,

drugs and nutrition is very common in hospital.

Intravenous infusion of fluids has become widely used as a therapeutic

modality in the care of neonates. The nurse has the important role and

responsibility in monitoring this type of therapy. Intravenous therapy is the

quickest and most effective means of administering fluid or medicine to the ill

neonates, infant and child, as much as, is a relative common pediatric therapy.

Intravenous fluid may be infused into a peripheral vein, a central access device,

or a peripherally inserted central catheter. It is necessary to understand the

principles of intravenous therapy, including the fluid and caloric needs of the

child to act as a second level of protection against over hydration or under

hydration during intravenous fluid therapy.

WHO (2009) estimated about India’s neonatal intravenous

complications African journal of health and sciences (2008).A study was

conducted on peripheral intravenous catheter complications in critically ill

children. Six hundred fifty-four peripheral intravenous catheters in 303 pediatric

intensive care unit patients were examined to determine complications rates and
1
associated risk factors. Phlebitis13%, extravasation 28%, and bacterial

colonization11%, sepsis occurred respectively. Replacing catheters in critically

ill children every 72 hours would not decrease phlebitis, bacterial colonization,

or catheter-induced sepsis and could increase extravasations risk. Catheters can

be safely maintained with adequate monitoring for up to 144 hours in critically

ill children.

Journal report on United Kingdom health and sciences (2004).

Neonatal Intensive Care Unit (NICU) will undergo the insertion of a peripheral

intravenous therapy is routine, Common injuries observed in the NICU include

cellulites, infection, necrosis, scarring, nerve damage, and permanent

contractures. The incidence of extravasation injury resulting in skin necrosis to

be approximately 4%, with 70% of such injuries occurring in infants. The study

report shows that children with intravenous cannula for more than 72 hours are

more prone or vulnerable to develop intravenous cannulation with related

complication such as infection, burning sensation, redness, swelling, phlebitis

etc.

Nosocomial infection associated with intravenous therapy area major

concern in today’s medical care. There are two major sources of blood stream

infection associated with any intravascular devices: colonization of the devices

itself and contamination of the fluid administered through devices.

For most intravenous infusion in neonates, an over-the-needle 24 –gauge

catheter may be used if therapy is expected to last less than 5 days. The length of

2
the catheter may be directly related to infection and embolus formation. The

shorter the catheter, the fewer the complications. Determining the best catheter

for the patient early in the therapy provides the best chance of avoiding catheter

related complications.

Infiltration and extravasations of intravenous fluid is a complications of

neonatal intensive care that results in varying degree of morbidity. If

extravasations are next to a major artery in the forearm or leg, vascular flow can

be obstructed and amputation required. The severity of damage depends on the

volume and type of the fluid in filtered. Infiltration is the most common

complication of peripheral intravenous therapy. Complication rates of

intravenous infiltration range from 0 to 78 percent. Intravenous extravasations

are estimated to occur in 11 percent of NICU patients, with tissue sloughing

occurring in 43.6 percent of those infants. Common site of extravasations include

the dorsum of the hands, the anticubital fosse and the ankle. Serious

extravasations can result in pain, infection, disfigurement, prolonged

hospitalization, increased hospital costs and possible litigation.

The risk factors of intravenous related complications with 40 neonates. By

using observation check list the signs & symptoms were assessed which reveals

that, the type of infusion, duration of cannulation more than 3 days (50%), IV

antibiotics (12%), female sex(12%), catheter material PEO - vialon and Teflon

(6%), anatomic site - forearm related (12%) and wrist(8%).

3
 An article on prevention of infection in peripheral intravenous devices

stated that the possible uses of the catheters that are available in different sizes.

14-16G are used for major trauma/surgery, epidural, massive fluid replacement.

18G for routine blood transfusions, rapid infusion, 20G for routine infusions,

bolus drug administration, 22G for small, fragile veins, short-term access and

24G for small, fragile veins.

The main advantages of using Intravenous cannula are, it allows volumes

of fluids, medications, colloids, blood products, Parental nutrition and

chemotherapy.

A group of complications can occur after peripheral intravenous therapy

and arterial vascular cannulation. The main reason for complications is

inappropriate use and poor technique which is followed by health professionals.

Some of the important complications are infection, phlebitis, Thrombophlebitis,

infiltration, Hematoma, nerve damage, fluid overload, electrolyte imbalance,

embolism and extravasations.

As Intravenous Cannula is common and routine procedure for children ,

nurses responsibility in taking care of these children begins with preparing the

material, selecting the vein, selecting proper gauzed catheter, cleaning and

disinfecting the area, insertion of catheters, placement of catheter, restoring

intravenous therapy and safe withdrawing of inserted intravenous catheter.

4
 NEED FOR THE STUDY

The requirements for fluids and electrolytes of the newborn are unique. At

birth, there is an excess of extra-cellular water, and this decreases. Over the first

few days after birth Furthermore, extra- cellular water at birth and insensible

water loss decrease as birth weight and gestational age increase. Several days

after birth, fluid and electrolyte requirements increase as the infant starts to grow.

Fluid therapy may be required in a wide verity of clinical situation to

correct fluid and electrolyte imbalances, administer medications, administration

blood products and nutrients.

Clinical conditions requiring fluid therapy includes continuous gastro

intestinal fluid losses in vomiting, diarrhea, nasogastric tube aspiration,

colostomy, burn injury, diabetic ketoacidosis, pyloric stenosis and salicylate

intoxication.

Fluid, electrolyte, and nutrition management is important because most

infants in a neonatal intensive care unit require intravenous fluids and have shifts

of fluids between intracellular, extracellular, and vascular compartments.

Therefore, careful attention to fluid and electrolyte balance is essential. If

inappropriate fluids are administered, serious morbidity may result from fluid

and electrolyte imbalances. Inadequate attention to nutrition in the neonatal

period leads to growth failure, osteopenia of prematurity and other

complications.

5
 WHO (2010) A study was conducted to evaluate the effect of nurse

training on the improvement of intravenous applications. Nurses were found to

have high knowledge levels, but their practices were not suitable to their

knowledge levels. Of the patients who participated in the study, 67.24% showed

symptoms of phlebitis. We found that there was a significant relationship (P <

.05) between the selection of the vein and the occurrence of phlebitis in patients

who had an intravenous catheter. We also found that the relationships between

the age groups of the patients and phlebitis and the relationships between the

diagnosis and phlebitis were statistically significant (P < .05).

An article on prevention of infection in peripheral intravenous devices

stated that the possible uses of the catheters that are available in different sizes.

14-16G are used for major trauma/surgery, epidural, massive fluid replacement.

18G for routine blood transfusions, rapid infusion, 20G for routine infusions,

bolus drug administration, 22G for small, fragile veins, short-term access and

24G for small, fragile veins.

Kagel EM, Baptist Medical Center, Oklahoma City, (2011)Worldwide conducted

study on intravenous therapy complications among neonates hand and forearm

over a 3-year period .There were 56 minor and 11 major complications. More

than 50% of minor complications occurred in the hand and wrist, and more than

50% of major complications occurred in the hand. Minor complications

comprised 26 intravenous infiltrations, 23 cases of thrombophlebitis, and 7 cases

of cellulites. Major complications included septic thrombophlebitis in 3%,

6
hematomas resulting in skin necrosis in 2%, and infiltration related

complications in 6%, resulting in skin necrosis in2%, compressive nerve lesions

in 2% digital stiffness in 1%, and compartment syndrome in1% occurring.

Jamia, Hamdard Research Hospital in India Delhi (2003) peripheral

venous catheter-associated complications were prospectively evaluated in a 2

month-study performed in 3 different hospitals. A total of 525 peripheral venous

catheters were included. Main clinical complications were erythematic (22.1%),

tenderness (21.9%), swelling or indurations (20.9%), palpable cord (2.7%) and

purulence (0.2%). Phlebitis was observed in 22%. therapy colonization occurred

in 13%.Risk factors for phlebitis were skin lesions, active infection unrelated to

peripheral venous catheter, "poor quality" peripheral vein and > 72 hour-of

intravenous therapy. The study shows that Complications associated with

peripheral venous catheters are frequent but remain benign. They could probably

be reduced by a systematic change every 72-96 hours as recommended by

different guidelines.

Rajivgandhi university of health science karnataka, (2009) serious

complications related to peripheral intravenous cannulation is uncommon, but do

occur with prolonged use. A study findings revealed that phlebitis occur most

commonly and the frequency is from 2.5 to 45% or more and the chance for

developing thrombophlebitis was between 12%-34% after 24 hours and 36-65%

after 48 hours of intravenous cannula insertion.

7
 MGR university of health and science Tamil Nadu (2010).A study was

conducted on peripheral intravenous catheter complications in critically ill

children. Six hundred fifty-four peripheral intravenous catheters in 303 pediatric

intensive care unit patients were examined to determine complication rates and

associated risk factors. Phlebitis13%, extravasation 28%, and bacterial

colonization11%, sepsis occurred respectively. Replacing catheters in critically

ill children every 72 hours would not decrease phlebitis, bacterial colonization,

or catheter-induced sepsis and could increase extravasations risk. Catheters can

be safely maintained with adequate monitoring for up to 144 hours in critically

ill children.

S.Sivaram (2011) Jawaharlal Institute of Postgraduate Medical Education

and Research, Puducherry, India. conducted a study in Department of pediatric,

Peripheral venous therapy thrombophlebitis is a common complication of

intravenous cannulation, occurring in about 30% of patients. They evaluated the

effect of elective re-sitting of intravenous cannulae every 48 hours on the

incidence and severity of peripheral venous catheter in neonates receiving

intravenous fluids/drugs. Elective re-sitting of intravenous cannulae every 48

hours results in a significant reduction in the incidence and severity of peripheral

venous catheter .

Dechenla, ST Hospital, Kumbakonam (2009) A standardized prospective

survey was conducted for nosocomial infections, to determine the interplay of

factors that contribute to the risk of thrombophlebitis in peripheral intravenous

8
therapy. They studied 3094 patients with 5161 total episodes of peripheral

intravenous therapy(PIVT) from the day of admission until the day of discharge.

The results showed that the overall rate of phlebitis was 2.3% and the rate of

intravenous therapy-associated bacteremia was 0.08%. In all other

circumstances, 48-72 hours was recommended.

A study was conducted in USA,(2010) to describe the effect of nurse

experience and competence on the length of time and the number of attempts to

establish a successful intravenous placement in the hospitalized child. Data from

a convenience sample of 592 evaluable patients and 1135 venipunctures showed

that successful intravenous placements required an average of 2 venipunctures

over 28 minutes. Although nurse experience and self-rated competence were

correlated with attaining a successful intravenous placement, time of day,

predicted difficulty of the venipuncture, and cooperativeness of the child

appeared to be better predictors of success.

The risk factors of intravenous related complications with 40 patients. By

using observation check list the signs & symptoms were assessed which reveals

that, the type of infusion, duration of cannulation more than 3 days (50%),

intravenous antibiotics (12%), female sex(12%), catheter material PEO - vialon

and Teflon (6%), anatomic site - forearm related (12%) and wrist(8%).

All nurses are likely to be responsible for the administration and

management of some form of intravenous therapy. The important responsibility

of the nurse is to protect the child from infection during the intravenous infusion.

9
Infiltration of fluid is common in children nurse has to make sure that the needle

is in place and patent in the basis of scientific principle the protocol using

evidence based resources .The overall focus was on raising awareness, providing

information and educating and practicing importance of delivering intravenous

cannula care among staff nurse technique may reduce the complications, so the

investigator intended to do the study.

10
STATEMENT OF THE PROBLEM:

A study to evaluate the effectiveness of nursing intervention on

prevention of intravenous therapy related complications among neonates

admitted in NICU at SMVMCH, puducherry.

OBJECTIVES OF THE STUDY:

 To prepare a standardized protocol for nursing intervention on prevention

of intravenous therapy related complications among neonates .

 To evaluate the effectiveness of standardized protocol for nursing

intervention on prevention of intravenous therapy related complications

among neonates.

 To associate the effectiveness of standardized protocol for nursing

intervention on prevention of intravenous therapy related complications

among neonates with their selected demographic variable.

ASSUMPTION:

 Standardized protocol for nursing intervention may reduce the risk of

intravenous therapy related complications.

 Standardized protocol act as an effective nursing intervention in

preventing the complications of intravenous therapy.

11
HYPOTHESIS:

 H1-there will be a significant relationship between the standardized

protocol for nursing intervention and intravenous therapy related

complications among neonates.

 H2- there will be a significant association between the effectiveness of

nursing intervention on prevention of intravenous therapy related

complications among neonates with their selected demographic variable.

OPERATIONAL DEFINITION:

Evaluate: It refers to draw a conclusion of nursing intervention on

prevention of intravenous therapy related complications.

Effectiveness: It refers to the significant outcome of the nursing

intervention on prevention of intravenous therapy related complications

among neonates.

Standardized protocol: It refers to the techniques of carrying out a

procedure in a systematic way, with related scientific principles which

provides the basis for carrying out technical procedures.

Nursing Intervention: It refers to the action undertaken by the

investigator to prepare and execute the standardized protocol on safety

precaution of neonates which includes hand hygiene, selection of site and

cannulation techniques, dressing of sit and maintenance, drug loading,

administration and proper maintenance of patency of intravenous fluids.

12
 Intravenous therapy: It refers to administration of fluid substance and

medication directly in to the vein.

Prevention of complications :It refers to reduce the risk of developing

the side effect and complications related to intravenous therapy such as

redness,tenderness,pain,swelling,phlebitis,thrompophlebitis,infiltration,ex

travasation,hematoma,nervedamage,venous air embolism.

Neonate: It refers to the new born from birth to 28 days after delivery.

DELIMITATIONS:

 The study was limited the neonates only admitted in NICU at SMVMCH.

 The study was limited to standardized protocol for nursing care

intervention on prevention of intravenous therapy related complications.

 A study was limited to 6 weeks duration.

 Study was limited to sample size of 60 neonates.

13
 CHAPTER II
REVIEW OF LITERATURE
Review of literature is a key step in research process. Review of literature

refers to an extensive, exhaustive and systematic examination of publications

relevant to the research project. A review of research and non research literature

relevant to the study was undertaken which helped the investigator to develop

deeper insight into the problem and gain information what has been done in the

past.

1. Review of Literature related to intravenous therapy related

complications.

2. Review of Literature related to protocol for intravenous

therapy.

1. Review of Literature related to intravenous therapy related

complications.

Batten. R et. al., (1996) had conducted non randomized study to

compare the rates of phlebitis of peripheral intravenous lines left in place for 72

hours versus rates of those left in place 96 hours. Design was a prospective,

nonrandomized study. Setting was a university teaching hospital with 375 beds.

Neonates were consecutive neonates who received peripheral intravenous lines

and were admitted to the wards. Results were a total of 2503 peripheral lines

were evaluable. The overall phlebitis rate was 6.8%. It was estimated that in 1

14
month approximately 300 intravenous lines potentially could be prolonged

beyond 72 hours; 215 lines were changed at 72 hours despite no signs of

inflammation, 61 lines were kept till 96 hours, and 19 lines were kept beyond 96

hours. The study concluded that the Phlebitis rate for peripheral intravenous

catheters at 96 hours was not significantly different from that at 72 hours.

Vicky. D et. al., (2002) had conducted a non experimental study on

reviewed the evidence linking thrombosis with peripheral vein infusion

thrombophlebitis. The study found that peripheral vein infusion thrombophlebitis

occurred among 25% to 35% of the hospitalized neonates with peripheral

intravenous catheters. The duration of the catheterization, catheter-related

infection and catheter material are the important risk factors while the neonates

related risk factors were not elucidated.

Ritchie.S et.al., (2007) had conducted experimental study on “Risk of

complications of short peripheral intravenous catheters placed for indefinite

periods.” During 5 months, general pediatric neonates receiving intravenous

therapy through short peripheral intravenous catheters were monitored. Major

endpoints were infection and phlebitis. Per-day risk of complications and

catheter colonization were calculated. They studied 642 Teflon catheters in place

for 525 neonates. There were no cases of catheter sepsis, 1% possible insertion-

site infection, and 7% cases of phlebitis. Catheter colonization occurred in 92

(26%) of 348 catheters cultured. Current guidelines recommend replacement of

peripheral intravenous catheters in adults within 2 to 3 days; no

15
recommendations are made for children. Findings and those of others indicate

that the overall risk of peripheral catheter complications in children is

extremely low and would not be reduced substantially by routine catheter

replacement.

Falingezicht.J et.al., (2007) had conducted “A comparative study on

“Peripheral intravenous catheter complications in critically ill children.” Six

hundred fifty-four peripheral Teflon catheters in 303 pediatric intensive care unit

patients were examined to determine complication rates and associated risk

factors. Phlebitis13%, extravasation 28%, and bacterial colonization11%, sepsis

occurred respectively. Replacing catheters in critically ill children every 72 hours

would not decrease phlebitis, bacterial colonization, or catheter-induced sepsis

and could increase extravasations risk. Catheters can be safely maintained with

adequate monitoring for up to 144 hours in critically ill children.

Sunil.T et. al.,( 2008) had conducted “A comparative study on

complications of intravenous therapy with steel needles and Teflon catheters

with 954 cannula insertions. The risk of phlebitis was significantly greater with

Teflon catheters (18.8 % with Teflon catheters, 8.8 % with steel needles), steel

needles were significantly associated with infiltration (17.9 % with Teflon

catheters, 40.1% with steel needles). The overall rate of complications was

significantly greater for the group in which steel needles were used (53.8 %

versus 64.0 %), basically due to the increased risk of infiltration with steel

needles.

16
 Halvorsommerfelt. E et. al., (2009) had conducted descriptive study on

incidence and complications of intravenous infusion with the aim of identifying

the IV related complication. The samples were 650 neonates with IV cannula

from Nice University Hospital. The Chi-square findings show that 54(13.6%)

had thrombophlebitis, 50(13.2%) had Infiltration and 9 (2.3%) had swelling and

local infection.

Cluster. Bet. al., (2010) had conducted descriptive study on identifying

the risk factors of intravenous related complications with 40 neonates. By using

observation check list the signs & symptoms were assessed which reveals that,

the type of infusion, duration of cannulation more than 3 days (50%), IV

antibiotics (12%), female sex(12%), catheter material PEO - vialon and Teflon

(6%), anatomic site - forearm related (12%) and wrist(8%)

AK dutta.et. al., (2011) had conducted “A descriptive study on

relevance and complications of intravenous infusion at emergency unit.” 630 of

2515 neonates (25%) received a peripheral venous cannulation, Indication for the

peripheral venous cannulation was considered unjustified in 24.8% of cases upon

arrival at the emergency department, and 33.8% upon leaving the emergency

department. Out of 318 neonates, the peripheral venous cannula was left in place

for no reason in 63 (20%). Overall, 390 peripheral venous cannulations were

followed until the time of their removal. Among these 390 neonates, 62 (15.9%)

developed complications, of which 54 (13.6%) had thrombophlebitis and 9

(2.3%) developed local infection.

17
 Wilkinson .R et. al., (1989) had conducted study on “Randomized

Controlled Trial on factors Affecting Complications and Patency of peripheral

IVs. This prospective interventional study was conducted over a period of 6

months in a general ward .This sample was composed of 88 patients, from

neonates to 12-year-olds, on whom a total of 377 catheters were started.

Intravenous cannulations were randomized for heparin flushes (1:100 dilutions)

and splints. Prospective data was collected regarding duration of patency and

complications. Both univariate and multivariate analysis were done. There was a

statistically significant increase in the duration of patency with the use of heparin

flushes and splints. Shorter patency duration and increased complications were

associated with younger age, wrist and scalp insertions, and 24-gauge catheters.

Blatter. DP et. al., (2006) had conducted cross sectional study

“Complications are phlebitis rates reported for neonates receiving intravenous

therapy” there were 503,300 hospital stays with IV cannulated noted an increase

of nearly 80% since. More than 90% of the neonates had intravenous cannula in

NICU and general ward 100 % of neonates had IV cannula line. In comparison

56.5% of male neonates and rest of them were female neonates. The cross

sectional study results shows that complication are phlebitis rates reported for

neonates receiving intravenous therapy have been as high as 80%, with the rates

in most hospitals ranging between 20% and 80%. Other complications resulting

from intravenous cannulation include thrombophlebitis, extravasation, and

infection.

18
2. Review of Literature related to protocol for intravenous therapy.

Lawson .S Let. al.,(2012 May31) had conducted study on cross

sectional survey was carried out to evaluate the outcome of implemented

evidence based clinical guidelines in handling of peripheral intravenous

therapy.” A structured observation protocol was developed. Results

demonstrated that “no signs of thrombophlebitis” (degree0) were reported

in2%(p<0.01) and number of thrombophlebitis episodes are lower (p<0.001).

The use of 0.8mm size cannula had increased by 22% (p<0.001). The study also

showed that the documentation had increased (p<0.001) after implementation of

structured observation protocol.

Matthew. R et. al.,(2012)had conducted non experimental study on aims

to describe the current approach to extravasations injury (EI) prevention and

management in Neonatal Intensive Care Units (NICUs) in Australia and New

Zealand. The survey received a 96% response rate. Approximately two thirds of

Australian and New Zealand NICUs have written protocols for prevention and

management of extravasations injury. Considerable practice variation was seen

for both prevention and treatment of EI. 92% of units had experienced cases of

significant EI. We recommend that neonatal staff should remain vigilant,

ensuring that guidelines for the prevention and treatment of EI are available, and

rigorously followed. A written policy for the prevention and recognition of EI

was used by 69% (18/26) of units. A further 23% (6/26) had no written policy

but utilized a standard practice. 8% (2/26) of units had no written policy or

19
standard practice. Broken down by country, 83% (5/6) of the New Zealand units

had a written policy, compared to 65% (13/20) of Australian units.

Sharathkumar. V et. al., (april2009)had conducted correlation study on

“Nurses performance of peripheral intravenous therapy with their nursing

experience and their level of educational preparation.” correlation study was

conducted to examine the impact of nurses performance of peripheral

intravenous therapy with their nursing experience and their level of educational

preparation. Peripheral intravenous therapy assessment tool was developed.

Statistical analysis model was used for statistical analysis. To find the association

between nurses performance of peripheral intravenous therapy with nursing

experience and level of education, hierarchical multiple regression was used.

Results showed that patients demographic variables (age, gender, first language,

and day, impatient status of patient) did not significantly predict overall rating of

intravenous therapy F(426)=1.20 ; p>0.05. Nurses year of experience and level

of educational preparation significantly predicted overall ratings of intravenous

therapy F(1218) =3.97; p<0.01.

Giancarlo. C et. al., (2007)had conducted non experimental study on

universal hospital, Italy aimed to investigate the most suitable location of

peripheral venous therapy to reduce the incidence of thrombophlebitis”. An

observational survey carried out with 427 neonates in one Italian hospital. A

standardized protocol was used to survey the frequency of thrombophlebitis and

the relationship of location and size of peripheral intravenous therapy. The

20
variables evaluated were age, gender, term of birth, weight of baby, therapy size

and site of therapy location. The study shows that the frequency of peripheral

intravenous therapy thrombophlebitis was higher in weight of the baby

(P < 0·006). The highest incidence was found in neonates with therapy inserted

in the dorsal side of the hand veins compared to those with therapy inserted in

cubital fossa veins (P < 0·001). The use of cubital fossa veins rather than forearm

and hand veins should be encouraged to reduce the risk of thrombophlebitis in

neonates with peripheral.

Saxena .A et. al.,(2009)had conducted experimental study on “To assess

whether intravenous care conformed to the hospital policy”. The study was done

on 131 neonates with 155 peripheral IV lines in St Luke’s Hospital,

Pennsylvania. The peripheral line assessment revealed those 87 sites (56%) < 72

hours old, 4 sites (3%) > 72 hours old and 64 sites (41%) that were not recorded.

The researcher suggested need for improvements which included the need to date

all dressings/ infusion tubing, proper labeling of all bottled/bags and efforts to

ensure that neonates wear an identification bracelet.

Roberts .Set al., (2007) had conducted non experimental study on “A

point survey of all in patients at Auckland City Hospital.” to define the

utilization of the intravascular devices and to measure the prevalence of

infectious complications from this device. 376 out of 830 patients had

intravenous devices and 25 of them had either confirmed infection or showed

signs of infection. The study concluded that the health workers require ongoing

21
education to ensure prompt removal of devices that are not required for patient

care.

Jerassy. P et. al., (2006) had conducted non experimental study on

“Nine-point prospective surveillance of phlebitis associated with peripheral

intravenous catheters on all the hospitalized” neonates with peripheral

intravenous cannula. In between these surveys, findings and guidelines for

improvement were distributed among the staff. During the surveys, 40% ± 8% of

hospitalized neonates had peripheral intravenous cannula. The rate of peripheral

intravascular catheter- associated phlebitis decreased from 12.7% (20/157) in

1998 to 2.6% (5/189) in 2003 (P < .01) throughout the study period.

Amita peter. Ret. al., (2005)had conducted comparative study on

compare catheter-related complications rates in patients who had infusion

devices placed by infusion nurses with complication rates in neonates who had

devices placed by generalist nurses. The data demonstrated that peripheral

infusion devices placed by infusion nurses exhibited a statistically

significant(p<0.001) intravenous injection without antibiotic lower rate of

leakage, phlebitis, and infiltration complications and remained in the vein

significantly longer than those placed by generalist nurses. However,

significance was not achieved with pain complication rates between the two

groups.

22
 CONCEPTUAL FRAMEWORK

LYDIAHALL’S CORE, CARE, CURE , THEORY

“Conceptual framework means the interrelated concepts or abstractions”

that are assembled together in some rationale scheme by virtue of their relevance

to a common.

- Polit&hungler(2006)

THEORY OVERVIEW:

 Theory developed in late 1960’s Nursing care can be delivered on three

interlocking levels Care = Hands on bodily care. Core = Using self in

relationship to patient. Cure = The disease applying medical knowledge.

CORE CIRCLE:

According to the theory ,the core refers to patient care is based on social

sciences Therapeutic use of self Helps patient learn their role is in the healing

process Patient is able to maintain who they are Patient able to develop a

maturity level when nurse listens to them and acts as sounding board Patient able

to make informed decisions.

Nurses have to be especially compassionate when taking care of patients

in the NICU. Not only do the babies need gentle care but nurses have to be

prepared to work with the parents and families, who are scored and worried and

need comforting, as well.

23
 In this study, the core circle refers to staff nurse, investigator, student

nurses having therapeutic relationship with each other for discussing about the

preventive aspects of intravenous therapy related complications and providing

protocol base nursing intervention for neonates admitted in NICU.

CARE CIRCLE :

According to the theory, the care refers to nurturing component of care It

is exclusive to nursing “Mothering” Provides teaching and learning activities

Nurses goal is to “comfort” the patient patient may explore and share feelings

with nurse Care

In the present study the investigator administering protocol for

intravenous therapy administration among neonates to prevention of

complications. Before start intravenous therapy proper hand wash, strict aseptic

technique when starting intravenous therapy, clean the site before insertion

intravenous infusion using an alcohol swab( wipe and allow to dry), avoid joints

when selecting a site, Avoid veins over joint flexion, Proper supportive measured

use in splint, Assess the intravenous site frequently, intravenous site with sterile

dressing, utilizes single –use intermittent medication tubing, inspect access site

and equipment regularly, change administration set and solution according to

patient care, maintain prescribed flow rate with regular patient assessment,

monitor vital signs.

24
CURE CIRCLE:

According to the theory, the cure refers to Care based on pathological and

therapeutic sciences Professional nurse helps patient through the rehabilitative

phase of care Nurse is patient advocate in this area Nurses role changes from

positive quality to negative quality Cure.

In this study status of neonates was prevention of intravenous related

complications during their stay in NICU by giving prompt nursing intervention.

25
 CHAPTER III

RESEARCH METHODOLOGY

Research methodology is a way to solve the problems systematically. It

indicates the general pattern of organizing the procedures for gathering the valid

and reliable data for the purpose of investigation.

This chapter deals with the methodology adopted to assess the

effectiveness of standardized protocol for nursing care intervention on

prevention of intravenous therapy related complications among neonates

admitted in NICU at SMVMCH, puducherry.

It includes, research approach, research design, setting, population,

Sample and Sampling technique, selection and development of tool, description

of the tool, data collection techniques and plan for data analysis.

RESEARCH APPROACH:

A research approach tell the researcher, what data to collect and how to

analysis it, it also suggest possible to be drawn from the data.

RESEARCH DESIGN:

The research design refers to the researcher’s overall plan for testing the

research hypothesis. The research design helps the researchers in the selection of

the subject’s manipulation of experimental variable, procedure of data collection

and type of statistical analysis to be used to interpret the data.

A pre experimental one group post test only design.

24
 RESEARCH METHODOLOGY

Research Approach
Quantitative Approach

Research Design
Quasi experimental post test only design

Target Population
All neonates admitted in NICU

Accessible
theD.T.Ed students studying Population
in District Institute of Education and
Neonates admitted in NICU inSMVMCHwith intravenous infusion
Training at Puducherry

Sampling Technique
Conveniente Sampling Technique

Experimental Group 60 neonates

Administration of protocol based IV therapy among

neonates neonates

Post test assessment of intravenous related

complications by using
- Tool observational check list
- Check list for staff nurse

-
Data Analysis
Descriptive Statistics: Frequency distribution, Mean, Standard Deviation
Inferential Statistics: Chi Square test, Paired‘t’ test

Result
Positive outcome of nursing intervention in terms of
prevention of intravenous related complications

FIG:2SCHEMATIC REPRESENTATION OF THE RESEARCH DESIGN

25
POPULATION:

The term population refers to the aggregate (or) totality of all subject (or)

numbers that confirm to the set of specification.

Target populations were all neonates admitted in NICU.

SETTING OF THE STUDY:

Setting is the physical location and condition in which data collected takes

place.

The study was conducted in NICU at SMVMCH, multi specialty hospital

located in kalitheerthalkuppam, puducherry,

SAMPLE:

Sample refers to the Subject of the population that is selected for a study.

In this study, sample consists of neonates who fulfill the inclusion criteria.

SAMPLE SIZE:

 Sample is the subset of population.

 In this study sample size consists of 60 neonates

SAMPLING TECHNIQUES:

It refers to the selecting a population to represent the entire population.

Convenience sampling: subject in the study who happened to be in right place

at the right time, with addition of available subjects until the desired sample size

is reached.

Convenience sampling technique is selected for the present study.

26
CRITERIA FORSAMPLE SELECTION:

Inclusion criteria:

 Neonates who are admitted in NICU.

 Neonates for whom intravenous therapy prescribed.

 Neonates to whom the intravenous therapy started at first day.

 Both male and female neonates.

Exclusion criteria:

Neonates already present with intravenous therapy.

VARIABLES:

Variable is defined as an attribute of a person or object that varies (or)

takes different values (Aballah and levine, 1979).

The term variables are concepts at different level of abstraction that are

concisely defined to promote their measurement (or) manipulated with in a

study.

Dependent variable: Intravenous therapy related complication

Independent variable: Standardized intravenous protocol for nursing

intervention

Extraneous variable: Catheter material, duration of catheter, mechanical

complications, kinking of intravenous tubing, right of solution amount of

solution reaming encounter.

27
INFLVENCE ING VARIABL

 Age of days

 Sex
DEPENDANT VARIABLE
INDEPENDENT
 Term of birth VARIABLE
Prevention of intravenous
 Type of delivery
therapy related -Standardized
 Wight of the baby protocol for nursing
complications
intervention
 Duration of IV therapy

 Site of IV cannula

 Type of IV fluid

 IV injection with and without

antibiotic

EXTRANEOUS VARIABLE

-catheter material

-duration of catheter

-mechanical complications

-kinking of intravenous tubing

-right of solution amount of solution

reaming encounter

FIG:3 RELATIONSHIP OF THE VARIABLES

-history of mother with GDM

-History of activity of child

-GDM

24
DESCRIPTION OF THE TOOL:

Description of the tool with the investigators personal and professional

experiences and with the extensive review of literature and discussion with

experts tool was administration to neonates.

Section A: Demographic variables such as age, sex, term of baby, type of

delivery, duration of intravenous fluid, site of intravenous

infusion, size of intravenous set, type of intravenous fluid,

intravenous injection with and without antibiotic, indication of

intravenous therapy.

Section B: observational check list with 10 items.

Section C: observational check list for staff nurse which is 10 items not

included for statistics analysis.

SCORING: Items are scored as follows:

1-10- no complications.

11-20 mild complications.

21-30 moderate complications.

31-40 sever complications.

25
CONTENT VALIDITY

Validity is the essential characteristics of the entities, procedures or

devices actually to measure the dimensions that they meant to measure.

The contents of the tool were evaluated by five experts from Child Health

Nursing Department. A criterion rating scale for validation of the tool was

developed experts were asked to give opinion and suggestion about the content

of the tool modification was made as per the experts opinion.

This modification was incorporated in the final preparation of the tool.

RELIABILITY:

The reliability of the tool was established by using split of method (r=0.5).

It shows that the tool is reliable for main study.

PILOT STUDY:

A pilot study is a trail run for the main study to test the practicability,

appropriateness of the instrument and feasibility of the study.

The investigator visited SMVMCH, NICU in Pediatric Department,

obtained permission to conduct the study. After a formal approval from the HOD

of Pediatric department, the investigator conducted a pilot study, to test the

feasibility and practicability. The investigator approach the NICU staff nurses

and informed regarding the objectives of the study and obtained the consent from

them then intravenous therapy protocol been implemented.

26
 For 10 neonates investigator assessed for intravenous therapy

complications by means of observational check list on 7th day of infusion. The

result of the pilot study revealed that the study was feasible and practicable and

modification was made in the tool after pilot study in the aspect of protocol. And

observational checklist was prepared for staff nurses. Suggested by the experts.

DATA COLLECTION PROCEDURE:

The study was conducted in NICU, at SMVMCH it is a 900 bedded

multispecialty hospital located in kalitheerthalkuppam, puducherry, Formal

permission were obtained from the hospital authority. Sample was selected based

on inclusion criteria through convenient sampling. The investigator standardized

protocol for nursing intervention on prevention of complications related to

intravenous therapy. The procedure was implemented on the basis of prepared

protocol for nursing intervention on prevention of intravenous complications. Per

day 4 babies were selected at the end of the 7thdaylevel of intravenous therapy

related complications was assessed by the investigators.

27
PLAN FOR DATA ANALYSIS:

The data obtained was analyzed in terms of the objective of the study

using descriptive and inferential statistics. The plan of data analysis was as

follows.

 Descriptive statistics: Frequency, percentage distribution, mean,

mean percentage and standard deviation.

 Inferential statistics: Paired ‘t’test, chi square test in the form of

tables and figures.

28
CHAPTER IV

DATA ANALYSIS AND INTERPRETATION

This chapter deals with analysis and interpretation of the information

collected from 60 neonates selected hospital SMVMCH at puducherry. The

present study is designated to assess the effectiveness of standardized protocol

for nursing intervention on prevention of therapy related complications among

neonates admitted in NICU at SMVMCH, puducherry.

Analysis is a method of formulating data in such a way that the research

question can be answered.

The collected data was obtained, organized, analyzed and interpreted

using inferential statistics. Analyzed and interpreted data are based on the

objectives of the study data presented under the following headings.

Table 1:Distributionof selected demographic variable of neonates

Table 2:Distribution of mean, SD, post tests core on standardized protocol for

neonates.

Table 3:Distribution level of complications related to intravenous therapy for

neonates.

Table 4:Association between the levels of complications related to intravenous

therapy on standardized protocol of neonates with selected

demographic variable.

29
Table 1: Distribution of selected demographic variable of neonates

S.No Demographic variables Frequency Percentage

1. Age in days:
1-6 days 34 56.67
7-15 days 10 16.67
16-28 days 16 26.66
2. Sex :
Male 34 56.67
Female 26 43.33
3. Religion:
Hindu 39 65
Muslim 13 21.67
Christian 8 13.33
4. Term of Birth:
Term baby 53 88.33
Pre term baby 2 3.33
Post term baby 5 8.33
5. Type of delivery :
Vaginal Delivery 45 75
Elective LSCS delivery 10 16.67
Forceps delivery 5 8.33
6. Weight of baby :
1.3-2.3kg 2 3.33
2.4-3.3kg 27 45
>3.3kg 31 51.67
7. Duration of IV therapy:
6-10days 45 75
>10 days 15 25
8. Site of IV CANNULA:
Digital vein 40 66.67
Basilic vein 15 25
Cephalic vein 5 8.33
9. Type of IV fluid :
Hypertonic 25 41.67
Isotonic 35 58.33
10. IV Injection with and without antibiotic:
Yes 37 61.67
No 23 38.33
11. Indication of IV therapy:
Respiratory disorders 16 26.67
Neonatal infection 12 20
Electrolyte imbalance 10 16.67
Baby with physiological and pathological 17 28.33
jaundice
metabolic disorders 5 8.33

30
Inference:

Distribution of selected demographic variable of neonates with

intravenous therapy regarding the Age of neonates 34 (56.67%),of them were 1-

6days,10 (16.67%) of them were 7-15days, and remaing16 (26.66%),of them

were belong to 16-28 age in days.

Regarding sex of the neonate 34 (56.67%) of them were male neonates,

and 26 (43.33%) were female.

Regarding Term of birth53 (88.33%) of neonates were born in term2

(3.33%) of them were born in preterm 5 (8.33%) of them were post term baby.

Regarding Type of delivery of neonates45 (75%) of them were vaginal

delivery,10 (16.67%)of them were elective LSCS, 5 ( 8.33%) of them were

forceps delivery.

Regarding weight of baby 2 (3.33%) of them were belong to (1.3-

2.3Kg), 27 (45%) of the them were belong to(2.4-2.3Kg),31 (51.67%) of them

were belong to (>3.3Kg).

Regarding duration of intravenous therapy 45 (75%) of them were

received (6-10days),15(25%) of them were received(>10days).

Regarding the site of intravenous cannula 40 (66.67%) of them were

belong to (digital vein), 15 (25%) of them were belong to (basilic vein), 5

(8.33%)of them were belong to (cephalic vein).

Regarding the type of intravenous fluid 25(41.67%)of them were received

the (hypertonic fluid), 35 (58.33%) of them were received the (isotonic fluid).

31
 Considering the Intravenous injection with and without antibiotic of

neonates 37 (61.67%) of them were received the antibiotic, 23 (938.33%) of

them not received antibiotic.

32
 Term baby
Pre term baby
Post term baby
88.33%
100
80
60
40
20 3.33% 3.33%

0
Term baby
Pre term
Post term
baby
baby

Fig.4:Distribution of term of birth of neonates

33
 6-10 days
>10 days
25%

75%

Fig.5:Distribution of duration of intravenous cannula. of neonates

34
 Digital vein
Basicila vein
66.67%
Cephalic vein
70
60
50
40 25%

30 8.33%
20
10
0
Digital vein Basicila vein Cephalic vein

Fig.7: Distribution of site of intravenous cannula of neonates.

35
 Yes
No

58.33% 41.67%

Fig. 8 distribution of intravenous injection with antibiotic and with

out antibiotic of neonates

36
Table-2: Distribution of mean post test score of standardized protocol among

neonates.

Area Max. Range Mean SD Mean%

score

Overall 40 10-14 10.47 0.947 26

Inference:

Table 2: the above table shows that mean post test score for

standardized protocol for nursing intervention on prevention of complications of

intravenous therapy mean value is 10.47 and the standard deviation is 0.947.

37
 Table -3: Distribution of level of complications related to intravenous

therapy for neonates.

Level of Post test

complications F %

No 44 73.33

complications

Mild 16 6.67

Moderate - -

Severe - -

Total 60 100

Inference:

Table 3: The above table shows that distribution of level of complications

related to intravenous therapy among neonates are classified as four level such as

no complications, mild complications, moderate complications, sever

complication. Post test score shows44 neonates had (73.33%) no complications,

16 neonates (26.67%) had mild complications and no neonates are affected with

mild and moderate complications.

38
 73.33%
80 No Complications
70 Mild
60 Moderate
50 Severe
Percentage

40 26.67%
30
20
10 0% 0%
0
No Complications Mild Moderate Severe

Level of complications

Fig:9.Distribution of level of complications related to intravenous therapy among neonates .

39
Table 4: Association between the level of complications of intravenous therapy
among neonates with selected demographic variable.
S. No No complications Mild
Demographic variables complications χ2 p-value
F % F %
1. Age in days:
1-6 days 25 41.67 9 15
7-15 days 8 13.3 2 3.3 0.39 0.001**
16-28 days 11 18.3 5 8.3 (df=2)
2. Sex :
Male 26 43.3 8 13.3 0.39 0.001**
Female 18 30 8 13.3 (df=1)
3. Religion:
Hindu 28 46.7 11 18.3 1.37 0.468
Muslim 11 18.3 2 3.3 (df=2)
Christian 5 8.3 3 5
4. Term of Birth:
Term baby 39 65 14 23.3
Pre term baby 2 3.3 0 0 1.18 0.01*
Post term baby 3 5 2 3.3 (df=2)
5. Type of delivery :
Vaginal delivery 35 58.3 10 16.7 3.35
Elective LSCS delivery 7 11.7 3 5 (df=2) 0.187
Forceps delivery 2 3.3 3 5
6. Weight of baby :
1.3-2.3kg 2 3.3 0 0
2.4-3.3kg 20 33.3 7 11.7 0.82 0.001**
>3.3kg 22 36.7 9 15 (df=2)
7. Duration of IV therapy:
6-10days 32 53.3 13 21.7 0.45 0.001**
>10 days 12 20 3 5 (df=1)
8. Site of IV Cannula:
Digital vein 32 53.3 8 13.3 0.256
Basilic vein 9 15 6 10 2.73
Cephalic vein 3 5 2 3.3 (df=2)
9. Type of IV fluid :
Hypertonic 21 35 4 6.7 2.49 0.146
Isotonic 23 38.3 12 20 (df=1)

10. IV Injection with and

without antibiotic:
Yes 28 46.7 9 15 0.278
No 16 26.7 7 11.6 (df=1) 0.06**

40
 Indication of IV
therapy:
11. Respiratory disorders 13 21.7 3 5
Neonatal infection 9 15 3 5 3.51 0.476
Electrolyte imbalance 5 8.3 5 8.3 (df=4)
Baby with physiological 13 21.7 4 6.7
and pathological
jaundice
Metabolic disorders 4 6.7 1 1.7
*-p<0.05 significant, ** -p<0.01 & ***-p<0.001 highly significant

S-Significant, NS-Non significant ,DF-Degree of freedom

41
 Inference:

Table-4: The above table shows that calculated value of x2 is significant

at 1% level of significant shows that age in days(p<0.001), sex (p<0.001), term

of birth (p<0.01), weight of baby (p<0.001), duration of intravenous therapy

(p<0.001), intravenous injection with and without antibiotic (p<0.06). It all shows

that statistically highly significant.

There is no association between the post test score x2 value with

demographic variable like Religion, type of delivery, site of intravenous cannula,

type of intravenous fluid, Indication of intravenous therapy.

42
 V. CHAPTER

DISCUSSION
The goal of the study was “A study to evaluate the effectiveness of

nursing intervention on prevention of intravenous therapy related complications

among neonates admitted in NICU at SMVMCH, puducherry. The discussion of

the present study is based on the findings obtained from statistical analysis of

collected data.

A total number of 60 neonates were selected for the study. The

effectiveness was assessed by modified visual complications score scale for

observation check list and observation check list for staff nurse to assess the

level complications among neonates. According to the score, I have assessed the

effectiveness of standardized protocol for nursing intervention on intravenous

therapy. In that result shows that 44 neonates (73. 33%) had no complications of

intravenous therapy, 6 neonates (26.67%) had mild level of intravenous therapy

related complications and no neonates are affected with moderate and sever

complications.

I. To prepare a standardized protocol for nursing intervention on

prevention of intravenous therapy related complications among neonates.

Table 1: Reveal that the level of complications in intravenous therapy is

assessed by modified visual complications score scale among neonates admitted

in NICU were mostly lies between the age group of 1-6 days (56.67%).when

coming to the gender male neonates are more common 34(56.67%) .Most of the

43
neonates belong to Hindu religion 39 (65%). Most of the babies term of birth 53

(88.33%). 6-10 days of duration of intravenous therapy is prescribed 45

(75%).Isotonic intravenous fluid was prescribed for 35 (58.33%) neonates. 37

(61.67%) were prescribed with antibiotic intravenous injection.17 (28.33%)

neonates were admitted in NICU ,with complaints of physiological and

pathological jaundice.

Based on the finding it is clear that most of the neonates admitted in

NICU are prompt to get intravenous infusion based in their illness.

Lawson .SL et.al.(2012)In this study was supported by an “ A cross

sectional survey was carried out to evaluate the outcome of implemented

evidence based clinical guidelines in handling of peripheral intravenous

therapy.” A structured observation protocol was developed. Results

demonstrated that “no signs of thrombophlebitis” (degree0) were reported in2

%(p<0.01) and number of thrombophlebitis episodes(degree 1-3 ) are lower

(p<0.001). The use of 0.8mm size cannula had increased by 22% (p<0.001). The

study also showed that the documentation had increased (p<0.001) after

implementation of structured observation protocol for on this finding it is clear

that most of the neonates admitted in NICU are prompt to get intravenous

infusion based on their illness.

44
 Batten.Ret.al. (1996) In this study was supported by an For most IV

infusion in neonates, an over-the-needle 24 –gauge catheter may be used if

therapy is expected to last less than 5 days. The length of the catheter may be

directly related to infection and embolus formation. The shorter the catheter, the

fewer the complications. Determining the best catheter for the patient early in the

therapy provides the best chance of avoiding catheter related complications.

II. To evaluate the effectiveness of a standardized protocol for

nursing intervention on prevention of intravenous therapy related

complications among neonates.

Table 3: Represents 44 (73.33%) of neonates does not develop any IV

complications only 16 (26.67%) of neonates developed only mild complications.

There is no complications of moderate and sever complications.

S.Sivaram. et,al. (2012) Jawaharlal Institute of Postgraduate Medical

Education and Research, Puducherry, India.“Experimental study conducted

by in Department of pediatric, peripheral venous therapy thrombophlebitis is a

common complications of intravenous cannulation, occurring in about 30% of

patients. They evaluated the effect of elective re-sitting of intravenous cannula

every 48 hours on the incidence and severity of peripheral venous catheter in

neonates receiving intravenous fluids/drugs. Elective re-sitting of intravenous

cannulae every 48 hours results in a significant reduction in the incidence and

severity of peripheral venous catheter.

Giancarlo Cicolini, et ,al., (2007)had conducted a study on “ universal

hospital, Italy aimed to investigate the most suitable location of peripheral

45
venous therapy to reduce the incidence of thrombophlebitis”. An observational

survey carried out with 427 neonates in one Italian hospital. A standardized

protocol was used to survey the frequency of thrombophlebitis and the

relationship of location and size of peripheral intravenous therapy. The variables

evaluated were age, gender, term of birth, weight of baby, therapy size and site

of therapy location. The study shows that the frequency of peripheral intravenous

therapy thrombophlebitis was higher in weight of the baby(P < 0·006). The

highest incidence was found in neonates with therapy inserted in the dorsal side

of the hand veins compared to those with therapy inserted in cubitalfossa veins

(P < 0·001). The use of cubital fossa veins rather than forearm and hand veins

should be encouraged to reduce the risk of thrombophlebitis in neonates with

peripheral.

III. To associate the effectiveness of nursing intervention on

prevention of intravenous therapy related complications among neonates

with their selected demographic variable.

Table 4:Association was found by using chi-square test indicate that there

was an association between the age of child term of birth duration of intravenous

therapy, intravenous therapy injection with antibiotics without antibiotics with

the level of complication of intravenous therapy finding revels that neonates with

less age and duration of intravenous therapy causes a complications due to any

extraneous variable like gestational diabetics mellitus, illness of the baby,

delicate vein.

46
 Wilkinson. Ret.al.LadyHardinge Medical College and Associated

Kalawati Saran Hospital.(2005) In this supported by an “Lady Hardinge

Medical College and Associated Kalawati Saran Hospital.”A Randomized

Controlled Trial on factors Affecting Complications and Patency of peripheral

IVs. This prospective interventional study was conducted over a period of 6

months in a general ward .This sample was composed of 88 patients, from

neonates to 12-year-olds, on whom a total of 377 catheters were started.

Intravenous cannulation were randomized for heparin flushes (1:100 dilutions)

and splints. Prospective data was collected regarding duration of patency and

complications. Both univariate and multivariate analysis were done. There was a

statistically significant increase (p<0.001) in the duration of intravenous therapy

patency with the use of heparin flushes and splints. Shorter patency duration and

increased complications were associated with younger age, wrist and scalp

insertions, and 24-gauge catheters.

Amita peter. Ret,al. (2010) A study conducted on compare catheter-

related complication rates in patients who had infusion devices placed by

infusion nurses with complication rates in neonates who had devices placed by

generalist nurses. The data demonstrated that peripheral infusion devices placed

by infusion nurses exhibited a statistically significant(p<0.001) intravenous

injection without antibiotic lower rate of leakage, phlebitis, and infiltration

complications and remained in the vein significantly longer than those placed by

generalist nurses. However, significance was not achieved with pain

complication rates between the two groups.

47
 SUMMARY

The focus of the study was to determine the effectiveness of standardized

protocol for nursing intervention on prevention intravenous complications an

extensive review of literature, professional experience and expert guided lead the

investigator to design methodology.

The conceptual frame work developed for the study was based on the

“Lydia hall (1960).

The population 60 neonates of the study was considered as neonates who

admitted in NICU and to samples were selected for the study.

Convenient samples techniques was adopted one group post test only

design was used.

The data was collected by using VIP complications scale which includes

demographic variable observational checklist to assess the intravenous

complications likes’ pain edema, hematoma, infiltration, thrombophlebitis.

Various expert child health nursing department obtained the content

validity of tool. The pilot study was conducted with 10 neonates at SMVMCH,

puducherry.

The ethical aspect of research was maintained throughout the period from

the authority. Investigator initiated intravenous injection by following

48
standardized protocol and assessed for intravenous complications based on the

duration of intravenous canula site.

MAJOR FINDINGS IN THE STUDY

The post test assessment of intravenous therapy related complications

based on standardized protocol reveals that distribution of level of complications

44 neonates (73.33%) had no complications of intravenous therapy, 16 neonates

(26.67%) had mild level of complications of intravenous therapy and no

neonates are affected with moderate and sever complications.

The over all mean value is 10.47% and SD level of 0.947 there is

association at 1% level of significant of post test level of complications with

selected demographic variable, such as age in day, sex, term of birth, weight of

baby, duration of intravenous therapy, intravenous injection with and without

antibiotic. It shows that highly significant.

49
 CONCLUSION

The study was conducted among 60 neonates to find the effectiveness of

standardized protocol for nursing intervention on intravenous therapy related

complications at puducherry. The result shows there is 44 neonates did not

develop no complications, 16 neonates have mild complications and no neonates

are affected with moderate and sever complications. So the standardized protocol

is effectiveness there is association of selected demographic variable like, Age in

days, sex, term of birth, weight of baby, duration of intravenous therapy,

intravenous injection with and without antibiotic. It shows that highly significant

with post test score of level of complications.

NURSING IMPLICATIONS

1. The present study can help nurses to enrich their knowledge skill, practice

by using standardized protocol in order to prevent intravenous therapy

complications among neonates.

The following protocols are:

a) Before injecting intravenous infusion proper hand washing should be

done because it is one of the universal procedure. (Mainly in order to

prevent infection).

b) Strict aseptic techniques should be followed to avoid high risk

infection.

c) Avoid joint when selecting a site in order to prevent edema, swelling,

thrombosis then others complications

50
 d) In order to maintain proper position splint should be used because it is

one of safety support for neonates for maintain intravenous site.

e) Injured site should be secured with sterile dressing.

f) According to doctor order flow rate should be maintain properly for

the neonates in order to prevent overload and inadequate fluid.

g) Every hour vital signs should be monitored and recorded in an

appropriate manner.

If we follow these standardized protocols a nurse can prevent intravenous related

complications among neonates, if she implement in an effective manner. If nurse

practice this standardized protocol daily in their clinical setup she’s become well

expert with good knowledge, skill, practice, to prevent intravenous related

complications among neonates in the future also.

NURSING EDUCATION

1. Efforts should be made to improve and expand nursing curriculum to provide

to more content in the area of nursing intervention like prevention of

complications related intravenous therapy.

2. Standardized Protocol for nursing intervention among neonates by insertion

of intravenous cannula to prevent of complications related intravenous

therapy.

3. Nurse should be provided with adequate opportunities in developing skills in

handling such clients and how to identify their difficulties and help them to

promote comfort and wellbeing.

51
4. As nursing educator, need to strengthen the evidence based nursing practices

about intravenous therapy among the UG and PG nursing students.

NURSING PRACTICE

1. Nurses working in NICU should have enough knowledge and special skills

to identify the level of intravenous complications as early as possible and to

take immediate action and take care of neonates.

2. Nurse should follow these standardized protocols in effective manner

intravenous therapy complications can be prevented among neonates.

3. Nurses play a vital role in caring neonates’ intravenous insertion therapy by

following this protocol for nursing intervention.

4. This can be followed as a routine care in NICU. It has to establish as a

evidence based nursing practice.

NURSING ADMINISTRATION

1. Nurse Administrator can make necessary policies to implement the protocol

for nursing care services related to intravenous insertion therapy.

2. Nurses Administrator can organize in service education program for staff

nurse (NICU) regarding standardized protocol for intravenous therapy.

3. Nurse Administrator should select the staff nurses with good knowledge,

practice, skill in their clinical set ups.

4. Nurse Administrator should arrange live demonstration related to protocol

for nursing intervention followed by insertion of intravenous therapy among

neonates.

52
5. The nursing administrator should take initiative in organizing the continuing

nursing education programs and on newly devised strategies such as protocol

for nursing care followed by using insertion of intravenous therapy.

NURSING RESEARCH

1. The findings of the study help the nurses and students to develop the inquiry

by providing baseline. The general aspect of the study result can be made by

further replications of the study.

2. A Nurse Researcher can provide supportive care measures which may

improve the physical well being for neonates.

3. Nursing researcher should encourage clinical nurses to implement the

innovative research findings in their nursing care to avoid complications of

intravenous therapy among neonates.

4. The researcher should disseminate the findings through publications in

journals and in the World Wide Web.

LIMITATIONS

 The study was limited the neonates only admitted in NICU at SMVMCH.

 The study was limited to standardized protocol for nursing care

intervention on prevention of intravenous therapy related complications.

 A study was limited to 6 weeks duration.

53
 RECOMMENDATION

Based on findings of the present study, the following recommendations have

been made,

 Similar study can be conducted in other areas with a large sample.

 The same study can be conducted in different settings.

 The same study can be conducted with true experimental research

design.

 The study can be replicated with larger samples for better

generalization.

 The study can be done as a longitudinal study.

 The study can be replicated with bio-physical parameters.

 A comparative study can be conducted between pharmacological and

non Pharmacological intervention.

 The standardized protocol should be used for the adult also.

54
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5. DalalSS,Chawla D, Singh J, Agarwal RK, Deorari AK, Paul VK.Limb

splinting for intravenous cannulae in neonates: a randomised controlled

trial .Department of Paediatrics. All India Institute of Medical Sciences.

New Delhi-110029, India. 2009 November. http://www.ncbi.nlm.nih.gov.

6. http://27/photobucket.com/album/jj158/derive/IVpic.jpghttp://www.nursi

ngcentre.com

7. http://www.Elitemedical.com

8. http://www.Karolinska.com

9. http://www.medtexx.com

10. http://www.nursingtimes.net

11. http://www.ribben-med-med.com/assets/imagesRIBBEL-safe Bronch.jpg.

12. http://www. Royalunited hospital Bath.com

64
 APPENDIX-I
RESEARCH TOOLS

SECTION:A-DEMOGRAPHIC DATA
Sample no:

Procedure started date:

Procedure ended date:

1.AGE IN DAYS:
A. 1-6 days
B. 7-15 days
C. 16-28 days

2.SEX :
A. Male
B. Female

3.RELIGION:
A. Hindu
B. Muslim
C. Christian

4.TERM OF BIRTH:
A. Term baby
B. Pre term baby
C. Post term baby

5.TYPE OF DELIVERY:

A. Vaginal delivery
B. Elective LSCS delivery
C. Forceps delivery

6.WEIGHT OF BABY :
A. 1.3-2.3kg
B.4-3.3kg
C.>3.3kg

7.DURATION OF IV THERAPY:
A. 6-10days
B. >10 days

65
8.SITE OF IV CANNULA:

A. Digital vein
B. Basicilic vein
C. Cephalic vein

9.TYPE OF IV FLUID :
A. Hypertonic
B. Isotonic

10. IV INJECTION WITH AND WITHOUT ANTIBIOTIC:

A. Yes
B. No

11.INDICATION OF IV THERAPY:
A. Respiratory disorders
B. Neonatal infection
C. Electrolyte imbalance
D. Baby with physiological and pathological
E. Jaundice
F. Metabolic disorders

66
 SECTION: B-MODIFIED VISUAL COMPLICATIONS SCORE

SCALE

COMPLICATIONS:

1.Pain near the IV side by using facial grimace scale

a. No pain(1)

b. Mild pain (2)

c. Moderate(3)

d. Sever(4)

2.Infiltration:

a. Absent(1)

b. Inflammation near the insertion site(2)

c. Skin blanched(3)

d. Slowed (or)stopped infusion (4)

3. Hematoma:

a. Absent(1)

b. Edema(2)

c. Redness(3)

d. Skin discoloration(4)

4. Thrombosis:

a. Absent(1)

b. Swelling (2)

c. Tenderness(3)

67
 d. Obstruction of flow(4)

5.Thrombophlebitis:

a. Absent(1)

b. Erythematic(2)

c. Low grade fever(3)

c. Palpable cords(4)

6.Pulmonaryemboliusm:

a. Absent (1)

b. Dyspnea(2)

c. Cough(3)

d. Hemoptysis(4)

7.Air embolism:

a. Absent(1)

b. Pain(2)

c. Dizziness(3)

d. cardiac arrest(4)

8. Septicemia:

a. Absent(1)

b. General malaise and high greade fever(2)

c. Flushed skin(3)

d. Tachycardia(4)

68
9.Pulmonary edema:

a. Absent(1)

b. Restlessness(2)

c. Shortness of breath(3)

c. Hypoxia(4)

10.Speed shock:

a. Absent(1)

b. Hypotension(2)

c. weak (or)absent pulse(3)

d. Cold (or) blue extremities(4)

COMPLICATIONS SCORE:

1. 1-10-No complications

2.11-20 Mild complications

3.21-30 Moderate complications

4.31-40 Sever complications

69
 SECTION: C-OBSERVATIONAL CHICK LIST FOR
STAFF NURSE

S.NO COMPLICATIONS YES NO

1. Pain near the IV side by using facial grimace
scale:
no pain/mild pain /moderate pain/ sever pain.

2. Infiltration:
Absent/inflammation near the insertion site/skin
blanched slowed (or)stopped infusion.
3 Hematoma:
absent /edema/redness/skin discoloration.
4 . Thrombosis:
Absent/swelling /tenderness/obstruction of flow.
5 Thrombophlebitis:
Absent/erythema/low grade fever/palpable cords.
6 Pulmonary emboliusm:
absent /dyspnea/cough/ hemoptysis.
7 air embolism:
absent/pain/dizziness/ cardiac arrest.
8 septicemia:
absent/general malaise and high greade
fever/flushed skin/tachycardia.
9 pulmonary edema:
absent/restlessness/shortness of breath/hypoxia.

10 speed shock:
absent/hypotension/ weak (or) absent pluse/cold
(or) blue extremities.

70
 APPENDIX-II

LETTER SEEKING PERMISSION TO CONDUCT STUDY

FROM:
S.ASWINI
MSC, NURSING (II-YEAR),
SRI MANAKULA VINAYAGAR NURSING COLLEGE,
KALITHEERTHALKUPPAM,

TO:

THE MEDICAL SUPERINDENTENT,

SRI MANAKULA VINAYAGAR NURSING COLLEGE,
KALITHEERTHALKUPPAM,
PUDUCHERRY.

Respected sir,
sub: Request to accord permission for conducting research project

As a part of our curriculum requirement I am s. ASWINI studying MSC,

Nursing (II-year) at Sri ManakulaVinayagar Nursing College would like to conduct a
research project on “A study to evaluate the effectiveness of nursing intervention
on prevention of intravenous therapy related complications among neonates
admitted in NICU at SMVMCH, puducherry”.Under the guidance of Dr, R.
Danasu,Principal, Sri ManakulaVinayagar Nursing College. Here by I request your kind
self to grand permission to collect data at your esteemed institution in the area of
Neonatal intensive care unit (pediatric department ) with the effect from (25.09.2013) to
(11.11.2013) six weeks of period. Kindly request to consider and grant me a
permission.

Thanking you
Yours Faithfully

S.ASWINI

71
 LETTER SEEKING PERMISSION FOR CONDUCTING THE
STUDY

Date: 27.09.2013

TO:

The Medical Superintendent,

Sri ManakulaVinayagar Medical College And Hospital,

Puducherry.

Sir,

Sub: Letter requesting permission for conducting data collection

Miss.ASWINI.S is a bonafide postgraduate student of our institution. She has

selected the topic for her research project and has to go four weeks period of data
collection.

TOPIC:“A study to evaluate the effectiveness of nursing intervention on

prevention of intravenous therapy related complications among neonates

admitted in NICU at SMVMCH, puducherry.”

Regarding this project data collection she is in need of your esteemed help
and co-operation. I request you to kindly permit her to conduct proposed data
collection. Kindly do the needful.

Thanking you,

Yours sincerely,

PRINCIPAL.

72
 APPENDIX – III

LIST OF EXPERTS

1. MRS.SUMATHI,
PROFESSOR IN CHILD HEALTH NURSING,
KGCON,
PUDUCHERRY.

2. MRS.ROSE RAJESH,
PROFESSOR IN CHILD HEALTH NURSING,
PIMS,
PUDUCHERRY.

3. MRS.V.SASI,
PROFESSOR IN CHILD HEALTH NURSING,
VMCON,
PUDUCHERRY.

4. MRS.SUJATHA,
PROFESSOR IN CHILD HEALTH NURSING,
PIMS,
PUDUCHERRY.

5. MRS.BARANI,
HOD IN CHILD HEALTH NURSING,
RAAK,
PUDUCHERRY.

73
 APPENDIX – IV
LETTER FOR VALIDATION OF TOOL

From

Ms.ASWINI.S ,

M.Sc, (Nursing) II year,

Sri ManakulaVinayagar Nursing College,

Kalitheerthalkuppam.

To

Through the Proper Channel

Respected Sir/Madam,

Sub: Requesting the Experts opinion and suggestions for establishing the content
validity.

I, Aswini.S, M.Sc Nursing II year student of Child Health Nursing

Department at Sri ManakulaVinayagar Nursing College, Kalitheerthalkuppam,
Puducherry, conducting a study on “A study to evaluate the effectiveness of
nursing intervention on prevention of intravenous therapy related complications
among neonates admitted in NICU at SMVMCH, puducherry.”Hence ,I humbly
request you to validate the tool and give your valuable suggestions regarding the
appropriateness of the tool.

Thanking You,

Yours faithfully.

(ASWINI.S)

Enclosures:
1. Research tool
2. Certificate of validation
3. Evaluation check list

74
 CHECK LIST FOR VALIDATION OF TOOL

Introduction
The expert is requested to go through the following criteria for evaluation
of check list. Three columns are given for response and a column for remarks.
Kindly place tick mark in the appropriate column and give remark,

Interpretations of columns
Column I - Meets the criteria

Column II - Partly meets the criteria

Column III - Does not meet the criteria

S.NO CRITERIA I II III REMARKS

1. Scoring
Appropriateness
Adequacy
Accurateness
Clarity
Simplicity
2 Brief description of assessment
tool
Clarity
Adequacy
Appropriateness
Relevance
3 Content
Organization
Adequacy
Appropriateness
Practicability

Any other suggestions ___________________________________________

Signature :

Name, Designation :

Address :

75
 CERTIFICATE OF VALIDATION

I hereby certify that I have validated the tools prepared by

Ms.ASWINI.S, II Year, M.Sc (Child Health Nursing) student of Sri Manakula

Vinayagar Nursing College, Puducherry who has undertaken study field title of

“A study to evaluate the effectiveness of nursing intervention on prevention

of intravenous therapy related complications among neonates admitted in

NICU at SMVMCH, puducherry”.

SIGNATURE OF THE EXPERT

Name :

Designation :

Date :

76
 APPENDIX-V

CERTIFICATE OF ENGLISH EDITING

This is to certify that the project entitled “A study to evaluate the

effectiveness of nursing intervention on prevention of intravenous therapy

related complications among neonates admitted in NICU at SMVMCH,

puducherry” is corrected for English language appropriateness by me.

SIGNATURE

DATE :

PLACE :

77
 APPENDIX-VI
INFORMANT CONSENT

I Mr/Mrs/Miss State that, my self

Voluntarily take active participation in the conducted study conducted by Miss.

ASWINI.S M.SC Nursing II nd year, on the topic.“A study to evaluate the

effectiveness of nursing intervention on prevention of intravenous therapy related

complications among neonates admitted in NICU at SMVMCH, puducherry. ”

SIGNATURE

78
 APPENDIX-VII
DATE COLLECTION SCHEDULE
DATE OF T
DATA TIME ACTIVITIES/ PROCEDURE
COLLECTION
25/9/2013 to 7am to 7pm -First day I assessed the child condition and then I
1/10/2013 Checked the physician order.
-Before injecting hand washing done.
- Selected the site by avoiding the joint areas.
-Clean the site with alcohol swab (wipe and allow
to dry).
- Select the appropriate size of venflon ,prepare
few Strip of adhesive tapes and keep ready for use.
- Apply tourniquet firmly 6 to 8 inches proximal
to the venipuncture site.
-Inserted needle into the vein by holding the
needle at a 30 degree angle with the bevel, pierce
the skin lateral to the vein, when back flow of
blood occurs into the needle and tubing, insert the
needle further up into the vein about ¾ or 1 inch,
release the tourniquet.
-Secured venflon H method or crises cross
method.
-Supportive the site with splint.
-Then connected with the intravenous tubing.
-The pattern of tubing maintaining still 7am to
7pm.Then after that 7pm to 7am hand over to the
staff nurse to maintain patency.
-Observational check list was given to the staff
nurse.
-To was assess the complications among neonates.

79
7am to7pm -Second day I assessed the intravenous line.
-Check for flow rate overload or inadequacy is
beassessed.
-Check for the movement of hand, assessed the
baby activity assessed intravenous site.
-Secured with sterile dressing.
-Change intravenous site dressing if necessary,
then monitored the vital signs.
7am to 7pm -In third day I assessed the intravenous site.
-If any other complications occurs means I was
removed intravenous line.
-Again restart the new intravenous line therapy
by using standardized protocol infusion.
7am to 7pm -In fourth day I assessed the intravenous line.
-If the child condition is good recovered means,
safely removed the intravenous therapy.
7amto7pm -In fifth and six days I followed same routine
standardized protocol for nursing intervention for
neonates.

7am to 7 -In seventh days I observed the VIP intravenous

pm infusion complications.
-Observational check list finally it was given to
the staff nurse to assess the level of
complications among neonates and it should be
reported to me.

80
 APPENDIX- VIII
INTRAVENOUS PROTOCOL MODULES
PROTOCOL FOLLOWED FOR NURSING INTERVENTION ON
PREVENTION INTRAVENOUS THERAPY COMPLICATIONS

Step-1
Proper hand washing

Step-2

Avoid joints when selecting a site

Step-3

Clean the site before insertion using an alcohol

swab (wipe and allow to dry)

Step-4

Strict aseptic technique followed.

81
Step-5

Proper supportive measured used

Step-6

Assess the IV site frequently

Step-7
Joint flexion Avoid veins over

82
S.NO FOLLOWED PROTOCOL FOR NURSING INTERVENTION ON
PREVENTION OF INTRAVENOUS THERAPY COMPLICATIONS

1. Before injecting iv infusion proper hand washing

2. Avoid joints when selecting a site

3. Clean the site before insertion iv infusion using an alcohol swab (wipe and allow to
dry)
4. Strict aseptic technique when starting iv

5. Proper supportive measured use in splints

6. Assess the iv site frequently

7. Avoid veins over joint flexion

8. Do not reapply tourniquet to the same limb after an unsuccessful start

9. IV site secured with sterile dressing

10. Change IV site dressing if necessary

11. Utilize single-use intermittent medication tubing

12. Thoroughly inspect medication and solution containers prior to use

13. Inspect access site and equipment regularly

14 Change administration set and solution according to Patient Care Guideline

15 Utilize single-use intermittent medication tubing

16 Maintain prescribed flow rate with regular patient assessment

17 Monitor vital signs

83
 PROTOCOL FOLLOWED NURSING INTERVENTION ON
PREVENTION OF INTRAVENOUS THERAPY RELATED
COMPLICATIONS AMONG NEONATES

INTRODUCTION:

Intravenous cannulationis now an integral part the majority of nurses’

professional practice. It is theintroduction of the drug directly into a vein by
means of a cannula. A cannula is a flexible tube containing a needle which may
be inserted into a blood vessel. Any nurse who performing intravenous line
cannulation must be competent in all clinical aspects of intravenous therapy and
have validated competency in clinical practice in accordance with hospital
protocol. Training and assessment should include the care of intravenous line
cannula care in order to avoid possible complication.

AIM OF PROTOCOL:

To provide a guide to peripheral intravenous line cannulation and advice

on continuing care of babies with such devices in place.

OBJECTIVE OF THE PROTOCOL:

Each nursing personal will able to

 Decide the size of intravenous line cannula to be used
 Choose an appropriate insertion site
 Prepare the appropriate equipments
 Complete the procedure safety
 Conclude the care episode with removal of intravenous line
1
 cannula

DEFINITION OF INTRAVENOUS LINE CANNULATION:

Intravenous line cannulation is the insertion of tube into a vein to provide

access to the circulation for the administration of short term intravenous therapy
thatincludes blood, blood products, isotonic fluids and drugs.

INDICATION OF INTRAVENOUS LINE CANNULATION:

Cannulation may be used to

 Administer drugs
 Maintain correct hydration
 Transfuse blood and blood products
 Keep vein patent
PRINCIPLES TO ADOPT PRIOR TO INTRAVENOUS LINE
CANNULATION:
 cannulate veins in the lower arm and hand first, if no success, select legs
 No more than 3 attempts at cannulation shall be made by one individual.
After 3 unsuccessful attempts additional attempts shall be made by some
one with more experience
 use sterile equipment and apply principles of asepsis
 ensure correct identification of patient prior to procedure
 decontaminate hands prior to procedure
 cleanse babies skin using surgical spirit swabs and allow 30 second to dry
prior to insertion of cannula
 the volume of intravenous fluid for administration should be calculated
 accurate labeling of additives to the intravenous fluid is essential

SELECTION OF APPROPRIATE INTRAVENOUS LINE CANNULA:

The following should be considered

2
 the cannula length should correspond approximately to the length of
straight vein to be used
 expected duration (short length and small gauge permit better blood flow)
 infusion rate

DIFFERENT SIZES OF INTRAVENOUS LINE CANNULA:

GUAGE COLOUR CODE CATHETER WATER

LENGTH(mm) FLOWRATE
ml/min
14G Orange 45 270

16G Grey 45 172

18G Green 45 76
20G Pink 33 54
22G Blue 25 31
24G Lime(yellow) 19 14

3
 SELECTION OF SITE INTRAVENOUS LINE CANNULATION:

o Always allow adequate time for assessment of appropriate vein

o Use veins on babies’ less dominant side
o Distal veins should be used first with subsequent vein punctures proximal to
previous site
o Choose the areas without joint flexion
o Select a site with no sign of edema, dermatitis, cellulites, av fistula, wounds,
skin graft, fractures, shock or previous cannulation.
NURSES RESPONSIBILITYU IN CARING A PATIENT WITH
INTRAVENOUS CANNULA:
 Prepare the intravenous fluid aseptically and safely, checking the container
for color, clarity expiry date and leakage , and prepare immediately prior to
administration
 Check order and identify the baby before intravenous line cannulations
 Check and maintain patency of the intravenous line cannula regularly
 Inspect the site of intravenous line cannula and managing and reporting
complication where appropriate
 Control the flow rate of infusion as per calculation
 Monitor the condition of the baby intermittently
 Make clean and immediate records of all intravenous cannula care
procedure.

PROCEDURE:

Preliminary assessment:

 identify the baby

 Check general condition of the baby
 Review the physician order

Preparation of articles

4
Sterile tray contains

a. Intravenous line cannula kit containing stainless steel bowl (1) sterile
cotton swabs (3) sterile towel(1)
b. Sterile gloves

Clean tray contains

1. Soap with soap dish

2. Clean mackintosh and towel
3. Tourniquet
4. Surgical spirit – bottle
5. Venflon with covering
6. Easy fix plaster
7. Intravenous solution( sterile clear) ready for use
8. Intravenous set
9. Kidney tray

I.V stand

In the nurses station

1. Wash hands

5
 2. Arrange all articles in nurse station
3. Check the intravenous solution (color, clarity, expiry date, leakage)
4. Open the infusion set, maintaining sterility of both ends of tubings
5. Clean the top of the solution bottle with a spirit swab
6. Insert infusion set in the fluid bottle and close the roller clam fill
drip chamber
7. Release slowly the roller clamp to allow the fluid travel from drip
chamber to tubing with out air bubble
8. Replace the tubing cap at the end of the tube

Preparation of the baby:

1. Explain the procedure to the mother

2. Bring the prepared articles nearby the baby and hang the intravenous fluid at
18 – 24 inches from the cannula site in IV – stand
3. Identify the accessible vein for intravenous line cannula insertion
4. Place the site of intravenous line cannula insertion lower that baby heart
5. Place a clean mackintosh and a clean towel under the side of cannula
insertion
6. Cleanse the insertion site with a spirit swab one inch from the centre to the
periphery as a circle

6
Insertion of intravenous line cannula:

1. Wash hands and wear the gloves

2. Take the cannula from the protective cover
3. Use non dominant hand to pull the shin taut below the entry site
4. Hold the cannula at 15 – 30 degrees with bewel up and insert it through
the skin
5. Once the needle entered the skin lower the angle of the needle so that it
would become parallel with the skin and enter vein
6. When back flow of the blood occurs into the tubings insert the needle
about one inch and loosen the tourniquet
7. Remove the stillette slowly
8. Stabilizes the cannula by applying a gentle but firm pressure at the site of
the tip of cannula with non dominant hand
9. Quickly connect the end of IV tubing to cannula
10. Release the roller clam slowly to flow the fluid
11. Remove the gloves and the tourniquet
12. Secure the cannula by a readymade easy fix plaster
13. Adjust the flowrate

Aftercare of baby and articles

1. Collect all used articles washed, cleaned and replaced and dispose the
waste appropriately
2. Wash hands
3. Observe the client for adverse reaction at the site of cannula insertion,
such as pain, infliltration, allergic reaction etc.
4. Ask the baby mother (or) relatives to report if any unfavorable signs such
as fever, chills, etc. occur
5. Document the procedure with date, time, type of intravenous fluid and
drops per minute, with signature

7
DAILY CARE OF INTRAVENOUS LINE CANNULA:

1. Provide information to baby mother regarding intravenous cannula care

2. Wash hands
3. Prepare all the articles for the care of intravenous line cannula care

Clean tray with

1. Soap and soap dish

2. Normal saline (0.9%) – 1 bottle with top covering
3. Sterile syringe with protective covering
4. Kidney tray (1)
5. Steel bowl with cotton swabs(2)
6. Check the cannula insertion site is clean and dry without soiled
7. Check all the intravenous line connection such as leurlockplug, roller clamp.
IV tubing insertion site etc for tightness when not in use

8
8. Inspect the site of cannula insertion for adverse reaction such as pain,
thrombophlebitis etc,
9. Take 2 ml of normal saline (0.9%) from the IV bottle in aseptic manner in a
sterile 5 ml syringe
10. Flush the intravenous line cannula with 2 ml normal saline (0.9%) twice
(morning & evening ) within a minute (except for intravenous normal saline)
11. Instruct the patient (or) caretaker to report if any chills, fever, edema, etc.
12. Collect all the used articles, replaced properly and dispose the waste
appropriately.
13. Wash hands.
14. Document the procedure (date, time, condition of vein) with signature.

REMOVAL OF INTRAVENOUS LINE CANNULA

1. Provide the information to the baby mother about the removal of cannula
2. Wash hands
3. Prepare and then arrange all the articles for the intravenous cannula removal
nearby baby bedside in a clean stool.

Sterile tray with

9
 a.Intravenous line cannula care kit containing
Steel bowl – 1
Swabs – 2
Sterile towel – 1
Sterile gloves

Clean trey with

 Soap with soap dish

 Adhesive plaster with scissors
 Kidney tray – 1
 Surgical spirit
 Mackintosh, towel
1. Place a clean mackintosh and a clean towel under the intravenous line
cannula insertion site
2. Loosen the adhesive slowly from the surrounding s towards cannula
insertion site by applying counter traction to the skin
3. Hold a spirit swab over the venipuncture site
4. Withdraw the cannula by keeping it parallel to skin
5. Apply firm pressure for 2 to 3 minutes and hold the extremity above the
level of heart
6. Place sterile cotton over vein puncture site with adhesive tape
7. Examine catheter to see if it is intact and report if any part is missing
8. Check the site for any adverse reaction such as bleeding, pain etc.
9. Collect all the used articles for removal of intravenous line cannula,
washed, replaced and dispose the waste appropriately
10. Wash hands
11. Document the procedure (date, time and action of cannula insertion site)
with signature.

10
COMPLICATIONS OF INTRAVENOUS LINE CANNULATION

Local complications

 vein roll : rolling of vein cause multiple attempts

 haematoma : formed by leakage of blood from vein to surrounding tissuse
due to inappropriate vein puncture
 Infiltration: occurs when irritant solution (or) medicine enters the
subcutaneous tissue rather than the vein Eg. I.V fluids
 Extravasation : occurs when irritant solution (or) medicine enters to
surrounding tissues.
 Thrombo phlebitis : inflammation of vein due to septic measures and
mechanical (or) chemical irritation (or) infection

 Thromboembolism : occurs when a blood clot on catheter (or) vein wall

bedetached and is carried by the venous flow to heart and pulmonary
circulation
 Clotting : occurs when infusion is not flushed appropriately

11
SYSTEMIC COMPLICATIONS:

 fluid over load : due to on non adjustment of fluid rate (or) drops
 air embolism : a possible hazard during all forms of intravenous therapy
due to careless administration without expelling air in tube
 infection:
 nerve damage : due to improve placement of arm (or) too tight tying of
arm board (or) splint

SELF PROTECTION MEASURES FOR NURSES

 The use of protective sterile glove is advised for this procedure

 Nerve resheath needle to prevent stick injury. In the event of a needle stick
injury, squeeze and expresses blood and wash hands under running water
and take remedial measure soon.

CONCLUSION:

Intravenous line cannulation is increasing being performed by nurse in a

variety of clinical settings. To undertake this procedure successfully, a range of
knowledge and skill is required. Also in most institution policies and procedures
are there is order to avoid complications.

12
13
Neonates admitted in NICU. Arrange all articles in nurse station

14
Assessment and identification of vein Administering intravenous cannula

15
Observation of any complications. Proper replacement of articles

16
 Adjust the flow rate

17
18