Rajiv Gandhi University of Health Sciences, Karnataka s55

Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

DISSERTATION PROPOSAL

“A Study to Assess the Effectiveness of Video Assisted Teaching Programme on peripheral Intravenous Cannulation among First Years Bsc. Nursing Students at a Selected Nursing College in Bangalore”

SUBMITTED BY,

Ms ASHLY K THOMAS

1ST YEAR M.Sc. NURSING

ROYAL COLLEGE OF NURSING

UTTARAHALLI

BANGALORE-61

Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore

PROFORMA SYNOSPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / Name of the Candidate and Address / Ms ASHLY K THOMAS
1ST YEAR M.Sc. NURSING
ROYAL COLLEGE OF NURSING 7TH MAIN, 1ST BLOCK, UTTARAHALLI, BANGALORE-560061
2. / Name of the Institution / Royal college of nursing
3. / Course of study / 1st Year MSc. Nursing,
Medical Surgical Nursing
4. / Date of admission to course / 01-06-2011
5. / Title of the Topic:
“A Study To Assess The Effectiveness Of Video Assisted Teaching Programme On peripheral Intravenous Cannulation Among First Years Bsc. Nursing Students At A Selected Nursing College In Bangalore”
6. / Brief resume of the intended work: 6.1 Need for the study 6.2 Review of literature 6.3 Objectives of the study 6.4 Operational definitions 6.5 Hypothesis of the study 6.6 Assumptions 6.7 Delimitations of the study 6.8 Pilot study 6.9 Variables / Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed Enclosed
7. / Materials and methods 7.1 sources of data- Data will be collected from student nurses who are studying at a selected nursing college in Bangalore. 7.2 Methods of data collection- structured knowledge questionnaire. 7.3 Does the study require any interventions or investigation to the patients or other human being or animals? Yes 7.4 Has ethical clearance been obtained from your institution? Yes, ethical committee’s report is here with enclosed.
8. / List of references / Enclosed

Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

6. BRIEF RESUME OF THE INTENDED WORK:

INTRODUCTION

“When we touch the human we touch the heaven”

- “Novalis”

A cannula is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering data. In simple terms, an IV cannula can surround the inner or outer surfaces of a trocar needle thus extending needle approach to a vein by half or more of the length of the introducer1

A venous cannula is inserted into a vein, primarily for the administration of intravenous fluids, for obtaining blood samples and for administering medicines. An arterial cannula is inserted into an artery, commonly to the radial artery, and is used during major operations and in critical care areas to measure beat-to-beat blood pressure and to draw repeated blood samples1

There are various techniques to maximise venous access. Patients with difficult venous access may require application of a moist heat source to the site to assist vein distension. Lowering the extremity over the side of the bed improves venous filling gently tapping the vein may assist. Asking the patient to clench and unclench their first may make veins more visible1

Adequate skin preparation is essential to prevent the introduction of skin flora under the skin and to prevent the contamination of blood culture specimens. Ensure that the patient is not allergic to the prep solution. Allow the site to dry prior to puncturing the skin.

In determining cannula size and site consideration must be given to the purpose of cannulation and the likely duration of IV therapy. As a general rule you should the smallest gauge and shortest length cannula that will meet the patient’s needs.

Before the IV cannulation the nurses has to explain procedure and obtains consent and should prepares equipment and positions patient. Selects appropriate site and standard precautions. She should obtains adequate specimen.

In most circumstances cannulation should be attempted on the most distal part of the patients arm. Palpating a vein is important to determine its condition. Press lightly over the vein then release to assess elasticity and rebound filling. The vein should not feel hard and knotty. Ideally the cannula should be in the patients non-dominant arm. Always consider the purpose of the cannula.

The common sites should be avoided includes, veins distal to a previous IV site, joints or bony prominences, veins of the lower extremity, sclerosed or thrombosed veins, the patients dominant hand (where possible), the limb affected by axillary clearance ,veins with overlying cellulitis or skin breakdown.

Complications may arise in the vein as a result of the cannulation procedure, the four main groups of complication are:

Hematoma is a collection of blood, which can result from failure to puncture the vein when the cannula is inserted or when the cannula is removed. Selection of an appropriate vein and gently applying pressure slightly above the insertion point on removal of the cannula may prevent this2

Infiltration is an infusate enters the subcutaneous tissue instead of the vein. To prevent this, a cannula with accurate trim distances may be used. It is essential to fix the cannula in place firmly2

Embolism can be caused by air, a thrombus, or fragment of a catheter breaking off and entering the venous system. Such things can go on to lodge in an artery, blocking circulation to the corresponding area. Air emboli can be avoided by making sure that there is no air in the system. A thromboembolism can be avoided by using a smaller cannula2

Phlebitis is an inflammation of the vein resulting from mechanical or chemical irritation or from an infection. Phlebitis can be avoided by carefully choosing the site for cannulation and by checking the type of infusate used2

The ability to obtain peripheral intravenous access is an essential skill for all nurses. Although considered one of the simplest invasive procedures, mastering this potentially lifesaving intervention requires refined skills and experience. Cannulating a vein, particularly a small one, can be challenging. Indications Peripheral intravenous catheterization is required in a broad range of clinical applications, including intravenous drug administration, for intravenous hydration, transfusions of blood or blood components, during surgery, during emergency care, and in other situations

6.1 NEED FOR THE STUDY

“Education is the deliberate and systematic influence exerted by the mature person upon the immature person through instruction, discipline and the harmonious development of all the power of the human being”

- Redden and Ryan.

Venipuncture, or the ability to gain access to the venous system for administering fluids and medications, is an expected nursing skill in many settings. This responsibility includes selecting the appropriate venipuncture site and type of cannula and being proficient in the technique of vein entry.

Before performing venipuncture, the nurse carries out hand hygiene, applies gloves, and informs the patient about the procedure. Next the nurse selects the most appropriate insertion site and type of cannula for a particular patient. Factors influencing these choices include the type of solution to be administered, the expected duration of IV therapy, the patient’s general condition, and the availability of veins. The skill of the person initiating the infusion is also an important consideration.

Many sites can be used for IV therapy, but ease of access and potential hazards vary. Veins of the extremities are designated as peripheral locations and are ordinarily the only sites used by nurses. Because they are relatively safe and easy to enter, arm veins are most commonly used. The metacarpal, cephalic, basilic, and median veins as well as their branches are recommended sites because of their size and ease of access. More distal sites should be used first, with more proximal sites used subsequently. Leg veins should rarely, if ever, be used because of the high risk of thromboembolism. Additional sites to avoid include veins distal to a previous IV infiltration or phlebitic area, sclerosed or thrombosed veins, an arm with an arteriovenous shunt or fistula, or an arm affected by edema, infection, blood clot, or skin breakdown3

The most common I.V. complications included skin slough or necrosis (28 percent) followed by swelling/inflammation/infection (17 percent), nerve damage (17 percent) and fasciotomy scars from compartment syndrome (16 percent). Burns due to heat compresses used to treat I.V. infiltrations accounted for 3 percent of claims.

Engum SA, Jeffries P conducted a study School of Medicine, Indiana University School, USA on intravenous catheter training system, computer-based education versus traditional learning methods. This study compares the effectiveness of an interactive, multimedia, virtual reality computer IVcatheter simulator with a traditional laboratory experience of teaching IV venipuncture skills to both nursing and medical students. A randomized, pretest-posttest experimental design was employed. The methods of IV catheter education compared included a traditional method of instruction involving a scripted self-study module which involved a 10-minute videotape, instructor demonstration, and hands-on-experience using plastic mannequin arms. The second method involved an interactive multimedia, commercially made computer catheter simulator program utilizing virtual reality. The study concluded that the combination of these two methods of education is essential for teaching intravenous catheter training4

Lyons MG, Kasker J published an article in journal of continuing education in nursing regarding outcomes of a Continuing Education Course on Intravenous Catheter Insertion for Experienced Registered Nurses. Many experienced nurses report a lack of confidence in their intravenous (IV) catheter skills despite training with a phlebotomist and designated orientation time with the IV team. This study assessed the success of an IV catheter insertion continuing education class aimed at improving experienced nurses' skills levels, confidence, and knowledge regarding IV catheter insertion, maintenance, and infection prevention. Through a partnership between a hospital and a college of nursing continuing education program, a 1-day course was provided for 33 experienced nurses. The educators sought to determine whether a continuing education course improved the knowledge and skills of experienced nurses regarding theinsertion of peripheral IV catheters and whether the nurses retained the knowledge and skills learned in a formal IV course over time. The findings showed that the continuing education IV course improved the knowledge and skills of experienced nurses. Improvement in knowledge was shown immediately after the course and 8 to 12 weeks later. Skills improvement with regard to infection prevention and policy adherence was evident. Because confidence data were collected with two different scales before and after the course, they were unusable for statistical testing. Further study is needed to determine whether nurses' confidence levels would improve after the implementation of a formal IV course. Replication studies are also needed to validate the results with a larger sample size5

Researcher had many experiences with patients those who have suffered complications of IV cannulation. The researcher felt that this complications can be prevented by improving the knowledge of nurses. Then the researcher thought of taking the task of assessing the knowledge of nursing students and educating them.

6.2 REVIEW OF LITERATURE

The review of literature entails systematic identification, location, scrutiny, and summary of the written material that contains information relevant to the research topic was done to gain insight and to collect maximum information for laying the foundation of the study.

The review of literature is discussed under the following headings

· Studies related to effectiveness of IV cannula education programme.

· Studies related to complications of IV cannulation.

· Studies related to prevention of IV complications.

Studies related to effectiveness of IV cannula education programme.

Depledge J, Gracie F published an article in British Journal of Community nursing regarding Providing IV therapy education to community nurses. The delivery of intravenous therapy (IVT) in the community has expanded considerably in the UK in the last 20 years. Although some primary care trusts are more actively engaged in providing intravenous services than others, whatever the degree of engagement, staff require knowledge and skills to practice safely. An education provider was commissioned by a group of trusts in West London to deliver education on the principles of IVT. Feedback suggested that this enabled nurses to challenge current intravenous practice in their areas and improve service delivery for the benefit of their patients. This article presents the basis of the curriculum delivered and experience of providing education in IVT to community nurses in West London6

Anna Lundgren, Lis Karin Wahren published an article in journal of clinical nursing regarding Effect of education on evidence-based care and handling of peripheral intravenous lines. Deficient routines in use, care, handling and documentation of peripheral intravenous vein cannulae (PIV) have previously been reported, and complications have been noted in 50–75% of the patients. The aim of the study was to examine whether specially trained nurses change their actions to decrease complications when using cannulae. The study included 36 nurses assigned to experimental and control groups. The experimental group followed an education programme explaining how to use and take care of a PIV. To evaluate the intervention document analysis, observations and patient interviews were performed in 99 patients with 172 PIVs in situ for less than 24 h. After the education programme, fewer complications, more carefully performed care and handling, and better documentation and information were found in the experimental group. Nurses in the control group followed current routines, which resulted in a greater degree of complications. Education in evidence-based care and handling gives nurses the opportunity to improve their ability to use theoretical knowledge in clinical problems7

Studies related to complications of IV cannulation.

Scales K. published an article in Nursing standard regarding Correct use of chlorhexidine in intravenous practice. This article reviews the routes by which microorganisms may contaminate vascular access devices, and examines the role of chlorhexidine in the prevention of catheter-related bloodstream infections. Chlorhexidine-based cleansing products for use in intravenous therapy are reviewed and their correct use is discussed, with reference to clinical guidelines8