Articles
- Nursing Samples
- Hits: 1162
Infection Control. Examining the care of patients With peripheral venouscannulas.
Problem Statement
As creamer indicates, Peripheral venous cannulas has become a complication with an estimate of one in three patients in a hospital having a peripheral venous catheter at any given time. Catheters are hollow pipes that are advanced into veins inside the skin with a needle, with the aim of delivery of intravenous therapy. The major complications that are caused during the process of cannulation are infection and phlebitis. As creamer elaborates, these complications are mostly attributed to substandard care from nurses and the lack of a clear framework for the management of the condition.
The major complication of the cannulation process is phlebitis with other patients developing septicemia (Parker, 1999) which results in an increased morbidity in patients and increased hospital costs due to prolonged hospitalization. The research by Pearson (1996)revealed that the development of sepsis is mostly attributed to prolonged catheter duration of more than 48-72 hours. The research was necessitated by the fact that the finding of the 2nd National Prevalence Survey (Emmerson et al, 1996) showed that our hospitals currently have a whopping infection rate of 4.2% compared to the national average figure which stands at 1.9%. This was a worrying trend especially given that there existed enough study on the infection of associated with cannulation and the various guidelines to be followed in order to minimize the infection. The research, therefore, seeks to analyze the gap that exists in the past studies and come up with a working model that can effectively fill the existing gap.
The purpose and research question of the study
The major purpose of the study done by creamer was to identify the relationship between the nurses’ issues and the treatment and care of patients with PVC. The aim was to develop a working model that correlates and integrates at the variables that would be identified in the study.
The study also aimed at studying some of the existing literature on PVC. The intention of this was to understand the gap that exist in the care of PVC. The end means would be arrived at through keen and intensive analysis of the methodologies and structures of various studies. It is evident that the previous research that have been conducted in the past were quantitative, this research aimed at developing a qualitative approach.
Research Questions
- What are the complications associated with cannulation?
- What would are some of the shortcoming of previous studies conducted in this field and what steps are being taken in the new study to eliminate the shortcomings?
- What framework would best be suited to sorting the identified variables that bridge the gap that exists in the treatment and care of patients with PVC?
Literature Review
As the author elaborates, the major and serious complication that can occur from intravenous therapy is infection. The infection can cause phlebitis and septicemiain patients (Maki, 1991; Collign on, 1994; Pearson, 1996; Curran et al, 1998). It is worth noting that the other infection risk factors include the method of insertion, and patient susceptibility and the purpose of the cannula. The study seeks to assess how the duration of cannulation can increase the risk of infection inpatients. The current existing research point at the fact that a cannulation than is done for longer than 48-72 hours heightens the risk of infection in the patients (Lundgren et al, L996; Pearson, 1996). It is always desired that the duration of cannulation is minimized as much as possible but several factors including poor access, a decision could be made to increase the period of time.
As creamer (2000) elaborates, the most effective way to detect and prevent complications at its early stage is through the regular assessment if the PVC site. This regular assessment can be boosted by the keeping records of cannulation time and other medical records on PVC in locations that are accessible to everyone. In case there is a suspicion of infection, it is advisable that cannula is removed. Creamer points out the fact that there exists a gap in the current structures and knowledge in that the hospital guidelines lack a clear direction and definition of roles on the responsibility of recording of data on patients and removal of cannula.
The gap that exists in the current structures of hospitals is due to the lack of clearly defined roles on the insertion and care of the cannula. The normal sharing of roles always assigns the insertion of the cannula to a medical staff while the care of the PVC is left under the auspices of the nursing fraternity. The role of insertion, however, could be done by the intravenous therapy team (IVfs)or specialized nurses (Scales, 1996). As Creamer points out, the integration of the IVfs team into a hospital setting is the best approach to ensure that the infection are reduced. As Maki (1991) points outs, the other methods that can be adopted in the process of reducing infection is through the education and training of the hospital staff on the insertion and care of the cannula. The aim of the education and training exercise is to ensure strict adherence to the set protocols and awareness on some of the practices that cause various complications.
As indicated earlier, much literature is available on PVC infections, risk and the guidelines for reducing the indicated risks. The major limitation to the existing structures is that it depend purely on the provision of adequate care by a nurse and there is no organizational structure to aid in the process. It is worth noting that the research that have been done in the past have adopted a positivism approach which is based on quantitative methods and not qualitative methods. This method is usually less preferred in the examination of human behavior which is a key factor in the study of infection control.
To ensure that the research was precise and concise, Creamer adopted a qualitative approach which integrates the ground theory in his study. As Glaser and Strauss (1967) elaborate, a ground theory is an exploratory design which uses theoretical sampling and constant comparative analysis. Creamer adopted a qualitative approach so as to identify and develop a theoretical framework on the solution of the problem. The approach was effective as it provided a platform to analyze the effect of the interaction of the environment, the researcher and the research object.
Theoretical Framework
The major purpose of the study was to analyze the issues around nursing and evaluate the correlation that exists with PVC cannulation with the aim of improving the health medical practice. For this to be to be achieved the two factors had to be considered. The nurse role was of paramount importance in the research especially because the reduction in the number of infection was purely dependent on the nurses’ knowledge on the role in relation to policy and PVC care.
It is expected that the lack of experience and knowledge of nurses on there has a direct relation with the increasing number of infection. This in direct correlation with creamer view that the registered nurses must ensure that their knowledge on the treatment and management of PVC was up to date and evidence based.
The key to a correct diagnosis of the situation lies with a correct assessment. The other variable that had to be studied in the examination of patients with PVC was correct assessment. This assessment could only be arrived at through the understanding of all the signs of infection. The lack of experience with assessment could lead to a wrong conclusion. The result could be disastrous since an infection that could have been avoided is left to progress to the next stage.
From the studies analyzed under literature review, a model to be adopted in hospitals can be developed. The model is important as it would bridge the gap of management, especially with the lack of clearly defined roles in hospitals. As Bowditch and Buono (1994) point out, an effective approach this issue encompasses four models which include effectiveness, organizational support, practice and development. All the models presented have two dimensions of perception, with one perception being reflected in the other dimension. A good example of this can be seen from the fact that a dimension of theory is affected by documentation while the vice versa is true. The development model involves the initials stages of training and education of personnel who will administer PVC treatment and care.
The organization model involves the coming up of a well-documented policy framework that will govern a certain hospital setting on the various rules and policies that will guide the administering of PVC care and treatment. An organizational framework policy always has an effect on the training program since the new guidelines will have to be taught for a correct enforcement to be achieved. The same applies to the other models listed.
The adoption of an effectiveness framework is of the essence because it points out all the factors and variables that are involved in the treatment and care of patients with PVC. Once all the variables have been identified, the data to be collected can then be placed in harmony with the research question to be adopted.
References
Collignon, P, J. (1994). Intravascular catheter-associated sepsis: a common problem,TheAustralianstudyon intravascular catheter-associated sepsis .Med J Aust161:374- 8. Creamer, E. (2000). Examining the care of patients with peripheral venous cannulas. British Journal of Nursing, 2000, Vol, 9 Curran, E.,Coia, J., Gilmour, H.,McNamee, S.,Hood, J. (1998). Multi CentreResearch Surveillance Project to Reduce Infections/PhlebitisAssociatedwith PeripheralVascularCatheters. Infection Control Nurses'Association,Edinburgh Emmerson, A, M., Enstone, E., Griffin, M., Kelsey, M, C. & Smyth, ET,M. (1996). These second national prevalence survey of infection in hospitals—overview of the results.HospInfect32:175-90. Glaser, B. &Strauss, A. (1967). The Discovery of GroundedTheory:StrategiesforQualitative Research.Aldine,New York. Lundgren, A& Wahren, L, K. (1996). Peripheral intravenouslines:timeinsiturelatedtocomplications. IntravenNurs19(5):229-38. Maki, D, G. (1991). Infection caused by intravascular devices:pathogenesis, strategies forprevention. In: MakiDG,ed.ImprovingCatheterSite care.Royal Society ofMedicineServices,London:3-27. Parker, L.(1999). I V devices and related complications:causesandcomplications. BrJNurs8 (22):1491-8. Pearson, M, L. (1996). Guidelines for prevention of intravascular-device-related infections. Infect Control Hosp Epidemiol17:438-73. Scales, K. (1996). Legalandprofessionalaspects of intravenous therapy. Nurs Stand11(3):41-5
