Undergraduate Nursing Topic and Outline Sample

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An Investigation of the Effective Strategies to Prevent Infections (Phlebitis and Septicemia) in Patients Requiring Peripheral Intravenous Cannulations in Acute Care Settings.

Research Background and Rationale

Peripheral intravenous catheters /cannulations are the recognised and commonly utilised invasive tools used in hospital care, which treat around 60% of patients in hospitals, up to 90% of those who get admitted in the emergency rooms or ICUs ( Qamar et al., 2017). These patients receive PIC for the direction of fluids and drugs and to acquire blood samples.

As claimed by the researchers and medical specialists, most of the time, the injunction of peripheral intravenous cannulation leads to multiple complications related to vascular access. More specifically, many shreds of evidence are present that prove the suffering of patients requiring PIC with infections like phlebitis and septicemia.

However, these complications and difficulties can be avoided if the risk factors of such conditions are appropriately recognised, facilitating the recognition of potentially problematic situations at early stages (Bertoglio et al., 2017). Numerous occasions have been reported where different punctures are needed to achieve successful catheterisation for the patients of peripheral intravenous cannulations.

Most of the time, their successive attempts can lead to pain and delay in initiation of diagnostic treatment or tests and different infections, as the repetition of cannula punctures can degrade patients’ vascular walls and reduce the health of individuals (Marsh et al., 2018). This type of situation is generally referred to as “difficult intravenous access’ (DIVA) and also as “difficult peripheral intravenous cannulation (DPIVC).

This study has significant importance because it will discover different aspects of the patients requiring peripheral intravenous cannulations and how they can stay away from being infected. Massive value will be added in the medical research area as this study will explore different practical strategies that can be used to prevent infections like septicemia and phlebitis in patients who need peripheral intravenous cannulations.

Aim and Objectives

The principal aim of this study is to explore the risks in the form of infections that patients who need peripheral intravenous cannulations in acute care settings might suffer. The primary objective of this study is to investigate multiple effective strategies in the medical settings that can be used to prevent infections like septicemia and phlebitis in the patients that are prone to them because they get punctures of peripheral intravenous cannulations.

Literature Review

According to Piredda et al., 2017, early identification of health risks is a significant action that should take place. The same is for the peripheral intravenous cannulation, for which it is imperative to adopt strategies to enhance the likelihood of success in intravenous cannulations and efficiently evaluate the utilisation of alternative administration methods or venous devices.

Another study proposed by Adams et al., 2018 suggests that peripheral intravenous cannulations are a standard process followed in hospitals, usually for certain patients, to deliver medicine and fluids. However, there are multiple risks associated with this method of injecting fluids, which might lead to phlebitis, particularly inflammation of the vein.

This infection is caused by chemicals or infectious irritation (Moureau et al., 2016).  According to Mandal et al., 2019, one of the best strategies to prevent this infection in patients requiring peripheral intravenous cannulations is to show best practice while inserting a cannula and using infection control. Heng et al., 2020 has suggested that numerous strategies can be used to cure or prevent phlebitis and septicemia infections; however, a careful replacement and taking care of good hygiene can be the best processes to avoid such conditions. These infections can also be cured if they are identified early.

On the other hand, vigilance is an approach that can be accompanied to prevent this infection as well as other complications like sepsis which is a mature form of septicemia. Alloubani et al., 2019 has claimed that patients who get to suffer from infections like septicemia and peripheral intravenous disorders should avoid certain things, including smoking, drugs, and sick people. Also, they should make a habit of exercising regularly and take a healthy diet.

Research Methodology

This research study will be accompanied based on definite methodology through data collected and analysed to deduce the results. Therefore, this study is going to rely on primary qualitative research. The research design that is going to be used to accomplish the study objectives is referred to as ethnography. This research design is used when real-life environment-related problems are to be solved through qualitative research.

For this purpose, open-ended interviews will be conducted following the ethnographic research design that is going to study the observations of participants and the patterns of collected data. Primary research is selected over secondary research because it leads to more accurate results, even if it takes time. The sample population of this study comprise patients and healthcare officials.

The participants will be asked specific questions to investigate the strategies that can be used to prevent infections like septicemia and phlebitis in patients who need peripheral intravenous cannulations. Also, as the data will be collected through open-ended questions, the participants will be given a complete chance to share their opinions and views about asked questions.

Later on, after collecting sufficient data, the collected information will be analysed using the qualitative thematic analysis technique. According to this analytical approach of primary research, multiple patterns and themes are identified in the data, which are later used to declare the study results. Furthermore, considering all the ethical concerns, the personal information of the study participants will be kept confidential, and their responses will not be disclosed with their names without their permission.

References:

Adams, D.Z., Little, A., Vinsant, C. and Khandelwal, S., 2016. The midline catheter: a clinical review. The Journal of emergency medicine, 51(3), pp.252-258.

Piredda, M., Biagioli, V., Barrella, B., Carpisassi, I., Ghinelli, R., Giannarelli, D. and De Marinis, M.G., 2017. Factors affecting difficult peripheral intravenous cannulation in adults: a prospective observational study. Journal of Clinical Nursing, 26(7-8), pp.1074-1084.

Moureau, N. and Chopra, V., 2016. Indications for peripheral, midline and central catheters: summary of the MAGIC recommendations. British Journal of nursing, 25(8), pp.S15-S24.

Mandal, A. and Raghu, K., 2019. Study on incidence of phlebitis following the use of pherpheral intravenous catheter. Journal of family medicine and primary care, 8(9), p.2827.

Heng, S.Y., Yap, R.T.J., Tie, J. and McGrouther, D.A., 2020. Peripheral vein thrombophlebitis in the upper extremity: a systematic review of a frequent and important problem. The American journal of medicine, 133(4), pp.473-484.

Alloubani, A., Awwad, M. and Akhu-Zaheya, L., 2019. Optimal Timing for Peripheral Intravenous Cannula Replacement. The Open Infectious Diseases Journal, 11(1).

Qamar, Z., Afzal, M., Kousar, R., Waqas, A. and Gilani, S.A., 2017. Assess nurses knowledge and practices towards care and maintenance of peripheral intravenous cannulation in Services Hospital Lahore, Pakistan. Saudi Journal of Medical and Pharmaceutical Sciences, 3(6B), pp.608-614.

Bertoglio, S., van Boxtel, T., Goossens, G.A., Dougherty, L., Furtwangler, R., Lennan, E., Pittiruti, M., Sjovall, K. and Stas, M., 2017. Improving outcomes of short peripheral vascular access in oncology and chemotherapy administration. The journal of vascular access, 18(2), pp.89-96.

Marsh, N., Webster, J., Larsen, E., Genzel, J., Cooke, M., Mihala, G., Cadigan, S. and Rickard, C.M., 2018. Expert versus generalist inserters for peripheral intravenous catheter insertion: a randomised pilot trial. Trials, 19(1), pp.1-10.

Extra References:

1. Vendramim, P., Avelar, A.F.M., Rickard, C.M. and Pedreira, M.D.L.G., 2020. The RESPECT trial–Replacement of peripheral intravenous catheters according to clinical reasons or every 96 hours: A randomised, controlled, non-inferiority trial. International journal of nursing studies, 107, p.103504.
2. Fisk, N., 2018. A comparative study of disinfecting catheter caps and their effectiveness in reducing equine IV catheter-related thrombophlebitis. Veterinary Nursing Journal, 33(3), pp.74-78.
3. Jones, J., 2017. Managing sepsis effectively with national early warning scores and screening tools. British journal of community nursing, 22(6), pp.278-281.
4. Nabhan, A.F., Allam, N.E. and Salama, M.H.A.A., 2016. Routes of administration of antibiotic prophylaxis for preventing infection after caesarean section. Cochrane Database of Systematic Reviews, (6).
5. Sinha, A.K., Murthy, V., Nath, P., Morris, J.K. and Millar, M., 2016. Prevention of late onset sepsis and central-line associated blood stream infection in preterm infants. The Pediatric infectious disease journal, 35(4), pp.401-406.
6. Popoola, V.O., Colantuoni, E., Suwantarat, N., Pierce, R., Carroll, K.C., Aucott, S.W. and Milstone, A.M., 2016. Active surveillance cultures and decolonisation to reduce Staphylococcus aureus infections in the neonatal intensive care unit. infection control & hospital epidemiology, 37(4), pp.381-387.
7. Evison, H., Sweeny, A., Ranse, J., Carrington, M., Marsh, N., Byrnes, J., Rickard, C.M., Carr, P.J. and Keijzers, G., 2021. Idle peripheral intravenous cannulation: an observational cohort study of pre-hospital and emergency department practices. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 29(1), pp.1-13.
8. Osti, C., Khadka, M., Wosti, D., Gurung, G. and Zhao, Q., 2019. Knowledge and practice towards care and maintenance of peripheral intravenous cannula among nurses in Chitwan Medical College Teaching Hospital, Nepal. Nursing open, 6(3), pp.1006-1012.
9. Piredda, M., Biagioli, V., Barrella, B., Carpisassi, I., Ghinelli, R., Giannarelli, D. and De Marinis, M.G., 2017. Factors affecting difficult peripheral intravenous cannulation in adults: a prospective observational study. Journal of Clinical Nursing, 26(7-8), pp.1074-1084.
10. Rodriguez-Calero, M.A., Fernandez-Fernandez, I., Molero-Ballester, L.J., Matamalas-Massanet, C., Moreno-Mejias, L., de Pedro-Gomez, J.E., Blanco-Mavillard, I. and Morales-Asencio, J.M., 2018. Risk factors for difficult peripheral venous cannulation in hospitalised patients. Protocol for a multicentre case–control study in 48 units of eight public hospitals in Spain. BMJ open, 8(2), p.e020420.
11. Gunasundram, S., Tan, M., Lim, K.Z. and Loh, V.M., 2021. Reducing the incidence of phlebitis in medical adult inpatients with peripheral venous catheter care bundle: a best practice implementation project. JBI Evidence Implementation, 19(1), pp.68-83.
12. Saliba, P., Hornero, A., Cuervo, G., Grau, I., Jimenez, E., Berbel, D., Martos, P., Verge, J.M., Tebe, C., Martínez-Sánchez, J.M. and Shaw, E., 2018. Interventions to decrease short-term peripheral venous catheter-related bloodstream infections: impact on incidence and mortality. Journal of Hospital Infection, 100(3), pp.e178-e186.
13. Baskin, K.M., Mermel, L.A., Saad, T.F., Journeycake, J.M., Schaefer, C.M., Modi, B.P., Vrazas, J.I., Gore, B., Drews, B.B., Doellman, D. and Kocoshis, S.A., 2019. Evidence‐Based Strategies and Recommendations for Preservation of Central Venous Access in Children. Journal of Parenteral and Enteral Nutrition, 43(5), pp.591-614.
14. Su, L.T., Huang, H.C., Liu, Y.C., Chang, H.Y., Ou-Yang, M.C., Chen, C.C., Chen, F.S., Chung, M.Y. and Chen, I.L., 2021. The appropriate frequency of dressing for percutaneous central venous catheters in preventing catheter-related blood stream infection in NICU–A randomised controlled trial. Pediatrics & Neonatology, 62(3), pp.292-297.
15. Olivier, R.C., Wickman, M., Skinner, C. and Ablir, L., 2021. The impact of replacing peripheral intravenous catheters when clinically indicated on infection rate, nurse satisfaction, and costs in CCU, Step-Down, and Oncology units. American journal of infection control, 49(3), pp.327-332.
16. Marwah, S., Topden, S.R., Sharma, M., Mohindra, R. and Mittal, P., 2017. Severe puerperal sepsis-a simmering menace. Journal of clinical and diagnostic research: JCDR, 11(5), p.QC04.
17. Tork-Torabi, M., Namnabati, M., Allameh, Z. and Talakoub, S., 2019. Vancomycin infusion methods on phlebitis prevention in children. Iranian journal of nursing and midwifery research, 24(6), p.432.
18. Freystätter, C., Radtke, C., Ihra, G., Thalhammer, F. and Fochtmann-Frana, A., 2018. Sepsis caused by multidrug-resistant Klebsiella pneumoniae infection in a 23-year-old burn patient: case report and literature review. Annals of burns and fire disasters, 31(2), p.113.
19. Buetti, N. and Timsit, J.F., 2019, August. Management and prevention of central venous catheter-related infections in the ICU. Seminars in respiratory and critical care medicine (Vol. 40, No. 04, pp. 508-523). Thieme Medical Publishers.
20. Rae, J. and Misselbrook, K., 2017. Lemierre’s syndrome–a rare cause of disseminated sepsis requiring multi-organ support. Journal of the Intensive Care Society, 18(4), pp.329-333.

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