Perifer intravenös infart i klinisk rutin : Utveckling av omvårdnadsrutiner för att minska risken för komplikationer

Detta är en avhandling från Linköping : Linköpings universitet

Sammanfattning: The general aim was to study the way nurses plan, take care of and document a peripheral intravenous cannula (PIV) line related to complications, and to give a basis for quality assurance in surgery and internal medicine wards. The methods used were examination of patients' records, interview of patients and nurses, and observation of the cannula and its insertion area. An analysis of risk factors was also performed. The sample included 300 patients with 501 inserted peripheral cannulae, as well as nurses. The patients were followed from the day of insertion until the day the insertion area and the vein were free from symptoms.A significantly higher frequency of thrombophlebitis and severe long-term problems were found in patients treated by nurses without special training than among those with (p<0.001 ). The complication risks increased after long time in situ and were especially high when hypertonic drugs, solutions, or anticoagulants were given. Complications could exist up to six months. The care and handling decreased with time in situ and the cannulae were not always removed or documented. The intention was that a cannula should be inserted less than three days, but nurses were aware that the PIV remained in situ longer. Bad routines and neglected areas were said to be the reasons. Discomfort reported by the patients could be directly referred to technical mistakes or/and bad routines. When asked what governed the work with PI Vs the most decisive factors in the case of PIV were said to be knowledge 86%, experience 83%, and routine 32%. Educated nurses performed more satisfactory care and handling. No significant difference could be found between the nurses· years of experience and care and handling of PIV.A gap was shown between nursing research and nurses practice. The findings were not in accordance with, or based on, well-tried experience or scientific performance and diverges from "good knowledge" and '"good care". Reflection over current routines should be of value. One example of a good routine to reduce infections is daily change of the cannula. The conclusion is that the nurse has to be technically and theoretically acquainted with the subject.Nursing care demands special competence and relevant knowledge to enable nurses to assess and give satisfactory care in relation to patients" needs. Good nursing care should include prevention of pain and discomfort, be planned and implemented in a secure way, and also follow research and development in this area so that new knowledge and experience can be brought into the profession.

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