Authors (including presenting author) :
Wu HM (1), Chan CY (1), Chan KY (1), Ip SL (1), Yu YK (1), Wong KL (1), Shek KY (1)
Affiliation :
Department of Accident and Emergency, Tseung Kwan O Hospital
Introduction :
Peripheral intravenous (IV) catheter insertion allows the delivery of liquid substances, such as aqueous medications, directly into a patient's vein. This is one of the most essential, indispensable, and everyday applications in Accident and Emergency Department (AED). Approximately one-quarter of patients treated and discharged from AED and almost 80% of admitted AED patients have peripheral IV access.
However, IV line insertion procedures tend to be difficult and uncomfortable. Specifically, around 40% of the patients will have some difficulty in inserting an IV catheter. Moreover, IV line insertion can lead to moderate pain. To increase the quality of nursing service, local hot application on IV insertion is an evidence-based nursing practice to improve the ease of venipuncture and reduce pain level.
Objectives :
1. To increase vein visibility to improve the ease of venipuncture
2. To reduce nurse-perceived difficulty in peripheral IV cannulation
3. To reduce the patient's pain level associated with peripheral IV cannulation
4. To improve patient satisfaction level with peripheral IV cannulation
Methodology :
We performed a pilot study between August 2022 to December 2022, which included a 1-month pre-survey in July and a 4-month study from August to December in A&E of TKOH. Patients with barely visible and palpable Dorsal Metacarpal veins or poor pain tolerance for IV line insertion as stated by patients were recruited, except critical and emergency cases and patients with diabetes mellitus.
Workflow of local hot application on IV cannulation:
1. Select appropriate cases according to inclusion and exclusion criteria
2. Obtain patient’s verbal consent
3. Apply tourniquet and grade the veins using Vein Assessment Scale, then remove tourniquet
4. Get a rechargeable hand warmer and check the temperature (39-42 °C)
5. Wrap the hand warmer with 2 layers of Triangular Bandage
6. Apply the hand warmer on patient’s catheter site over Dorsal Metacarpal area for 1-3 minutes
7. Look for any complications caused by applying the hand warmer
Apply tourniquet and grade the veins using Vein Assessment Scale again
8. Perform standard practice of IV catheterization
9 Discard the used Triangular Bandage and clean the hand warmer with an alcohol towel.
We compare the mean vein score before and after the local hot application, mean nurse-perceived difficulty and mean numeric pain score and patient satisfaction level with local hot application and without local hot application.
Result & Outcome :
In the 5-month period, 26 patients were recruited for the use of local hot application for peripheral IV cannulation.
The mean vein assessment score was improved from 3 to 3.8 (range from 1-5, p< 0.05). The nurse-perceived difficulty was improved from 5.8 to 2.8 (range from 0-10, p< 0.05). The mean pain score was decreased from 5.4 to 4.1 (range from 0-10, p< 0.05). The patient satisfaction level was increased from 3 to 3.9 (range from 1-5, p< 0.05). However, the number of IV attempts was similar, 1.2 for local hot application and 1.3 for no local hot application (range from 1-2, p>0.05).
To conclude, the evidence-based nursing practice in local hot application for peripheral IV access is a cost-effective, easy and effective method to increase vein visibility, decrease nurse-perceived difficulty, reduce pain level and increase patient satisfaction level for patients with barely visible and palpable veins in AED.
