A study to assess the effectiveness of Glycerin Magsful application verses hot fomentation in relieving phlebitis among IV cannulated patients

in a selected hospitals.

Introduction: Today in hospital setting, intravenous (IV) therapy has become a major component of patient care. Intravascular lines are used for purposes varying from monitoring pressures, administering drugs and fluids. A common problem encountered during IV therapy is the phlebitis, ie the inflammation of the venous wall near the point of entry of the cannula into the veins. It is often due to patient movement and disruption of vein at the site of insertion of the cannula. The patients who are on cytotoxic drugs, hyper osmolar agents and vaso active drugs are more prone to phlebitis. The Infusion Nurses Society National standards of practice (Australia) stated that a nurse who administers IV medication or fluid must know its adverse effects and appropriate interventions to be taken before starting the infusion1. Although many strategies to reduce this failure have been suggested, because of its multi factorial etiology, IV administration still continues to fail. Hence nurses need to be aware of and consider certain interventions to reduce phlebitis when managing IV therapy in patients. Background of the study Intravenous (IV) therapy is the giving of substances directly into a vein. Intravenous therapy may be used to correct electrolyte imbalances, deliver medications, for blood transfusion or as fluid replacement. In modern medical practice, up to 80% of hospitalized patients receive intravenous therapy at some point during their admission. Compared with other routes of administration, the intravenous route is the fastest way to deliver fluids and medications throughout the body. The devices for intravenous therapy usually include a hypodermic needle, peripheral cannula, and intravenous catheter, etc. and this is the most common invasive procedure among patients admitted to hospital. It is estimated that 150 million peripheral intravenous devices are placed each year in North America alone . Because high concentration of drugs and strong stimulating drugs enter the vein, and the large plastic catheter may stay in situ long term, types of complications that occur frequently in patients with peripheral intravenous therapy include infusion phlebitis, infection, infiltration or extravasation, fluid overload, hypothermia, electrolyte imbalance and embolism. Infusion phlebitis is in almost all cases a biochemical reaction to the mechanical irritation caused by the presence of the intravenous catheter . Studies have shown that 20% to 70% of patients receiving peripheral intravenous therapy develop phlebitis . According to statistics, about 80% of the patients with intravenous therapy develop varying degrees of infusion phlebitis in China .

Need for the study IV medication administration refers to the process of giving medication directly into a patient's vein. All medication administration carries certain risks, but IV therapy adds another level of complexity. Even when the nurse follows the five rights she can go wrong if the practices do not meet the standard of care for intravenous therapy. Phlebitis is a common complication associated with the use of peripheral IV catheters, affecting between 27% and 70% of all clients receiving intravenous therapy. The cause may be mechanical, chemical, or bacterial, with bacterial being rarest. Phlebitis is painful, and cause discomfort to patients. Most often it results in recannulation, not only incurs extra costs but also takes up staff time. Signs and symptoms of phlebitis are painful intravenous site, sluggish flow rate, red lines visible above the venepuncture site and edema. A descriptive study conducted at University hospital, Turkey on pre-disposing factors of phlebitis in patients with peripheral intravenous catheters. Among 568 IV sites observed, 355 patients had IV catheter-related complications. Using a phlebitis evaluation scale, the degree of phlebitis was observed. More than half (54.5%) of the catheter sites had phlebitis. They concluded that phlebitis not only causes sepsis, pain, additional diagnostic investigations, treatments, increased duration of hospitalization, patients stress level, and financial burden, but also increases staff workload. They recommended that advanced practice nurses need to be aware of the factors that increase the likelihood of phlebitis and take appropriate action4. Hot and cold Glycerine magsulf application are effective and inexpensive interventions for relieving phlebitis. Glycerine magnesium sulphate gets absorbed into the skin easily, reduce inflammation and stiffness, thus alleviate pain and promote tissue metabolism as well as the process of healing. Hot fomentation of glycerine magsulf causes vasodialation and thus improves blood flow to injured body part, promotes delivery of nutrients and removal of wastes, lessens venous congestion in injured tissues.Considering this aspect, the researcher felt the need for conducting study to reduce the phlebitis in patients with IV cannulation. The purpose of the study is to find out the effective intervention to reduce phlebitis, both glycerine magsulf and hot fomentation are cost-effective.

Problem statement

A study to assess the effectiveness of Glycerin Magsful application verses hot fomentation in relieving phlebitis among IV cannulated patients in a selected hospitals.

Objectives of the study The objectives of the study are to : To assess the degree of phlebitis. To determine the effect of glycerine magsulf application in reducing phlebitis using visual infusion phlebitis scale. To determine the effect of hot fomentation in reducing phlebitis using Jacksons visual infusion phlebitis scale. To compare the effectiveness between glycerine magsulf application and hot fomentation reducing phlebitis. To assess the cost effectiveness. in Jacksons