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Proposal about heparin for cannula flashing
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Module title: INTRODUCTION TO RESEARCH
Module code: N3596
Title of the proposal:
STUDY THE EFFECT OF NORMAL SALINE AND HEPARIN-SALINE
SOLUTION TO MAINTAIN PATENCY OF INTRAVENOUS CATHETERS
BUE ID NO: 111322
QMU ID NO: 09007976
British University in Egypt
Faculty of Nursing
Third year student
BUE ID NO: 111322 QMU ID NO: 09007679
STUDY THE EFFECT OF NORMAL SALINE AND HEPARIN-SALINE
SOLUTION TO MAINTAIN PATENCY OF INTRAVENOUS CATHETERS
Table of content:
Introduction.
Statement of the problem.
Purpose of the study.
Review of the literature.
Hypotheses and study question.
The Design, Methods and procedures.
Limitations and delimitations.
References.
BUE ID NO: 111322 QMU ID NO: 09007679
INTRODUCTION
Intravenous catheters are essential tools to give intravenous solutions,
medications and blood products transfusion. Intravenous cannulation and care of
intravenous catheters are usually done by nurses in all health care facilities. More
than 90% of hospitalized patients have one of intravenous catheters that inserted into
peripheral or central veins. There are a lot of patients who do not need continues
intravenous solutions, that is used for maintaining established intravenous catheters
immediately accessible for intermittent intravenous medications. Continuous
intravenous solutions method is consume the time of nurses, that is already limited,
because of the nurses must calculate the rate of infusion and adjust rate of the drip as
prescribed, in addition; continuous solution limit the mobility of the patient and the
potential risk of too much fluid infusion. Alternative devices, intravenous lock
devices are available to be used for patients who in need to inject drugs or solutions
intermittently. Such devices are less time consuming and cost effective to maintain
venous access, (Matthew, Barbara, et al-2009. Tim, Ron, 2010).
Nurses are flushing the IV lock periodically with heparin-saline solution in
different concentration of heparin without alteration of normal clotting factors in the
body. However, in 2010, Hephzibah Alexander cleared that 0.9% saline solution has
the same effect of heparin-saline solution in maintaining patency of IV catheter. Lots
of differences around maintaining patency of intravenous locks are found in Egypt. I
BUE ID NO: 111322 QMU ID NO: 09007679
have chosen this problem to find out experimentally the efficacy of normal saline and
heparin solution for maintaining patency of intravenous line.
STATEMENT OF THE PROBLEM:
Study the effect of normal saline and heparin-saline solution to maintain
patency of intravenous catheters at El-sheikh Zayed Specialized Hospital in Egypt.
PURPOSE OF THE STUDY:
The purpose of the study is to compare between heparin solution versus 0.9%
normal saline as a flush solution to maintain patency of intravenous catheters, find
out the effectiveness of 0.9% normal saline to maintain patency of intravenous
catheters with selected demographic variables in the medical and surgical unit and to
determine the effectiveness of heparin-saline as a flush solution to prevent clots
formation in the intravenous catheters with selected demographic variables in the
medical and surgical units.
BUE ID NO: 111322 QMU ID NO: 09007679
REVIEW OF THE LITERATURE:
Heparin-saline solution for intravenous catheter flushing is standardise practice
in maintaining patency of the catheter lumen, but efficacy of this practice has not
proved yet. A systematic reviews shown that, there are no benefits in using heparin
flushing versus 0.9% sodium chloride in maintaining patency of peripheral venous
catheters, (Lopez-Briz, E. Garcia, G. et al- 2010).
In March 2006, Niesen, K and Harris, D have reported that a large academic
medical center has conducted a study that included 173 hospitalized pregnant women
to compare between the efficacies of heparin solution (10 U/mL) versus normal
saline to maintain patency of peripheral intravenous catheters. In this study there
were two groups, first group 36 women with peripheral intravenous catheter,
intravenous flushing performed between and after any medication with 1 ml sodium
chloride. Second group that was consisted of 37 women with peripheral intravenous
catheter, intravenous flushing performed also, but with heparin solution 10 U/ml. The
result of the study was; there were no statistically significant differences in patency of
intravenous catheters regarding both solutions, nor heparin or normal saline. Thus,
this study concluded that heparin solution as effective as sodium chloride as a flush
solution in maintaining patent intravenous catheters.
In Bangalore, at Sarvodaya Hospital (Agrahara Dasarahalli, 2007) has
conducted an experimental study to evaluate the effectiveness of intermittent saline
BUE ID NO: 111322 QMU ID NO: 09007679
flushing in maintaining the patency of peripheral venous catheter among hospitalized
patients. The researcher has used the experimental group to conduct the study which
found that in the pre-test mean scour were 12.1 with standard deviation 2.8. In the
post-test the mean scour were 11.7 with the standard deviation of 2.2. Thus, he has
concluded that saline flushing was effective in experimental group.
An experimental study was conducted in Nehru Hospital to evaluate patency of
intravenous cannula with normal saline lock. Total population of the study was 60
patients with intravenous cannula. Subjects of the study have allocated in the groups
by simple random sampling method. Result revealed that, all the cannula on the third
day of cannula insertion, which is the maximum duration for cannula to be inside the
vein, in the experimental group, all the cannula were patent in the morning and 96.7%
cannulas were patent in the evening. On the other hand, in the control group only
60% cannulas were patent in the morning and 56.7% cannulas were patent in the
evening (Kaur, M. Sharma, S. and Jain, S. 2006).
A study by Hamilton and et al on heparin solution versus 0.9% sodium
chloride flushing for maintaining patency of intravenous catheter. Patients who
required intermittent intravenous injections were randomly assigned to receive 1 ml
of a heparin solution 100units/ml flush solution or a 0.9% sodium chloride flush
solution .Observation were observed for each catheter. Patients were evaluated daily
for the development of venous complications as phlebitis. In the 160 patients for
whom complete data on catheter patency were available, there were 307 observation.
BUE ID NO: 111322 QMU ID NO: 09007679
No significant differences in the duration of catheter patency or incidence of venous
complications such as phlebitis, was observed between the groups.
HYPOTHESES:
Flushing with heparin solution will be more effective than flushing with
normal saline (0.9 % sodium chloride) in maintaining the patency of
intravenous catheter.
Incidence of complication will be more in flushing with heparin solution than
in flushing with normal saline (0.9 % sodium chloride).
THE DESIGN, METHODS AND PROCEDURES:
Research approach; experimental approach will be followed.
Research design; the design of this study will be shaped Experimental design.
Variables; in this study there are two variables, first one will be dependent
variable which is the patency of the intravenous catheter. Second one will be
independent variables that will include heparin-saline versus 0.9% sodium
chloride.
Procedure:
Experimental study will be carried out; the total number of the study
subjects will be 80 hospitalized patients, at medical and surgical departments at
Zayed Specialized Hospital, with new inserted peripheral intravenous catheter,
divided into two groups. First group will be experimental group that consist
of 40 patients, second group will be control group which also include 40
BUE ID NO: 111322 QMU ID NO: 09007679
patients, with newly inserted peripheral intravenous catheter. Pre and post test
will be used as the following:-
groups Operation (procedure)
Experimental-
Group (heparin)
pre test-1
(PT-1)
Heparin-saline flushing-1
(HF-1)
Post test-1
(PoT-1)
Control-Group
(saline)
pre test-2
(PT-2)
0.9% sodium chloride
Injection-2 (SF-2)
Post test-2
(PoT-2)
Experimental Group will be injected with 1ml heparin solution as
flushing for maintaining patency of intravenous catheter as the
following:
Pre test-1(PT-1): Assess the patency of Intravenous line before heparin flush.
Heparin-saline flushing-1 (HF-1): Performance of heparin flush.
Post test-1(PoT-1) Assess the patency of intravenous line after heparin flush.
BUE ID NO: 111322 QMU ID NO: 09007679
Control group will be injected with 1ml 0.9% sodium chloride as
flushing for maintaining patency of intravenous catheter.
Pre test-2(PT-2): Assess the patency of Intravenous line before saline flush.
0.9% sodium chloride Injection-2 (SF-2): Performance of heparin flush.
Post test-2(PoT-2): Assess the patency of intravenous line after saline flush.
Sampling:
Sample will include 80 patients with newly inserted peripheral intravenous
Cannula, in medical and surgical departments of Zayed Specialized Hospital.
Sample technique: simple random sampling is the technique of choice to
select the two groups.
Criteria for sampling:
1) Inclusive criteria:
Every patient must be in medical and surgical department.
Patients how have newly inserted intravenous Cannula.
Patients with regular intravenous drugs, 3 times per day and for minimal
duration between 3 to 4 days, standard duration for intravenous catheter are 72
hours.
BUE ID NO: 111322 QMU ID NO: 09007679
2) Exclusive criteria:
Patient with allergic reaction for heparin.
Patient with previously occluded intravenous catheter.
Patient how is suffering from coagulation and bleeding disorders.
Patient how already receiving any anticoagulant medications.
Data collection method:
Data will be collected by observing the effect of each solution on samples of the
two groups, the researcher himself how will record observations, within 4 to 6 weeks
Plan of data analysis:
This study will include quantitative data and qualitative data. So, with the
statistician consultation, descriptive statistics will be the method of choice to analyze
the results of the study. The data will be presented through table, diagrams and
graphs.
Ethical consideration:
Before conducting this study, permission will be obtained from authority of
Zayed Specialized Hospital director of the hospital
In addition, a written informed consent will be signed by those willing to
participate in the study.
BUE ID NO: 111322 QMU ID NO: 09007679
Those who will refuse to consent to participate in the study will be
excluded.
Confidentiality will be maintained throughout the study.
SETTING DESCRIPTION:
The study will be conducted at El-sheikh Zayed Specialized Hospital in El-
sheikh Zayed city in Egypt. The hospital is consisting of 7 floors. Samples that have
been selected are hospitalized in the medical and surgical units in the hospital.
BUE ID NO: 111322 QMU ID NO: 09007679
References:
1) Dasarahalli, A. 2007. Experimental Study to Evaluate the Effectiveness of
Intermittent Saline flushes in Maintaining the Patency of Peripheral Venous
Catheter among patients in Sarvodaya Hospital in Bangalore. Karnataka:
Rajiv Gandhi university of Health science.
2) Hepzibha Alexander. 2010. Heparin versus normal saline as a flush solution.
International journal for the advancement of science and arts, vol.1.
3) Lopez-Briz, E. Garcia, G. et al- 2010. Heparin versus 0.9% sodium chloride
intermittent flushing for prevention of occlusion in central venous catheters in
adults. Journal of Advanced Nursing.
[http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008462/pdf]. Issue 4,
April. Available from: http://www.thecochranelibrary.com. [Accessed July 13
2012].
4) Mitchell, M. Anderson, B. et al. 2009. Heparin flushing and other interventions
to maintain patency of central venous catheters: a systematic review. Journal
of Advanced Nursing.
[http://www.carloshaya.net/biblioteca/boletinenfermeria6p2/heparin.pdf]. pp,
2007-2021. Available from: www.carloshaya.net. [Accessed July 13 2012].
BUE ID NO: 111322 QMU ID NO: 09007679
5) Niesen, K. Harris, D. et al. 2006. The Effects of Heparin versus Normal Saline
for Maintenance of Peripheral Intravenous Locks in Pregnant Women. Journal
of Obstetric, Gynecologic and Neonatal Nursing.
[http://onlinelibrary.wiley.com/doi/10.1177/0884217503255203/abstract].
Available from: www.onlinelibrary.wiley.com. [Accessed July 13 2012].
6) Kaur, M. Sharma, S. and Jain, S. 2006. Patency of intravenous (I.V.) cannula
with 'Normal Saline Lock' for patients on intermittent medication. Nursing and
Midwifery Research Journal, 2 (4) October, pp.132-138.