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.