1. BY, ATHIRA.R

2. Effect of ball squeezing exercise on peripheral venous access of upper extremity . 3. NEED AND SIGNIFICANCE Cancer prevalence in India-2.5 million. Estimated cancer deaths in Indiaprojected to increase to 7 lakh by 2015. 4. CONTUES. Diagnosis of cancer as well asfinancial burden causes immense emotional trauma 5. Contues. Chemotherapy as an important means of treatment of malignant cancers 6. Contues.. Side effects of chemotherapyleads to poor health and malnutrition 7. Contues.. Chemotherapy and thrombophlebitis 8. Contnues Inflicting further pain to debilitated patients by multiple needle punctures 9. Contues.. Multiple punctures predisposing to iatrogenic infections 10. Contues. Wastage of time and material 11. Contues. Experiences from clinics 12. Contues.. Statistics in calicut medicalcollege 13. Contues.. Importance of ball squeezingexercise 14. National kidney foundation Italy in 2oo6, they proved that Strengthening the forearm by using isometric exercises to increase handgrip strength ,will increase blood flow, thereby enhancing vein maturation in patients with av fistula 15. In a research conducted by Kirstin N. Lane et al, Canada in 2006, Lymphoscintigraphy was used to measure lymphatic function at rest and during exercise in breast cancer survivors with lymphedema All groups displayed similar increases in clearance rate 16. Purpose of the study: Assess the effect of ballsqueezing exercise on peripheral venous access 17. STATEMENT OF THE PROBLEM: Assess the effect of ball squeezingexercise on peripheral venous access of upper extremity among patients receiving chemotherapy from NMCH Calicut. 18. OBJECTIVES Assess the venous status of patients receiving chemotherapy using vein assessment tool beforeintervention Assess the venous status of patients receiving chemotherapy using vein assessment tool after intervention 19. Objectives: Assess the effect of ballsqueezing exercise on peripheral venous access of patients receiving chemotherapy 20. Objectives: Find out the association betweenvariables such as nutritional status , chemotherapy agent used ,age , sex ,socioeconomic status and effect of ball squeezing on peripheral venous access. 21. OPERATIONAL DEFINITIONS EFFECT: In this study, effect refers to the outcome of ball squeezing exercise on peripheral veins ofpatients receiving chemotherapy as measured by vein assessment tool 22. Contues. BALL SQUEEZING EXERCISE: : Inthis study, ball squeezing exercise refers to series of exercise done by holding a squeeze ball as tight as possible in hand and relaxing and the exercise is practiced for 5 minutes thrice daily for 2weeks. 23. COTUES PATIENTS RECEIVING CHEMOTHERAPY:chemotherapy refers to the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen. This study considers only those patients who receive intravenous chemotherapy as mode of treatment for oncological problems. 24. Contues. PERIPHERAL VENOUS ACCESS:In thisstudy peripheral venous access means, accessibility of a peripheral vein to insert a needle in to either to withdraw sample blood or to infuse fluids and IVmedications 25. CONCEPTUAL FRAMEWORK BASED ON THEORY OF COMFORT BY KATHARINE KOLCABA 26. ASSUMPTION As the number of cycle ofchemotherapy increases compliance of patients to ball squeezing also increases 27. HYPOTHESIS: H1: There will be a significantdifference in vein assessment scores as per vein assessment tool before and after ball squeezing exercise 28. RESEARCH METHODOLOGY 29. RESEARCH APPROACH: Experimental approach - quazyexperimental approach 30. RESEARCH DESIGN : One group pretest post test designO1XO2 31. SETTING: Oncology wards of NMCH Calicut 32. POPULATION : patients receiving chemotherapy from NMCH Calicut 33. SAMPLE 50 patients receiving chemotherapy 34. SAMPLING TECHNIQUE purposive sampling technique 35. INCLUSION CRITERIA: Patients who have completed 4th cycle of chemotherapy Patients with poor or fair veinquality as per vein assessment tool 36. EXCLUSION CRITERIA Patients who are not willing to participate in the study. Patients who are not able to do ballsqueezing exercise 37. TOOL AND TECHNIQUE OF DATA COLLECTION:Tool-1: semistructuredinterview schedule by interviewing Tool-2: rating scale by observation done by two raters at different occassions 38. VEIN ASSESSMENT TOOL BY JOAN WEBSTER GOOD: Vein is easily visible and /or easy to palpate when tournequet is applied FAIR: Veins are small, scarred or difficult to palpate POOR:Veins unable to be seen or palpate(requires heat pack to aid vaso dilation) 39. PLAN FOR DATA COLLECTION: 40. PLAN FOR DATA ANALYSISChi square test 41. WORK PLAN 42. BUDGET 43. ETHICAL CONSIDERATIONS: