A STUDY TO EVALUATE EFFECTIVENESS OF COLD
APPLICATION AND MAGNESIUM SULPHATE
APPLICATION ON SUPERFICIAL THROMBOPHLEBITIS
AMONG PATIENTS RECEIVING INTRAVENOUS
THERAPY IN SELECTED HOSPITALS, AMRITSAR.
A Synopsis
Submitted for the partial fulfillment of the requirement for the degree of
MASTER OF SCIENCE IN NURSING
(Medical Surgical Nursing)
Of
Baba Farid University of Health Sciences,
Faridkot, Punjab
2012
Navjot Kaur
Mai Bhago College of Nursing, Tarn-Taran
1
A STUDY TO EVALUATE EFFECTIVENESS OF COLD
APPLICATION AND MAGNESIUM SULPHATE
APPLICATION ON SUPERFICIAL THROMBOPHLEBITIS
AMONG PATIENTS RECEIVING INTRAVENOUS
THERAPY IN SELECTED HOSPITALS, AMRITSAR.
A Synopsis
Submitted for the partial fulfillment of the requirement for the degree of
MASTER OF SCIENCE IN NURSING
(Medical Surgical Nursing)
Of
Baba Farid University of Health Sciences,
Faridkot, Punjab
2012
Navjot Kaur
Name and Signature
Of Supervisor
Mr. Sekar P.
Name and Signature
of Co-Supervisor
Ms. Jicy Shaji
Mai Bhago College of Nursing, Tarn-Taran
2
Title A study to evaluate effectiveness of cold application and
magnesium sulphate application on superficial thrombophlebitis
among patients receiving intravenous therapy in selected
hospitals Amritsar
For the degree of MSc (Nursing) Medical Surgical Nursing
Name of the
candidate
Navjot Kaur
Supervisor Mr. Sekar P.
Lecturer ( deptt. Of Medical Surgical Nursing)
Mai Bhago College of Nursing, Tarn-Taran
Institution Mai Bhago College of Nursing, Tarn-Taran
University Baba Farid University of Health Sciences, Faridkot
ABSTRACT OF PLAN OF THESIS
Superficial thrombophlebitis is defined as inflammation of superficial vein.The use of
intravenous devices is an integral part of patient care in hospitals. These devices are used
for the administration of fluid, nutrients, medications, blood products and to monitor the
hemodynamic status of a patient. Infusion phlebitis, defined as the inflammation of a
cannulated vein, is a common cause of pain and discomfort in these patients. Studies over
the past 2 decades have shown that 20 to 70% of patients receiving peripheral IV therapy
develop phlebitis. Some recent trends in hospital care include the application of
magnesium sulphate (Epsom salt) for reducing the oedema. Magnesium sulphate reduces
striated muscle contractions and blocks peripheral neuromuscular transmission by
reducing acetylcholine release at the myoneural junction. Cold application is a simple and
inexpensive therapy which is an effective nonpharmacologic intervention for
thrombophlebitis. Applying cold may help numb tissues and relieve muscle spasms. Ice
chips is used in reducing the inflammation, Ice reduces swelling by decreasing blood
flow of blood to an area and increase the platelet aggregation. The study is quasi
experimental in nature. The study will be conducted on 60 samples, 30 in magnesium
sulphate group and 30 in cold applications group. A standardized Visual infusion
3
phlebitis scale will be used to collect data. The data will be analyzed by using descriptive
and inferential statistics.
4
Index of content
Chapte
r no.
Title Page no.
1. Background of the study
Introduction 1-4
Need of the study 4,5
Research problem 5
Aim of the study 5
Objectives 6
Operational definitions 6
Hypotheses / assumptions 7
Delimitations 7
2. Review of literature 8-12
3. Methodology
Research design 13
Research setting 13
Target population 13
Sample and sampling technique 13
Inclusion and Exclusion criteria 13
Selection and Development of tool 14
Description of tool 14
Validity of tool 14
Reliability of tool 14
Pilot study 14
Data collection procedure 14
Ethical considerations 15
Plan of data analysis 15
References 16,17
5
Chapter-I
Background of the study
Introduction:
An ounce of prevention is worth a pound of cure
Health is a dynamic process and it is always changing. All have times of good
health, times of sickness, and maybe even times of serious illness. As lifestyles change,
so does the level of health. Health is the level of functional and (or) metabolic efficiency
of a living being. It is the general condition of a person in the mind, body and spirit,
usually meaning to be free from illness, injury or pain.1
An impairment of the normal state of a human being that interrupts or modifies its
vital functions is known as disease. Disease is a main reason for the people to seek
medical help and admit in hospitals. According to American hospital association,
hospitals are licensed institutions with at least six beds whose primary function is to
provide diagnostic and therapeutic client services for medical conditions.2
The use of intravenous devices is an integral part of patient care in hospitals.
These devices are used for the administration of fluid, nutrients, medications, blood
products and to monitor the hemodynamic status of a patient. In modern medical practice,
up to 80% of hospitalized patients receive intravenous therapy at some point during their
admission.3-4
A number of factors increase the risk of infection from intravascular devices. For
example, infection rates are higher among patients in large hospitals who may be
especially ill, those with burns or surgical wounds or those who are malnourished or
immune compromised. In addition, the rates are higher for certain devices, the type of
fluid being infused and the length of time the catheter is left in place.5
Serious complications related to peripheral IVs are uncommon, but problems do
occur, especially with prolonged use. That is why there are guidelines in different
6
hospitals about the recommended duration that a peripheral IV should be in place. As
with any side effect or complication of health care procedures, early detection, and good
communication between the patient and healthcare provider are important.6
Infusion phlebitis, defined as the inflammation of a cannulated vein, is a common cause
of pain and discomfort in these patients. Studies over the past 2 decades have shown that
20 to 70% of patients receiving peripheral IV therapy develop phlebitis According to
statistics; about 80% of the patients with intravenous therapy develop varying degrees of
infusion phlebitis in China alone.7
The incidence of superficial venous thrombosis is highly dependent on the
population studied as well as the means by which it is documented. It is generally
believed that incidence rates from epidemiological studies are underestimates since
autopsy studies indicate that up to 50% of venous thromboembolism are not recognized
ante mortem. Community based studies of hospitalized patients have suggested an annual
incidence of 56 per 100,000 while population based studies of healthy volunteers have
produced estimates of 122 per 100,000. Studies confirmed thrombophlebitis in Sweden
has suggested a somewhat higher incidence of 160 cases of new or recurrent disease per
100,000 population per year. Extrapolated to the population of the United States, this
represents 116,000 to over 250,000 new cases of clinically recognized infusion phlebitis
per year.8
Phlebology is the medical discipline that involves the diagnosis and treatment
of disorders of venous origin. The American Medical Association has added Phlebology
to their list of self-designated practice specialties. A medical specialist in Phlebology is
termed a phlebologist.
Phlebitis means inflammation of a vein. Thrombophlebitis is the term used when
a blood clot in the vein causes the inflammation. Thrombophlebitis usually occurs in leg
veins, but it may occur in arms. The thrombus in the vein causes pain and irritation and
may block the blood flow in the veins. Blood clots (thrombi) can form which may break
off and travel to the lungs. This is a potentially life threatening condition called
Pulmonary embolism.9
7
Some recent trends in hospital care include the application of magnesium
sulphate (Epsom salt) for reducing the oedema. Magnesium is the second most plentiful
cation of the intracellular fluids. It is essential for the activity of many enzyme systems
and plays an important role with regard to neurochemical transmission and muscular
excitability. Magnesium sulphate reduces striated muscle contractions and blocks
peripheral neuromuscular transmission by reducing acetylcholine release at the
myoneural junction. Additionally, Magnesium inhibits Ca2+ influx through
dihydropyridine-sensitive, voltage-dependent channels. This accounts for much of its
relaxant action on vascular smooth muscle.10
Cold application is a simple and inexpensive therapy which has been accepted
for decades as an effective nonpharmacologic intervention for thrombophlebitis.
Applying cold may help numb tissues and relieve muscle spasms. Ice chips is used in
reducing the inflammation, Ice reduces swelling by decreasing blood flow of blood to an
area and increase the platelet aggregation. While some blood flow is required to bring the
healing cells to the injured area, the body always overdoes it and sends too much blood,
that's why we can reduce blood flow without too much concern Ice also numbs the area,
thereby reducing pain. The nursing interventions should be meaningful and affordable by
the client in terms of this aspect this study is relevant to the profession.11
Need for study:
It is estimated that 150 million peripheral intravenous devices are placed each
year in North America alone. One of the most common complications of peripheral
intravenous catheter is phlebitis that may occur in up to 75-80 % of hospitalized patients.
It remains a significant problem in clinical practice and causes patient discomfort,
catheter replacement, prolonged hospital stay and healthcare costs. Maintenance of the
patency of these catheters and prevention of phlebitis is an important problem. It is
estimated that 200,000 cases of catheter related infections are occurring worldwide each
year.
Superficial Thrombophlebitis which occurs in about 75% of all patients receiving
intravenous therapy, deep vein Thrombophlebitis occurs at least 5% of surgical patients.12
8
In hospitalized individuals, the incidence of venous thrombosis varies
considerably, from 20% to 80%, and the incidence of Deep vein thrombosis is estimated
to be about 80 cases per 100,000 populations annually. Superficial Thrombophlebitis is
very common in hospitalized patients, but frequency is not known precisely because
many cases go unreported and untreated. Deep vein thrombosis frequency also is not
known precisely because of misdiagnoses.13
If Thrombophlebitis is in a vein just under the skin (superficial vein),
complications are rare. However, if the clot occurs in a deep vein the client may develop
a serious medical condition known as deep vein thrombosis. If that happens, the risk of
serious complications is greater. Complications may include: pulmonary embolism and
heart attack or shock.
A study conducted to evaluate superficial thrombophlebitis and the incidence of
cancer in primary care patients. the results conclude that only single exposure to
superficial thrombophlebitis does not cause cancer, but frequent exposure may cause
malignancies after 2-3 years of exposure.14
Student researcher during clinical practices had experienced that there is higher
incidence of superficial thrombophlebitis among patients who are receiving continuous
intravenous therapy. Some degree of erythema is a frequent occurrence around drip
infusion sites, so much so that it may easily be disregarded. The complaints of
patients who are troubled by the pain and irritation often pass unheard. Sometimes
the vein thromboses, the drip stops, and the patient are suffering from a full-blown
thrombophlebitis. This complication, although not so frequent nor apparently so
severe as in former times, is a very familiar problem; but the pathophysiology
remains poorly understood and hence the management is often unsatisfactory.
Thus, in extensive review of literature, investigator came across so many studies
regarding infusion phlebitis. So investigator felt need to conduct study to find out which
is the most effective method in relation to rapidity of subside the signs and symptoms,
and practicability in patients with superficial thrombophlebitis. The cost effective care
9
also one of the main concepts of quality of nursing care. The cost effective management
is necessarily carried out to reduce oedema and anxiety related to care.
Research problem
A study to evaluate effectiveness of cold application and magnesium sulphate application
on superficial thrombophlebitis among patients receiving intravenous therapy in selected
hospitals Amritsar.
Aim of the study:
To evaluate the effectiveness of two interventional strategies on treatment of superficial
thrombophlebitis.
Objectives:
Assess the pre test degree of superficial thrombophlebitis among clients
receiving IV therapy
Assess the post test superficial thrombophlebitis scores among clients
receiving IV therapy.
Assess the effectiveness of cold application on superficial thrombophlebitis.
Assess the effectiveness of magnesium sulphate on superficial
thrombophlebitis.
Compare the effectiveness of cold application and magnesium sulphate on
thrombophlebitis.
Find the association between post test superficial thrombophlebitis scores in
cold applications group with selected demographic variables.
Find the association between post test superficial thrombophlebitis scores in
magnesium sulphate group with selected demographic variables.
Operational definitions:
10
1. Effectiveness: The degree to which level of superficial thrombophlebitis is reduced
after the cold applications and magnesium sulphate. It is measured by visual infusion
phlebitis scale.
2. Cold Application: It is application of ice chips externally over the site 3 times a day
for 3 days to reduce sign and symptoms of superficial thrombophlebitis
3. Magnesium sulphate: It refers to the application of magnesium sulphate over the site
3 times a day for 3 days to reduce superficial thrombophlebitis. Magnesium sulphate is
crystal like substance which helps to reduce the redness, edema and swelling.
4. Superficial Thrombophlebitis: Inflammation of superficial vein followed by
formation of clot at the site of intravenous line.
5. Intravenous Therapy: Administration of fluids and drugs into veins through the use
of hypodermic needle, peripheral cannula, and intravenous catheter, etc
Hypothesis:
H 1: There will be significant association between selected clinical variables and pre-test
superficial thrombophlebitis score.
H 2 -There will be a significant effect of cold application on superficial
thrombophlebitis.
H 3 -There will be a significant effect of magnesium sulphate application on superficial
thrombophlebitis.
H 4 -There will be a significant difference among cold application and magnesium-
sulphate application in reducing the signs and symptoms of superficial thrombophlebitis.
Delimitations:
Study is limited to the patients who are receiving continuous IV therapy.
Study is limited to hospitals of only one district of Punjab.
Study is concise to small sample size.
11
Chapter-II
Review of Literature
A literature review is summary of previous research on a topic which can be either a part
of a large report of a research project, a thesis or bibliographic essay that is published
separately in scholarly journal. The purpose of literature review is to convey the reader
what knowledge and ideas have been established on topic and what are the strength and
weaknesses. It allows the reader to bring up to date reading the state of research in the
field and familiarizes the reader with any contrasting perspectives and view point on the
topic. There are many reasons for beginning a literature review before starting a research
paper.
a) Studies Related to superficial thrombophlebitis among clients with I V Cannulation.
b) Studies Related to magnesium sulphate and other topical drug therapies.
c) Studies Related to hot and cold applications.
a) Studies Related To superficial thrombophlebitis among clients with I V
Cannulation.
A prospective, randomized, controlled unblinded study was conducted to assess the
effectiveness of elective re-siting of intravenous cannula decrease peripheral
thrombophlebitis. Forty-two patients admitted for major abdominal surgery were
included in the study. The patients were allocated to either the study or the control group
using block randomization–restricted randomization method. Cannula in the study group
were changed and re-sited electively every 48 hours. All the patients were examined
every 24 hours for signs and symptoms of peripheral thrombophlebitis at the current and
previous sites of infusion. The incidence of peripheral thrombophlebitis was 100%
(21/21) in the control group and only 9.5% (2/21) in the study group (p<0.0001). The
severity of peripheral thrombophlebitis was also less in the study group compared with
12
that in the control group. Day-wise correlation of the incidence of peripheral
thrombophlebitis showed that 82.6% of the episodes of peripheral thrombophlebitis
occurred on day 3.15
A study was conducted to compare the rates of phlebitis of peripheral intravenous
lines left in place for 72 hours versus rates of those left in place 96 hours. Design was a
prospective, nonrandomized study. Setting was a university teaching hospital with 375
beds. Results were a total of 2503 peripheral lines were evaluable. The overall phlebitis
rate was 6.8%. It was estimated that in 1 month approximately 300 intravenous lines
potentially could be prolonged beyond 72 hours; 215 lines were changed at 72 hours
despite no signs of inflammation, 61 lines were kept till 96 hours, and 19 lines were kept
beyond 96 hours. Conclusion of the study was Phlebitis rate for our peripheral
intravenous catheters at 96 hours was not significantly different from that at 72 hours.16
A Randomized Controlled Trial on factors Affecting Complications and Patency
of peripheral IVs.This sample was composed of 88 patients, from neonates to 12-year-
olds, on whom a total of 377 catheters were started. Intravenous cannulations were
randomized for heparin flushes (1:100 dilutions) and splints. Prospective data was
collected regarding duration of patency and complications. Both univariate and
multivariate analysis were done. There was a statistically significant increase in the
duration of patency with the use of heparin flushes and splints. Shorter patency duration
and increased complications were associated with younger age, wrist and scalp insertions,
and 24-gauge catheters.17
A study was conducted on two groups of patients received one of two
intravenous catheters, a 20-gauge Criticon (C group;n=96) or a 20-gauge Vitaflon Plus
(V group;n=100).The incidence of early complications (erythema, swelling, tissue
hardness, pain) was comparable in both groups. The survival distribution curves for all
complications and swelling >2 cm were significantly longer in the V group. The
incidence of complications following cannulation was high in both groups. The period
from catheter insertion to the clinical onset of phlebitis was prolonged in both groups if
antiphlebitogenous fluids were used. The incidence of late complications (phlebitis,
displacement of the cannulae, etc.) and damage to the catheters was more frequent in the
C group. 18
13
A study was done on Relevance and complications of intravenous infusion.
Objective of the study was Insertion of peripheral venous catheters (PVCs) is current
practice within the hospital environment and particularly in the emergency department
(ED). During the study 2515 patients over 16 years of age attended the unit. Overall, 390
PVCs were followed until the time of their removal. Mean duration of IV infusion was 28
h. Among these 390 patients, 62 (15.9%) developed complications, of which 54 (13.6%)
had thrombophlebitis and 9 (2.3%) developed local infection. Conclusion of the study
was Insertion of PVC is common practice especially in EDs.19
b) Studies Related to magnesium sulphate and other topical drug therapies.
A quasi-experimental study was conducted to assess the effectiveness of the therapeutic
effect of tanshinone, magnesium sulphate and hirudoid in the treatment of infusion
phlebitis on 150 in patients with infusion phlebitis. Patients were randomly divided into
tanshinone group (n=50), hirudoid group (n=50) and magnesium sulphate group (n=50).
The therapeutic effect was assessed after 5 days treatment. The results shows the
excellence rate of 64% in tanshinone group, 36% in hirudoid group and 18% in
magnesium sulphate group, the differences was statically significant at level of p= 0.05.
The efficacy rate was 94% in tanshinone group, 80% in hirudoid group and 60% in
magnesium sulphate group, the differences was statically significant at level of p=0.001.20
A quasi experimental study was conducted to assess the effectiveness of cold
application, heparinoid application and magnesium-sulphate application on superficial
thrombophlebitis among patients in selected hospitals of Indore. Three-group pre test and
post test design was adopted for the study. 45 patients were selected using purposive
sampling and they were randomly assigned into three groups. A superficial
thrombophlebitis scale and pain intensity distress scale was used for data collection.
Following the pre-test, intervention with cold application was given to 1st experimental
group (C), for a period of twenty minute, 2nd experimental group (H) was intervened with
heparinoid application using thrombophobe ointment by gentle massage and similarly in
3rd experimental group (M), magnesium-sulphate dressing was done by dipping the gauze
in the magnesium sulphate glycerine solution and applied on superficial thrombophlebitis
three times a day for three days. The finding of the study indicated that the computed’t’
14
value of cold application group ('t'14 =14.33), heparinoid application group ('t14' =11.90)
and magnesium sulphate application group ('t'14 =20.82) were statistically significant,
which suggested that all three interventions were effective in reducing the signs and
symptoms of superficial thrombophlebitis. The computed 'F' ratio of all the three groups
('F'2.42 =10.10) showed that three types of application differ significantly. However, the
mean difference of magnesium sulphate group (18.34) was higher than the cold
application (13.33) and heparinoid application (12.8) group. This study concluded that
magnesium sulphate application is most effective intervention in reducing the superficial
thrombophlebitis.21
An interventional study was conducted in Mangalore on effectiveness of ice packs
versus thrombophobe gel for reducing intra venous infiltration in patients admitted in
paediatric wards. The study was conducted on 40 samples (20 for thrombophobe gel
group and 20 for ice cube group) selected using purposive sampling technique. The
infiltration was assessed by using modified infiltration scale. The results showed that
before the treatment, majority (65%) of patients had grade two infiltrations after the
treatment with thrombophobe and 100% of patient’s infiltration had reduced to grade one
infiltration. In group two majorities (80%) had grade two infiltrations after the treatment
with ice cube 100% had grade one infiltration. The study concluded that both
thrombophobe gel and ice pack are effective in reducing intravenous infiltration among
paediatric patients.22
A study was conducted on Anti-coagulant ointment in the prevention of post-
infusion thrombophlebitis. 169 cases were included (84 experimental, 85 control) to
study the effect of topical anticoagulant ointment. The finding was the Topical
anticoagulant ointment was effective in decreasing the incidence of thrombophlebitis if
the duration of infusion was up to 12 hours or less, the use of anticoagulant ointment
reduced the average number of days of recovery especially in moderate to severe grades
of thrombophlebitis. 23
A study was conducted on Topical heparin for the treatment of acute superficial
phlebitis secondary to indwelling intravenous catheter A double-blind, randomized,
placebo-controlled trial. Objective of the study was to assess the clinical efficacy of a
topical gel containing 1000 IU.g−1 of heparin, applied three times daily for a maximal
15
period of 7 days to patients with acute superficial phlebitis secondary to indwelling
intravenous catheter. Result of the study was, after treatment for 7 days superficial
phlebitis healed in 27 of the 61 patients (44.3%) who received topical heparin, and in 17
of the 65 patients (26.1%) receiving placebo, giving a relative risk of 1.69 (1.03–2.78).
Conclusion of the study was the topical heparin is safe and effective for the treatment of
superficial phlebitis secondary to indwelling intravenous catheter.24
A study was conducted on Topically Applied Heparins for the Treatment of
peripheral Vascular Disorders. A total of 1055 patients participated in a total of 20
studies that compared topical heparin formulations with placebo, no treatment,
subcutaneous heparin or with each other in the treatment of superficial thrombophlebitis.
In head-to-head studies comparing different topical heparin formulations, all preparations
appeared effective. Conclusion of the study was topical heparin preparations may be
useful for relieving the signs and symptoms of vascular disorders while improving
microcirculation.25
c) Studies Related To hot and cold applications.
A study was conducted on Effect of warm and cold applications on the resolution
of IV infiltrations. Differences in pain intensity, surface area measurements of
indurations and erythema, and interstitial fluid volume when warm versus cold
applications were randomly made to an intentional intravenous infiltrate of 5 mL of a
designated solution were examined. Three solutions were used: 0.5 saline (154 mOsm),
normal saline (308 mOsm), and 3% saline (1027 mOsm). The sample was 18 healthy
adults between 20 and 45 years. Pain intensity did not differ by treatment but a significant
difference was found by solution, with 3% saline producing the greatest difference.
Erythema was absent with all solutions. Study reveals that there is no significant
difference between the cold and warm application in resolution of IV infiltrations.26
A study was conducted on local warming and insertion of peripheral venous
cannulas it is a single blinded prospective randomised controlled trial and single blinded
randomised crossover trial. Objective of the study was to determine whether local
warming of the lower arm and hand facilitates peripheral venous cannulation. Setting was
Neurosurgical unit and haematology ward of university hospital participants were 100
neurosurgical patients and 40 patients with leukaemia who required chemotherapy.
16
Intervention was given was Neurosurgical patients' hands and forearms were covered for
15 minutes with a carbon fibre heating mitt. Results were In neurosurgical patients, it
took 36 seconds (95% confidence interval 31 to 40 seconds) to insert a cannula in the
active warming group and 62 (50 to 74) seconds in the passive insulation group
(P=0.002). The crossover study in patients with leukaemia showed that insertion time was
reduced by 20 seconds (8 to 32, P=0.013) with active warming and that failure rates at
first attempt were 6% with warming and 30% with passive insulation (P<0.001).
Conclusion of the study was Local warming facilitates the insertion of peripheral venous
cannulas, reducing both time and number of attempts required. This may decrease the
time staff spend inserting cannulas, reduce supply costs, and improve patient
satisfaction.27
17
Methodology flow chart
18
Research design
Quasi-experimental two groups pre test post test design
Research setting
Medical and surgical wards of selected hospitals of Amritsar, Punjab
Target population
Clients with infusion phlebitis
Sample size
The sample size for the study will be consisting of 100
Sampling technique
The purposive sampling technique
Research tool
Standardized infusion phlebitis scale
Data collection procedure
Samples will be selected purposively and randomly. Pre test and post test will be conducted by using visual infusion phlebitis scale. Selected interventions magnesium sulphate and cold applications will be provided to the group.
Data analysis
Descriptive and inferential statistics, unpaired ‘t’ test and chi square test will be used for analysis.
Chapter-III
Methodology
Research design
A quasi experimental two group pre test post test design will be adopted for the study to
evaluate the effectiveness of magnesium sulphate and cold applications on superficial
thrombophlebitis.
Research setting
This study will be conducted in Medical and surgical wards of selected hospitals of
Amritsar, Punjab.
Target population
The population of the study will be the clients who developed superficial
thrombophlebitis and having intravenous line and admitted in Medical wards of hospitals
of Amritsar, Punjab.
Sample and sampling technique:
The sample size for the study will be consisting of 60 samples those who fulfil the
inclusion criteria, 30 in magnesium sulphate group and 30 in cold application group. The
purposive sampling technique will be adopted for sampling and samples will be divided
into two groups randomly.
Inclusion and exclusion criteria:
Inclusion criteria
Clients with peripheral intravenous cannula induced phlebitis who are willing to
participate in the study.
Clients who are available during the period of data collection.
Clients who are hospitalized in medical and surgical wards.
19
Exclusion criteria
Clients with phlebitis who are having skin disorders.
Clients having open wounds.
Clients having associated vascular disorders like DVT, varicose veins etc.
Clients having hypersensitivity to magnesium sulphate
Selection and development of tool:
A standardized visual Infusion Phlebitis Scale will be selected.
Description of tool:
TOOL-1
Demographic questionnaire will be used to assess the demographic data of the
clients such as age, gender, occupation, diagnosis, purposes of intravenous
infusion, site of intravenous cannula, number of prick during the intravenous
cannulation procedure, size of peripheral intravenous cannula, types of medication
infused, period of hospital stay, and duration of peripheral intravenous cannula.
TOOL-II
Visual infusion phlebitis scale will be used to assess the severity of peripheral
intravenous cannula induced phlebitis.
Validity of tool:
Content validity will be determined by experts’ opinion.
Pilot study:
It will be conducted to find the reliability and feasibility of tool by taking 10
samples.
20
Data collection procedure:
Formal permission will be obtained from the concerned authority. Samples will be
selected purposively and randomly assigned into magnesium sulphate and cold
application group. Pre test will be conducted by using standard visual infusion
phlebitis scale. Selected interventions magnesium sulphate and cold application
will be provided to the respective groups. Post test will be conducted for the by
using the same tool after seven days of interventions.
Ethical considerations:
Approval of research/ethical clearance will be taken from research committee
of Mai Bhago College of Nursing, Tarn-Taran.
The formal permission will be taken from concerned authorities of selected
hospitals.
The written informed consent from each sample will be obtained.
Plan of data analysis
The plan of data analysis is as follow:-
The data obtained will be analysed in terms of the objective of the study using
descriptive and inferential statistics. The plan of data analysis is as follows.
Frequency and percentage distribution will be used to analyse the socio
demographic variables and severity of peripheral intravenous cannula induced
phlebitis.
Mean, mean percentage and standard deviation will be used to assess pre test and
post test severity of peripheral intravenous cannula induced phlebitis.
unpaired ‘t’ test will be used to compare pre test and post test severity of
peripheral intravenous cannula induced phlebitis of magnesium sulphate group
and cold applications group
21
Chi-square test will be used to determine association between pre test severities
of peripheral intravenous cannula induced phlebitis and selected socio
demographic variables.
22
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