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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 7  |  Issue : 1  |  Page : 22-26

Effectiveness of heparin flush and normal saline flush for the maintenance of patency of peripheral intracath line among the patients admitted to medical-surgical wards of selected hospital


1 Department of Medical Surgical Nursing, KLE University's Institute of Nursing Sciences, Belgaum, Karnataka, India
2 Department of Medical Surgical Nursing, Laxmi Memorial College of Nursing, Mangalore, Karnataka, India

Date of Web Publication2-Jul-2014

Correspondence Address:
Honnagouda Patil
Department of Medical Surgical Nursing, KLE University's Institute of Nursing Sciences, Belgaum, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2349-5006.135029

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  Abstract 

Background: Peripheral intracath line is the typical hospital I.V line put in the hand or forearm when patients are admitted to the hospital intravenous catheters represent the most common parenteral for medication administration. Maintenance of the patency of these peripheral intracath lines is important for minimizing patients discomfort and the expense associated with replacement. Keeping this in view a quasi experimental study was undertaken on effectiveness of Heparin flush and Normal Saline flush for the maintenance of patency peripheral intracath line among the patients admitted to medical surgical wards of selected hospital.
Materials and Methods: An experimental research approach with quasi experimental design with multiple measures was used for the study.
Results: The study was carried out in medical and surgical wards of A J Hospital and Research Centre, Mangalore. The sample comprised of patients between the age group of 20-60 years. Samples were selected by purposive sampling technique. The Study findings revealed that in Group I (Experimental group) the mean patency scores of 72 hours (Post test 6) were 1.50 ± 0.51, 1.50, whereas mean scores of before intervention (pre test) was 1 ± 0, 1 respectively. In Group II (Control group) the mean patency scores of 72 hours (Post test 4) were 1.90 ± 0.55, 2, whereas mean patency scores of before intervention (pre test) was 1 ± 0, 1 respectively. It was found that there was no significant difference in patency sores of peripheral intracath line in Group I (F (5, 114) = 1.46, P < 0.05) and Group II (F (5, 114) = 2.10, P < 0.05) at different timings. This suggests that patency scores were same at different timings in both groups for 72 hours. There was no significant difference in patency scores of back flow, flow rate, resistance, infiltration, extravasation, and phlebitis between the Group I and Group II (t38 = 2.02, P < 0.05) at different timings. Thus it was inferred that patency of peripheral intracath line was maintained in the both Group I (Experimental group) and Group II (Control group) for 72 hours. Both heparin flush and normal saline flush were effective in the maintenance of patency of peripheral intracath line.

Keywords: Effectiveness, patency of peripheral intracath line, heparin flush, normal saline flush


How to cite this article:
Patil H, Sams LM. Effectiveness of heparin flush and normal saline flush for the maintenance of patency of peripheral intracath line among the patients admitted to medical-surgical wards of selected hospital. Indian J Health Sci Biomed Res 2014;7:22-6

How to cite this URL:
Patil H, Sams LM. Effectiveness of heparin flush and normal saline flush for the maintenance of patency of peripheral intracath line among the patients admitted to medical-surgical wards of selected hospital. Indian J Health Sci Biomed Res [serial online] 2014 [cited 2019 Apr 22];7:22-6. Available from: http://www.ijournalhs.org/text.asp?2014/7/1/22/135029


  Introduction Top


Over 85% of patients admitted to hospital require a peripheral intravenous (IV) catheter in order to provide access for administration of drugs, fluids and parental nutrition.

In addition, many critically ill patients require arterial catheterization for hemodynamic monitoring and blood sampling. Once the IV catheter is inserted its patency has to be maintained as long as possible. Maintenance of the patency of IV catheters in a peripheral vein is important for minimizing patient's discomfort and the expense associated with replacement. Infiltration, extravasation, phlebitis, and infection related to the catheter are complications associated with the use of peripheral IV catheters. [1] Peripheral IV catheters are maintained by periodic flushing with a heparin saline solution. Different concentrations of heparin are used to maintain patency if peripheral IV catheter and to prevent clotting of blood without alteration of systemic clotting factors.

Parenteral administration of medications is a common nursing procedure. Nurses give parenteral medications intradermally, subcutaneously, intramuscularly, or intravenously. Because these medications are absorbed more quickly than oral medications and are irretrievable once injected, the nurse must prepare and administer them carefully and accurately. IV medications enter the blood stream directly by path (way) of vein, they are appropriate when a rapid effect is required. This route is also suitable when medications are too irritating to tissue to be given by other routes and desirable because it avoids the discomfort of other parental routes when IV line is already established. Following are methods to administer medications intravenously: Large-volume infusion of IV fluids, intermittent IV infusions, volume-controlled infusion (often used for children), IV push or bolus, intermittent injections ports (device). [2]

Intravenous therapy' or "IV therapy" is the giving of liquid substances directly into a vein. It can be intermittent or continuous; continuous administration is called an "IV drip." The word "IV" simply means "within a vein," but is most commonly used to refer to IV therapy. Therapies administered intravenously are often called "specialty pharmaceuticals." Compared with other routes of administration, the IV route is the fastest ways to deliver fluids and medications throughout the body. Some medications, as well as blood transfusions and lethal injections, can only be given intravenously. IV therapy may be administered for short-or long-term purposes. Short-term IV therapy can be given through veins that are smaller and very close to the skin surface (peripheral veins), such as in the hand, arm, leg, or foot. Long-term IV therapy is generally given through larger, deeper veins (central veins). [3] The problems associated with the peripheral IV catheter, such as kinking or other occlusion of the catheter itself, or developing a clot or an infection at the venous insertion site (phlebitis). The catheter may become dislodged from the vein, allowing medication and fluid to infuse into subcutaneous tissue (infiltration or extravasation), or air may be introduced into the vein (air embolism). [3] When a cannula is introduced into a vein, the traumatized tissues release chemicals in response to the injury. Among these histamines which dilate the vein and surrounding vessels increasing blood flow to the area. It also increases the permeability of the vessel wall enabling fluid and proteins to migrate to the area from the surrounding tissues. Collectively this causes complications like infiltration, extravasation, and phlebitis. About 4.0-60% of the patients develops infiltration and extravasation, [4] and about 2.3-67% of the patients develops phlebitis. [5] The risk of infiltration may be as much as 70% greater with a steel needle than with a plastic catheter, depending on the skill of the person performing the veni puncture and the compliance of the patient. [6] When trauma is caused to the vessel wall platelets adhere to the point of inflammation in the vessel lumen, forming a plug through which fibrin strands develop with the conversion of fibrinogen to fibrin. Blood cells are trapped in this structure forming the thrombus eventually leads to thrombophlebitis. [4]


  Materials and Methods Top


Quasi-experimental, with multiple measures" was selected to assess the patency of peripheral intracath line after heparin flush and Normal saline flush every 12 hourly among the patients admitted to medical-surgical wards. The independent variables of the study are heparin flush and Normal Saline flush and the dependent variable is patency of peripheral intracath line. The study was conducted on 40 hospitalized subjects who have peripheral intracath line for 3 days in medical-surgical wards, at selected hospital, Mangalore. Purposive sampling technique was used to collect the data. The observation check list was used as an instrument for the data collection on patency of peripheral intracathline includes items such as back flow of blood, flow rate, resistance, infiltration, extravasation, and phlebitis. Infiltration and phlebitis are measured by infiltration scale and phlebitis scale. The data collection tool was submitted to six nursing experts from Department of Medical Surgical Nursing, two intensivists, and one statistian with the demographic proforma and observation check list to establish the content validity. The data obtained was tabulated and analyzed in terms of objectives of the study using descriptive and inferential statistics.


  Results Top


The findings of the study were organized under the following headings:

Distribution of the sample according to frequency and percentage [Figure 1]
Figure 1: Frequency and percentage distribution of patients according to factors affecting patency of intracath line

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Frequency and percentage distribution of patients according to demographic characteristics

Highest percentage (40%) of the patients in Group I was between the age group of 41-50 years, whereas in Group II, the highest percentage (30%) of patients was in the age group of 21-30 years. Majority of patients in the Group I (55%) and Group II (65%) were males. The highest percentage (40%) of patients weight in the Group I was between the 41 and 50 kg, whereas in Group II highest (35%) number of the patients weight was between the 51 and 60 kg. Majority of patients length of therapy in Group I (60%) and in Group II (65%) was >3 days, whereas the majority of the patients type of therapy in Group I (60%) and in Group II (70%) was medical. Majority of patients diagnosis in Group I (60%) and Group II (70%) was medical. Majority of patients diagnosis in Group I (60%) and Group II (70%) was medical. Majority (90%) of patients purpose of IV therapy in Groups I and II was IV fluids and medications. Maximum of patients temperature in Group I (45%) and Group II (50%) was 98.6°F. Highest percentage of patients pulse rate in Group I (45%) and Group II (60%) was 70-80/mt. Maximum percentage (45%) of patients respiration rate in Groups I and II was <20/mt, whereas patients blood pressure in Group I (50%) and Group II (40%) was 120/80 mmHg.

Frequency and percentage distribution of patients according to factors affecting patency of intracath line

Majority of patients cannula gauge in Group I (60%) and Group II (85%) was 20 and length of cannula was 1.26 inch, whereas majority (55%) of patient's site of cannula insertion in Groups I and II was dorsal. Majority of the patients in Group I (75%) and Group II (70%) were administered antibiotics, whereas 50% of patients frequency of flush/drug administered was 12 h. In the Groups I and II all the patients veins were not used previously for IV cannulation.

Findings of patency of peripheral inracath line in Group I (heparin flush)

In Group I, the mean scores of 72 h (posttest 6) were 1.50 ± 0.51, 1.50, whereas mean scores of before intervention (pretest) were 1 ± 0, 1, respectively. To find out the significance of difference in mean patency scores ANOVA is computed. The calculated F value of patency scores of peripheral intracath line in Group I was less than the tabled value (F (5,114) = 2.29, P < 0.05). This shows that there is no significant difference in patency sores of peripheral intracath line at different timings in Group I. Suggesting that patency level is same before and after several time after heparin flush.

Findings on patency of peripheral inracath line in Group II (normal saline flush)

In Group II, the mean scores of 72 h (posttest 6) were 1.90 ± 0.55, 2, whereas mean scores of before intervention (pretest) were 1 ± 0, 1, respectively. In order to find the effectiveness of Normal saline flush to maintain the patency of peripheral intracathe line at different timings ANOVA is computed. The calculated F-value of patency scores of peripheral intracath line in Group II was less than the tabled value

(F (5,114) = 2.29, P < 0.05). This shows that there is no significant difference in patency sores of peripheral intracath line at different timings, suggests that patency scores were same at different timings.

Comparing the patency scores of characteristics of patency of peripheral intracath line at different timings between the Groups I and II

Data presented in [Table 1] shows that the calculated t-values of back flow at 1, 6, 12, 24, 48, and 72 h was 0, 0.46, 1.43, 1.79, 1.04, and 0.71; resistance was 1.46, 1.37, 0.77, 0.77, 1.37 and 0.96, respectively, whereas extravasation was one and infiltration was 1.45 at 72 h respectively. All the calculated t-values were less than the tabled value (t38 = 2.02, P < 0.05). This suggest that there is no significant difference in patency scores of back flow, flow rate, resistance, infiltration, extravasation, and phlebitis between the Groups I and II at different timings.
Table 1: Independent t-values of characteristics of patency of peripheral intracath line at different timings between Groups I and II (n=40)

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Comparing the patency of peripheral intracath line among the Groups I and II

The calculated t-values of 1, 6, 12, 24, 48, and 72 h of Groups I and II were less than tabled value (t38 = 2.02, P < 0.05) [Table 2].
Table 2: Median, SD, mean difference, and t-value patency of peripheral intracath line between Groups I and II (n=20+20=40)

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  Association of selected demographic variables with the patency of peripheral intracath lines Top


To test the significant association between the patency of peripheral intracath line and demographic variables Chi-square test was computed to test the association. There was a significant association between purpose of therapy (χ2 (5.991) = 15.35, P < 0.05), gauge (χ2 (3.841) = 8.10, P < 0.05), length of cannula (χ2 (3.841) = 14.40, P < 0.05), site of cannula insertion (χ2 (5.991) = 9.05, P < 0.05), drug administered (χ2 (3.841) = 8.10, P < 0.05) and patency of peripheral intracath line.


  Discussion Top


The results of the study showed that in Group I, maximum percentage (40%) of patients was between the age group of 41 and 50 years, in Group II 30% of patients were between the 21 and 30 years, and the majority of patients in Group I (55%) and Group II (65%) were males. The highest percentage (40%) of the patients weight in the Group I was between the 41 and 50 kg, whereas in Group II (35%) were between the 51 and 60 kg. Majority of the patients length of therapy in Group I (60%) and Group II (65%) was >3 days, whereas type of therapy and diagnosis in Group I (60%) and in Group II (70%) was medical. Majority (90%) of the patients purpose of therapy in Groups I and II was IV fluids and medications. Maximum percentage of the patients temperature in Group I (45%) and in Group II (50%) was 98.6°F. Highest percentage of patients pulse rate In Group I (45%) and Group II (60%) was 70-80/mt. Maximum percentage (45%) of patients respiration rate in Groups I and II was <20/mt, whereas patients blood pressure in Group I (50%) and Group II (40%) was 120/80 mmHg.

Majority of patients cannula gauge in Group I (60%) and Group II (85%) was 20, and length of cannula was 1.26 inch, whereas majority (55%) of patients site of cannula insertion was dorsal. Majority of the patients in Group I (75%) and Group II (70%) were administered antibiotics, whereas 50% of patients frequency of flush/drug administered was 12 h, and in Groups I and II all the patients vein was not used previously for IV cannulation.

In Group I the mean patency scores of 72 h (posttest 6) were 1.50 ± 0.51, 1.50, whereas mean scores of before intervention (pretest) was 1 ± 0, 1 respectively. And Group II the mean patency scores of 72 h (posttest 4) were 1.90 ± 0.55, 2, whereas mean payency scores of before intervention (pretest) was 1 ± 0, 1 respectively. It was found that there was no significant difference in patency sores of peripheral intracath line in Group I (F (5,114) = 1.46, P < 0.05) and Group II (F (5,114) = 2.10, P < 0.05) at different timings. This suggests that patency scores were same at different timings in both groups for 72 h.

There was no significant difference in patency scores of back flow, flow rate, resistance, infiltration, extravasation, and phlebitis between the Groups I and II (t38 = 2.02, P < 0.05) at different timings.

It was found that there was no significant difference in mean patency sores of peripheral intracath line of patients between the Groups I and II (t38 = 2.02, P < 0.05).

The association of patency of peripheral intracath line with demographic variables showed that there was a significant association found between purpose of therapy, gauge, length of cannula, site of cannula insertion, and drug administered (P > 0.05).

These findings of the study are also supported by a study was conducted on the effect of heparin versus normal saline for maintenance of peripheral IV locks in 73 pregnant women of which 35 in normal saline group and 38 in the heparin group between 24 and 42 weeks of gestation, hospitalized in the obstetric units. Groups were similar for maternal age, gravidity and parity. The original intent of the study was to measure and compare the outcomes in the two groups within 12, 24, 48 and 72 h. However, assessments of IV lock status were rare beyond 12 h, generally because of the initiation of fluid infusion. Because there were insufficient data to make comparisons in the 24, 48 and 72 h groups, only the assessments within 12 h for patency are reported. The result showed that of the 35 IV locks flushed with saline, 68.6% had no obstruction within 12 h, when compared to no obstruction within 12 h in 76.3% of the IV locks flushed with heparin (n = 38). This difference in patency was not significant as shown by P = 0.459. And it was concluded that there were no statistically significant differences in IV lock patency nor in phlebitis between heparin and normal saline flushes. [7]


  Conclusion Top


From the finding of the study it can be concluded that patency of peripheral intracath line was maintained in the both Group I (experimental group) and Group II (control group) for 72 h. Both heparin flush and normal saline flush were effective in the maintenance of patency of peripheral intracath line.

 
  References Top

1.Shinozaki T, Deane RS, Mazuzan JE Jr, Hamel AJ, Hazelton D. Bacterial contamination of arterial lines. A prospective study. JAMA 1983;249:223-5.  Back to cited text no. 1
[PUBMED]    
2.McAllister CC, Lenaghan PA, Tosone NC. Changing from heparin to saline flush solutions: a research utilization model for implementation. J Emerg Nurs 1993;19:306-12.  Back to cited text no. 2
[PUBMED]    
3.Resources Corporation, 20 May 2005. Available from: http://www.thebody.com.   Back to cited text no. 3
    
4.Theresa Finally. Intravenous therapy. Available from: http://www.books.google.co.in.  Back to cited text no. 4
    
5.White SA. Peripheral intravenous therapy-related phlebitis rates in an adult population. J Intraven Nurs 2001;24:19-24.  Back to cited text no. 5
[PUBMED]    
6.Benvenuto DB, Guenter P. I.V Therapy Made Incredibly Easy. Springhouse Corporation; 1998. p. 88.  Back to cited text no. 6
    
7.Niesen KM, Harris DY, Parkin LS, Henn LT. The effects of heparin versus normal saline for maintenance of peripheral intravenous locks in pregnant women. J Obstet Gynecol Neonatal Nurs 2003;32:503-8.  Back to cited text no. 7
    


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