Aswi Editted Copy Project

EFFECTIVENESS OF NURSING INTERVENTION ON
PREVENTION OF INTRAVENOUS THERAPY RELATED

COMPLICATIONS AMONG NEONATES ADMITTED IN NICU AT
SMVMCH PUDUCHERRY.
BY
ASWINI. S
Dissertation submitted to the Pondicherry University, Pondicherry in

Partial fulfillment of requirement for the degree of
Master of Science in Nursing
Under the guidance of
Mrs .SARASWATHI.L. Msc, NURSING
HOD (cum) Professor

Department of Child Health Nursing
SRI MANAKULA VINAYAGAR NURSING COLLEGE,
KALITHEERTHALKUPPAM,PUDUCHERRY
July 2014
A STUDY TO EVALUATE THE EFFECTIVENESS OF NURSING
INTERVENTION ON PREVENTION OF INTRAVENOUS
THERAPY RELATED COMPLICATIONS AMONG NEONATES
ADMITTED IN NICU AT SMVMCH PUDUCHERRY.
NAME OF THE CANDIDATE : ASWINI.S
REGISTER NUMBER : 12MSN302
NAME OF THE GUIDE :Mrs.L.SARASWATHI, MSC(N)
Head of the Department
NAME OF THE CO-GUIDE :Mrs.D.VASANTHAKUMARI, MSC(N)

Lecturer
DEPARTMENT : CHILD HEALTH NURSING
Signature of the Signature of the

Internal Examiner External Examiner
Date: Date:
i
A STUDY TO EVALUATE THE EFFECTIVENESS OF NURSING
INTERVENTION ON PREVENTION OF INTRAVENOUS
THERAPY RELATED COMPLICATIONS AMONG NEONATES
ADMITTED IN NICU AT SMVMCH PUDUCHERRY.
Approved By Dissertation Committee in July 2014
PROFESSOR IN NURSING RESEARCH:
DR.R. DANASU, M.Sc. (N) MA (Socio), M.Phil., Ph.D.(N)
Principal, College of Nursing
Sri ManakulaVinayagar Nursing College,

Kalitheerthalkuppam,
Puducherry
PROFESSOR IN CLINICAL SPECIALITY AND GUIDE:
Mrs.L, SARASWATHI. M.Sc. (N),
Head of the Department,

Child Health Nursing,
Kalitheerthalkuppam,
Puducherry.
A DISSERTATION SUBMITTED TO THE PONDICHERRY

UNIVERSITY, PUDUCHERRY IN PARTIAL FULFILMENT OF
REQUIREMENT FOR THE DEGREE OF MASTER OF SCIENCE
IN NURSING
JULY 2014
ii
KALITHEERTHALKUPPAM,
PUDUCHERRY
ENDORSEMENT BY THE PRINCIPAL/ HEAD OF THE

INSTITUTION
This is to certify that the dissertation titled “ASTUDY TO

EVALUATE THE EFECTIVENESS OF NURSING INTERVENTION ON
SMVMCH PUDUCHERRY.”Is a bonafide research work done by
MS.ASWINI.Sunder the guidance of Dr.R.DANASU, Principal
SriManakulaVinayagar Nursing College, Kalitheerthalkuppam, Puducherry.
SIGNATURE OF HEAD OF THE INSTITUTION
DR.R. DANASU, M.Sc. (N) MA (Socio), M.Phil., Ph.D.(N)

PRINCIPAL,
PUDUCHERRY.
DATE:
PLACE: Puducherry.
iii
PUDUCHERRY
CERTIFICATION BY THE GUIDE
This is to certify that the dissertation titled “A STUDY TO EVALUATE
THE EFFECTIVENESS OF NURSING INTERVENTION ON
SMVMCH PUDUCHERRY” in partial fulfillment of the requirement for the
degree of Master of science in Nursing in Child Health Nursing.
SIGNATURE OF THE GUIDE
MRS.L.SARASWATHI
HODCHILD HEALTH NURSING,
PUDUCHERRY.
DATE:
PLACE: Puducherry
iv
PONDICHERRY UNIVERSITY, PUDUCHERRY
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation/thesis titled “A STUDY TO
EVALUATE THE EFFECTIVENESS OF NURSING INTERVENTION
ON PREVENTION OF INTRAVENOUS THERAPY RELATED
SMVMCH PUDUCHERRY.” is a bonafide and genuine research work carried
out by me under the guidance of Dr.R. DANASU, Principal Sri Manakula
Vinayagar Nursing College, Kalitheerthalkuppam, Puducherry.
SIGNATURE OF THE CANDIDATE
Miss. ASWINI.S
DATE:
PLACE: Puducherry.
v
COPYRIGHT
DECLARATION BY THE CANDIDATE
I hereby declare that the Pondicherry University, Puducherry shall have
the rights to preserve, use and disseminate this dissertation/ thesis in print or
electronic format for academic/ research purpose.
SIGNATURE OF THE CANDIDATE
Miss. ASWINI.S
DATE:
PLACE: Puducherry.
vi
ACKNOWLEDGEMENT
I extremely thankful to the Sri Manakula Vinayagar Medical College and
Hospital for giving me an opportunity to accomplish this project work in their
esteemed Institution.
I am grateful to Shri.N.Kesavan, (Late)former Chairman and founder
of Sri ManakulaVinayagar educational trust, for the facilities offered in this
Institution.
I express my appreciation to Shri. M.Dhanasekaran, chairman cum
Managing Director, who extended the opportunity for this endeavor.
I wish to extend my heartfelt thanks to Shri.S.V.Sugumaran,Vice
chairman , Sri Manakula Vinayagar educational trust for his support.
I express my sincere thanks and heartiest gratitude to principal
Dr.R. Danasu, Principal, of Sri ManakulaVinayagar Nursing College, for lay
the foundation of the project and her direction and support given to me which
helped me to accomplish this study.
It is my great pleasure and privilege to express my deep sense of gratitude
to my esteemed guide Mrs.L.Saraswathi,HOD in child health
nursing,Mrs.D.Vasanthakumari, and Miss.P.Suganyasweetlin, lecturer in
child health nursing and Mrs.R.Sridevi, Department of Medical Surgical
Nursing for their consistent guidance, highly interactive suggestions, precious
advice, inspiration and encouragement.
vii
I would like to extend my hearty thank to pediatrics HOD
Mr.Ragavendiran, Mr.Chandankumarshaw for given permission to
conducted the study in successful manner in NICU and also express my lovable
thanks to Staff nurses, Mother of neonates for this valuable support.
I would like to thank all our Lecturer and Assistants Lecturer for their
guidance and support.
I would like to thank all my Lecturers and Assistants Lecturers for their
guidance and support. I extent my sincere thanks to Mr.Mani.V, Dept of
Biostatistics, Meenatchi Medical Mission Hospital, Madurai for his valuable
suggestions to do this research successfully.
I also wish to extend my thanks to Mrs.D.VIJI, Lecturer, in
krishnaswamy arts and science college cuddalore, for her interactive
suggestions regarding grammar and spelling checking in this study.
I am deeply indebted to the subjects for their kind co-operation for
without them the study could not have been done.
A special thanks to our classmates and friends for their support in times of
need, and those who helped me directly or indirectly towards the completion of
the study.
viii
I extended my heartfelt thanks to the librarians, office staff, computer
operators, printers and binders for their help in converting this manuscript into
printed matter.
SIGNATURE
Miss.ASWINI.S
DATE:
PLACE:
ix
ABSTRACT
INTRODUCTION
“An ounce of prevention is better than a pound cure”
Nurses who are able to plan and carry out nursing care with knowledge,
skill and confidence are better ambassadors for their specialty. Nurses practice
within a changing and evolving health care environment and therefore they are
required to develop their knowledge, skill and attitude. Nurses’ practice is
supported by knowledge that is continuously evolving and therefore must use the
best available evidence to guide their practice. Nurses who are performing
intravenous annulations will be competent practitioners in the expanded area of
practice and therefore will deliver a more responsive timely service that will
improve the patient’s journey within the health services.
To facilitate holistic and timely treatment for neonates, nurses
increasingly need to develop their competence in inserting intravenous cannula.
For nurses working with children and young people, this is usually regarded as
an expanded role. Before starting programmers of education and training, in
most cases practitioners will need to demonstrate competence and experience in
venipuncture and administering medicines intravenously to children and young
people. Intravenous infusion of fluids has become widely used as a therapeutic
modality in the care of neonates.
The nurse has the important role and responsibility in monitoring this
type of therapy. All nurses are likely to be responsible for the administration and
x
management of some form of intravenous therapy. The important responsibility
of the nurse is to protect the child from infection during the intravenous infusion.
Infiltration of fluid is common in children nurse has to make sure that the needle
is in place and patent in the basis of scientific principle the protocol using
evidence based resources .
STATEMENT OF THE PROBLEM
“A study to evaluate the effectiveness of nursing intervention on prevention
of intravenous therapy related complications among neonates admitted in NICU
at SMVMCH, puducherry.”
OBJECTIVES OF THE STUDY
 To prepare a standardized protocol for nursing intervention on prevention
of intravenous therapy related complications among neonates.
 To evaluate the effectiveness of standardized protocol for nursing
intervention on prevention of intravenous therapy related complications
among neonates.
 To associate the effectiveness of standardized protocol for nursing
among neonates with their selected demographic variable.
xi
HYPOTHESES:
1. H1-there will be a significant relationship between the standardized
protocol for nursing intervention and intravenous therapy related
complications among neonates.
2. H2- there will be a significant association between the effectiveness of
nursing intervention on prevention of intravenous therapy related
complications among neonates with their selected demographic variable.
CONCEPTUAL FRAMEWORK:
 The conceptual framework for the study was based on Lydia Hall, Core,
Care, Cure, theory, 1960.
METHODOLOGY:
The design adopted was pre experimental one group post-test only design.
The main study was conducted in SMVMC Hospital, Puducherry. The period of
data collection was six weeks. Totally 60 Neonates were selected by using
convenient sampling technique. Standardized protocol for intravenous therapy
administration among Neonates to assess the level of complications with
Modified visual infusion complications scale score.
The gathered data analyzed by using descriptive and inferential statistical
method and interpretations was made on the basis of the objectives of the study.
xii
RESULT OF THE STUDY:
The major findings of the study were;
The post test assessment of intravenous therapy related complications
based on standardized protocol reveals that distribution of level of complications
44 neonates (73.33%) had no complications of intravenous therapy, 16 neonates
(26.67%) had mild level of complications of intravenous therapy and no
neonates are affected with moderate and sever complications.
The over all mean value is 10.47% and SD level of 0.947 there is
association at 1% level of significant of post test level of complications with
selected demographic variable, such as age in day, sex, term of birth, weight of
baby, duration of intravenous therapy, intravenous injection with and without
antibiotic. It shows that highly significa433nt.
RECOMMENDATIONS
Based on findings of the present study, the following recommendations have
been made,
 Similar study can be conducted in other areas with a large sample.
 The same study can be conducted in different settings.
 The same study can be conducted with true experimental research
design.
 The study can be replicated with larger samples for better
generalization.
xiii
 The study can be done as a longitudinal study.
 The study can be replicated with bio-physical parameters.
 A comparative study can be conducted between pharmacological and
non pharmacological intervention.
 The standardized protocol should be used for the adult also.
CONCLUSION:
The study was conducted among60 neonates to find the effectiveness of
standardized protocol for nursing intervention on intravenous therapy related
complications at puducherry. The result shows there is 44 neonates did not
develop no complications, 16 neonates have mild complications and no neonates
are affected with moderate and sever complications. So the standardized protocol
is effectiveness there is association of selected demographic variable like, Age in
days, sex, term of birth, weight of baby, duration of intravenous therapy,
intravenous injection with and without antibiotic. It shows that highly significant
with post test score of level of complications.
xiv
TABLE OF CONTENTS
CHAPTER CONTENT PAGE NO.

I INTRODUCTION 1-4
 Need for the study 5-9
 Statement of the problem 10
 Objectives of the study 10
 Assumptions 10
 Hypothesis 11
 Operational definitions 11
 Delimitations 12
II REVIEW OF LITERATURE 13-20
 conceptual framework 21-23
III RESEARCH METHODOLOGY 24
 Research Approach 24
 Research Design
24-25
 Population
26
 Setting of the study
26
 Sample
 Sample size
26
 Sampling technique 26
 Criteria for sample selection 27
- Inclusion criteria 27
- Exclusion criteria 27
 Study variables
27-28
 Development and description of data
29
collection tool
29
 Content Validity
 Reliability 29
 Pilot Study 30
 Data collection procedure 31
 Plan for data analysis
xv
IV DATA ANALYSIS AND INTERPRETATION 2 34-47
V DISCUSSION, SUMMARY, CONCLUSION,
NURSING IMPLICATIONS, AND 48-58
RECOMMENDATIONS
 Discussion
 Summary
 Conclusion
 Nursing Implication
 Limitations
 Recommendations
BIBLIOGRAPHY 59-61
APPENDICES 62-91
xvi
LIST OF TABLES
TABLE TABLE NAME PAGE
NO. NO.
1. Distribution of selected demographic variable of neonates 35
2. Distribution of mean, SD post test scores of standardized 43
protocol among neonates.
3. Distribution of level of complications related to intravenous 44
therapy for neonates.
4. Association between the levels of complications of intravenous 46
therapy among neonates with selected demographic variable.
xvii
LIST OF FIGURES
FIGURES FIGURE NAME PAGE NO.
1. Conceptual frame work 23
2. Schematic representation of research design 25
3. Relationship of the variables 28
4. Distribution of term of birth of neonates 38
5. Distribution of duration of intravenous cannula of 40

neonates.
6. Distribution of site of intravenous cannula of 41

neonates.
7. Distribution of intravenous injection with antibiotic 42

and without antibiotic of neonates.
8. Distribution of level of complications related to 45

intravenous therapy among neonates.
xviii
LIST OF APPENDICES
APPENDIX
NO. CONTENT
Tool:
Section A:Demographic data
I Section B:Modified visual infusion complications score scale
Section C: Observational Check list for staff nurse
II Letter seeking permission for conducting the study
III List of experts
IV Letter for validation of tool
V Certificate for English Editing
VI
Informant consent
VIII Schedule for data collection
IX Intravenous protocol modules
X Data Collection Photos
xix
CHAPTER-I
INTRODUCTION
“An ounce of prevention is better than a pound cure”
Medication administration is a basic nursing function that involves skillful
techniques and consideration of children’s development, health status and safety.
The nurse needs knowledge base about drugs including drug name, preparation,
classification, adverse effect and physiologic factors that affect the drug action.
Among all method of drug administration, intravenous administration of fluids,
drugs and nutrition is very common in hospital.
Intravenous infusion of fluids has become widely used as a therapeutic
modality in the care of neonates. The nurse has the important role and
responsibility in monitoring this type of therapy. Intravenous therapy is the
quickest and most effective means of administering fluid or medicine to the ill
neonates, infant and child, as much as, is a relative common pediatric therapy.
Intravenous fluid may be infused into a peripheral vein, a central access device,
or a peripherally inserted central catheter. It is necessary to understand the
principles of intravenous therapy, including the fluid and caloric needs of the
child to act as a second level of protection against over hydration or under
hydration during intravenous fluid therapy.
WHO (2009) estimated about India’s neonatal intravenous
complications African journal of health and sciences (2008).A study was
conducted on peripheral intravenous catheter complications in critically ill
children. Six hundred fifty-four peripheral intravenous catheters in 303 pediatric
intensive care unit patients were examined to determine complications rates and
1
associated risk factors. Phlebitis13%, extravasation 28%, and bacterial
colonization11%, sepsis occurred respectively. Replacing catheters in critically
ill children every 72 hours would not decrease phlebitis, bacterial colonization,
or catheter-induced sepsis and could increase extravasations risk. Catheters can
be safely maintained with adequate monitoring for up to 144 hours in critically
ill children.
Journal report on United Kingdom health and sciences (2004).
Neonatal Intensive Care Unit (NICU) will undergo the insertion of a peripheral
intravenous therapy is routine, Common injuries observed in the NICU include
cellulites, infection, necrosis, scarring, nerve damage, and permanent
contractures. The incidence of extravasation injury resulting in skin necrosis to
be approximately 4%, with 70% of such injuries occurring in infants. The study
report shows that children with intravenous cannula for more than 72 hours are
more prone or vulnerable to develop intravenous cannulation with related
complication such as infection, burning sensation, redness, swelling, phlebitis
etc.
Nosocomial infection associated with intravenous therapy area major
concern in today’s medical care. There are two major sources of blood stream
infection associated with any intravascular devices: colonization of the devices
itself and contamination of the fluid administered through devices.
For most intravenous infusion in neonates, an over-the-needle 24 –gauge
catheter may be used if therapy is expected to last less than 5 days. The length of
2
the catheter may be directly related to infection and embolus formation. The
shorter the catheter, the fewer the complications. Determining the best catheter
for the patient early in the therapy provides the best chance of avoiding catheter
related complications.
Infiltration and extravasations of intravenous fluid is a complications of
neonatal intensive care that results in varying degree of morbidity. If
extravasations are next to a major artery in the forearm or leg, vascular flow can
be obstructed and amputation required. The severity of damage depends on the
volume and type of the fluid in filtered. Infiltration is the most common
complication of peripheral intravenous therapy. Complication rates of
intravenous infiltration range from 0 to 78 percent. Intravenous extravasations
are estimated to occur in 11 percent of NICU patients, with tissue sloughing
occurring in 43.6 percent of those infants. Common site of extravasations include
the dorsum of the hands, the anticubital fosse and the ankle. Serious
extravasations can result in pain, infection, disfigurement, prolonged
hospitalization, increased hospital costs and possible litigation.
The risk factors of intravenous related complications with 40 neonates. By
using observation check list the signs & symptoms were assessed which reveals
that, the type of infusion, duration of cannulation more than 3 days (50%), IV
antibiotics (12%), female sex(12%), catheter material PEO - vialon and Teflon
(6%), anatomic site - forearm related (12%) and wrist(8%).
3
An article on prevention of infection in peripheral intravenous devices
stated that the possible uses of the catheters that are available in different sizes.
14-16G are used for major trauma/surgery, epidural, massive fluid replacement.
18G for routine blood transfusions, rapid infusion, 20G for routine infusions,
bolus drug administration, 22G for small, fragile veins, short-term access and
24G for small, fragile veins.
The main advantages of using Intravenous cannula are, it allows volumes
of fluids, medications, colloids, blood products, Parental nutrition and
chemotherapy.
A group of complications can occur after peripheral intravenous therapy
and arterial vascular cannulation. The main reason for complications is
inappropriate use and poor technique which is followed by health professionals.
Some of the important complications are infection, phlebitis, Thrombophlebitis,
infiltration, Hematoma, nerve damage, fluid overload, electrolyte imbalance,
embolism and extravasations.
As Intravenous Cannula is common and routine procedure for children ,
nurses responsibility in taking care of these children begins with preparing the
material, selecting the vein, selecting proper gauzed catheter, cleaning and
disinfecting the area, insertion of catheters, placement of catheter, restoring
intravenous therapy and safe withdrawing of inserted intravenous catheter.
4
NEED FOR THE STUDY
The requirements for fluids and electrolytes of the newborn are unique. At
birth, there is an excess of extra-cellular water, and this decreases. Over the first
few days after birth Furthermore, extracellular water at birth and insensible
water loss decrease as birth weight and gestational age increase. Several days
after birth, fluid and electrolyte requirements increase as the infant starts to grow.
Fluid therapy may be required in a wide verity of clinical situation to
correct fluid and electrolyte imbalances, administer medications, administration
blood products and nutrients.
Clinical conditions requiring fluid therapy includes continuous gastro
intestinal fluid losses in vomiting, diarrhea, nasogastric tube aspiration,
colostomy, burn injury, diabetic ketoacidosis, pyloric stenosis and salicylate
intoxication.
Fluid, electrolyte, and nutrition management is important because most
infants in a neonatal intensive care unit require intravenous fluids and have shifts
of fluids between intracellular, extracellular, and vascular compartments.
Therefore, careful attention to fluid and electrolyte balance is essential. If
inappropriate fluids are administered, serious morbidity may result from fluid
and electrolyte imbalances. Inadequate attention to nutrition in the neonatal
period leads to growth failure, osteopenia of prematurity and other
complications.
5
WHO (2010) A study was conducted to evaluate the effect of nurse
training on the improvement of intravenous applications. Nurses were found to
have high knowledge levels, but their practices were not suitable to their
knowledge levels. Of the patients who participated in the study, 67.24% showed
symptoms of phlebitis. We found that there was a significant relationship (P <
.05) between the selection of the vein and the occurrence of phlebitis in patients
who had an intravenous catheter. We also found that the relationships between
the age groups of the patients and phlebitis and the relationships between the
diagnosis and phlebitis were statistically significant (P < .05).
An article on prevention of infection in peripheral intravenous devices
stated that the possible uses of the catheters that are available in different sizes.
14-16G are used for major trauma/surgery, epidural, massive fluid replacement.
18G for routine blood transfusions, rapid infusion, 20G for routine infusions,
bolus drug administration, 22G for small, fragile veins, short-term access and
24G for small, fragile veins.
Kagel EM, Baptist Medical Center, Oklahoma City, (2011)Worldwide conducted
study on intravenous therapy complications among neonates hand and forearm
over a 3-year period .There were 56 minor and 11 major complications. More
than 50% of minor complications occurred in the hand and wrist, and more than
50% of major complications occurred in the hand. Minor complications
comprised 26 intravenous infiltrations, 23 cases of thrombophlebitis, and 7 cases
of cellulites. Major complications included septic thrombophlebitis in 3%,
6
hematomas resulting in skin necrosis in 2%, and infiltration related
complications in 6%, resulting in skin necrosis in2%, compressive nerve lesions
in 2% digital stiffness in 1%, and compartment syndrome in1% occurring.
Jamia, Hamdard Research Hospital in India Delhi (2003) peripheral
venous catheter-associated complications were prospectively evaluated in a 2
month-study performed in 3 different hospitals. A total of 525 peripheral venous
catheters were included. Main clinical complications were erythematic (22.1%),
tenderness (21.9%), swelling or indurations (20.9%), palpable cord (2.7%) and
purulence (0.2%). Phlebitis was observed in 22%. therapy colonization occurred
in 13%.Risk factors for phlebitis were skin lesions, active infection unrelated to
peripheral venous catheter, "poor quality" peripheral vein and > 72 hour-of
intravenous therapy. The study shows that Complications associated with
peripheral venous catheters are frequent but remain benign. They could probably
be reduced by a systematic change every 72-96 hours as recommended by
different guidelines.
Rajivgandhi university of health science karnataka, (2009) serious
complications related to peripheral intravenous cannulation is uncommon, but do
occur with prolonged use. A study findings revealed that phlebitis occur most
commonly and the frequency is from 2.5 to 45% or more and the chance for
developing thrombophlebitis was between 12%-34% after 24 hours and 36-65%
after 48 hours of intravenous cannula insertion.
7
MGR university of health and science Tamil Nadu (2010).A study was
conducted on peripheral intravenous catheter complications in critically ill
children. Six hundred fifty-four peripheral intravenous catheters in 303 pediatric
intensive care unit patients were examined to determine complication rates and
associated risk factors. Phlebitis13%, extravasation 28%, and bacterial
colonization11%, sepsis occurred respectively. Replacing catheters in critically
ill children every 72 hours would not decrease phlebitis, bacterial colonization,
or catheter-induced sepsis and could increase extravasations risk. Catheters can
be safely maintained with adequate monitoring for up to 144 hours in critically
ill children.
S.Sivaram (2011) Jawaharlal Institute of Postgraduate Medical Education
and Research, Puducherry, India. conducted a study in Department of pediatric,
Peripheral venous therapy thrombophlebitis is a common complication of
intravenous cannulation, occurring in about 30% of patients. They evaluated the
effect of elective re-sitting of intravenous cannulae every 48 hours on the
incidence and severity of peripheral venous catheter in neonates receiving
intravenous fluids/drugs. Elective re-sitting of intravenous cannulae every 48
hours results in a significant reduction in the incidence and severity of peripheral
venous catheter .
Dechenla, ST Hospital, Kumbakonam (2009) A standardized prospective
survey was conducted for nosocomial infections, to determine the interplay of
factors that contribute to the risk of thrombophlebitis in peripheral intravenous
8
therapy. They studied 3094 patients with 5161 total episodes of peripheral
intravenous therapy(PIVT) from the day of admission until the day of discharge.
The results showed that the overall rate of phlebitis was 2.3% and the rate of
intravenous therapy-associated bacteremia was 0.08%. In all other
circumstances, 48-72 hours was recommended.
A study was conducted in USA,(2010) to describe the effect of nurse
experience and competence on the length of time and the number of attempts to
establish a successful intravenous placement in the hospitalized child. Data from
a convenience sample of 592 evaluable patients and 1135 venipunctures showed
that successful intravenous placements required an average of 2 venipunctures
over 28 minutes. Although nurse experience and self-rated competence were
correlated with attaining a successful intravenous placement, time of day,
predicted difficulty of the venipuncture, and cooperativeness of the child
appeared to be better predictors of success.
The risk factors of intravenous related complications with 40 patients. By
using observation check list the signs & symptoms were assessed which reveals
that, the type of infusion, duration of cannulation more than 3 days (50%),
intravenous antibiotics (12%), female sex(12%), catheter material PEO - vialon
and Teflon (6%), anatomic site - forearm related (12%) and wrist(8%).
All nurses are likely to be responsible for the administration and
management of some form of intravenous therapy. The important responsibility
of the nurse is to protect the child from infection during the intravenous infusion.
9
Infiltration of fluid is common in children nurse has to make sure that the needle
is in place and patent in the basis of scientific principle the protocol using
evidence based resources .The overall focus was on raising awareness, providing
information and educating and practicing importance of delivering intravenous
cannula care among staff nurse technique may reduce the complications, so the
investigator intended to do the study.
10
STATEMENT OF THE PROBLEM:
A study to evaluate the effectiveness of nursing intervention on
prevention of intravenous therapy related complications among neonates
admitted in NICU at SMVMCH, puducherry.
OBJECTIVES OF THE STUDY:
 To prepare a standardized protocol for nursing intervention on prevention
of intravenous therapy related complications among neonates .
 To evaluate the effectiveness of standardized protocol for nursing
among neonates.
 To associate the effectiveness of standardized protocol for nursing
among neonates with their selected demographic variable.
ASSUMPTION:
 Standardized protocol for nursing intervention may reduce the risk of
intravenous therapy related complications.
 Standardized protocol act as an effective nursing intervention in
preventing the complications of intravenous therapy.
11
HYPOTHESIS:
 H1-there will be a significant relationship between the standardized
protocol for nursing intervention and intravenous therapy related
 H2- there will be a significant association between the effectiveness of
complications among neonates with their selected demographic variable.
OPERATIONAL DEFINITION:
Evaluate: It refers to draw a conclusion of nursing intervention on
prevention of intravenous therapy related complications.
Effectiveness: It refers to the significant outcome of the nursing
among neonates.
Standardized protocol: It refers to the techniques of carrying out a
procedure in a systematic way, with related scientific principles which
provides the basis for carrying out technical procedures.
Nursing Intervention: It refers to the action undertaken by the
investigator to prepare and execute the standardized protocol on safety
precaution of neonates which includes hand hygiene, selection of site and
cannulation techniques, dressing of sit and maintenance, drug loading,
administration and proper maintenance of patency of intravenous fluids.
12
Intravenous therapy: It refers to administration of fluid substance and
medication directly in to the vein.
Prevention of complications :It refers to reduce the risk of developing
the side effect and complications related to intravenous therapy such as
redness,tenderness,pain,swelling,phlebitis,thrompophlebitis,infiltration,ex
travasation,hematoma,nervedamage,venous air embolism.
Neonate: It refers to the new born from birth to 28 days after delivery.
DELIMITATIONS:
 The study was limited the neonates only admitted in NICU at SMVMCH.
 The study was limited to standardized protocol for nursing care
intervention on prevention of intravenous therapy related complications.
 A study was limited to 6 weeks duration.
 Study was limited to sample size of 60 neonates.
13
CHAPTER II
REVIEW OF LITERATURE
Review of literature is a key step in research process. Review of literature
refers to an extensive, exhaustive and systematic examination of publications
relevant to the research project. A review of research and non research literature
relevant to the study was undertaken which helped the investigator to develop
deeper insight into the problem and gain information what has been done in the
past.
1. Review of Literature related to intravenous therapy related
complications.
2. Review of Literature related to protocol for intravenous
therapy.
1. Review of Literature related to intravenous therapy related
complications.
Batten. R et. al., (1996) had conducted non randomized study 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.
Neonates were consecutive neonates who received peripheral intravenous lines
and were admitted to the wards. Results were a total of 2503 peripheral lines
were evaluable. The overall phlebitis rate was 6.8%. It was estimated that in 1
14
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. The study concluded that the Phlebitis rate for peripheral intravenous
catheters at 96 hours was not significantly different from that at 72 hours.
Vicky. D et. al., (2002) had conducted a non experimental study on
reviewed the evidence linking thrombosis with peripheral vein infusion
thrombophlebitis. The study found that peripheral vein infusion thrombophlebitis
occurred among 25% to 35% of the hospitalized neonates with peripheral
intravenous catheters. The duration of the catheterization, catheter-related
infection and catheter material are the important risk factors while the neonates
related risk factors were not elucidated.
Ritchie.S et.al., (2007) had conducted experimental study on “Risk of
complications of short peripheral intravenous catheters placed for indefinite
periods.” During 5 months, general pediatric neonates receiving intravenous
therapy through short peripheral intravenous catheters were monitored. Major
endpoints were infection and phlebitis. Per-day risk of complications and
catheter colonization were calculated. They studied 642 Teflon catheters in place
for 525 neonates. There were no cases of catheter sepsis, 1% possible insertion-
site infection, and 7% cases of phlebitis. Catheter colonization occurred in 92
(26%) of 348 catheters cultured. Current guidelines recommend replacement of
peripheral intravenous catheters in adults within 2 to 3 days; no
15
recommendations are made for children. Findings and those of others indicate
that the overall risk of peripheral catheter complications in children is
extremely low and would not be reduced substantially by routine catheter
replacement.
Falingezicht.J et.al., (2007) had conducted “A comparative study on
“Peripheral intravenous catheter complications in critically ill children.” Six
hundred fifty-four peripheral Teflon catheters in 303 pediatric intensive care unit
patients were examined to determine complication rates and associated risk
factors. Phlebitis13%, extravasation 28%, and bacterial colonization11%, sepsis
occurred respectively. Replacing catheters in critically ill children every 72 hours
would not decrease phlebitis, bacterial colonization, or catheter-induced sepsis
and could increase extravasations risk. Catheters can be safely maintained with
adequate monitoring for up to 144 hours in critically ill children.
Sunil.T et. al.,( 2008) had conducted “A comparative study on
complications of intravenous therapy with steel needles and Teflon catheters
with 954 cannula insertions. The risk of phlebitis was significantly greater with
Teflon catheters (18.8 % with Teflon catheters, 8.8 % with steel needles), steel
needles were significantly associated with infiltration (17.9 % with Teflon
catheters, 40.1% with steel needles). The overall rate of complications was
significantly greater for the group in which steel needles were used (53.8 %
versus 64.0 %), basically due to the increased risk of infiltration with steel
needles.
16
Halvorsommerfelt. E et. al., (2009) had conducted descriptive study on
incidence and complications of intravenous infusion with the aim of identifying
the IV related complication. The samples were 650 neonates with IV cannula
from Nice University Hospital. The Chi-square findings show that 54(13.6%)
had thrombophlebitis, 50(13.2%) had Infiltration and 9 (2.3%) had swelling and
local infection.
Cluster. Bet. al., (2010) had conducted descriptive study on identifying
the risk factors of intravenous related complications with 40 neonates. By using
observation check list the signs & symptoms were assessed which reveals that,
the type of infusion, duration of cannulation more than 3 days (50%), IV
antibiotics (12%), female sex(12%), catheter material PEO - vialon and Teflon
(6%), anatomic site - forearm related (12%) and wrist(8%)
AK dutta.et. al., (2011) had conducted “A descriptive study on
relevance and complications of intravenous infusion at emergency unit.” 630 of
2515 neonates (25%) received a peripheral venous cannulation, Indication for the
peripheral venous cannulation was considered unjustified in 24.8% of cases upon
arrival at the emergency department, and 33.8% upon leaving the emergency
department. Out of 318 neonates, the peripheral venous cannula was left in place
for no reason in 63 (20%). Overall, 390 peripheral venous cannulations were
followed until the time of their removal. Among these 390 neonates, 62 (15.9%)
developed complications, of which 54 (13.6%) had thrombophlebitis and 9
(2.3%) developed local infection.
17
Wilkinson .R et. al., (1989) had conducted study on “Randomized
Controlled Trial on factors Affecting Complications and Patency of peripheral
IVs. This prospective interventional study was conducted over a period of 6
months in a general ward .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.
Blatter. DP et. al., (2006) had conducted cross sectional study
“Complications are phlebitis rates reported for neonates receiving intravenous
therapy” there were 503,300 hospital stays with IV cannulated noted an increase
of nearly 80% since. More than 90% of the neonates had intravenous cannula in
NICU and general ward 100 % of neonates had IV cannula line. In comparison
56.5% of male neonates and rest of them were female neonates. The cross
sectional study results shows that complication are phlebitis rates reported for
neonates receiving intravenous therapy have been as high as 80%, with the rates
in most hospitals ranging between 20% and 80%. Other complications resulting
from intravenous cannulation include thrombophlebitis, extravasation, and
infection.
18
2. Review of Literature related to protocol for intravenous therapy.
Lawson .S Let. al.,(2012 May31) had conducted study on cross
sectional survey was carried out to evaluate the outcome of implemented
evidence based clinical guidelines in handling of peripheral intravenous
therapy.” A structured observation protocol was developed. Results
demonstrated that “no signs of thrombophlebitis” (degree0) were reported
in2%(p<0.01) and number of thrombophlebitis episodes are lower (p<0.001).
The use of 0.8mm size cannula had increased by 22% (p<0.001). The study also
showed that the documentation had increased (p<0.001) after implementation of
structured observation protocol.
Matthew. R et. al.,(2012)had conducted non experimental study on aims
to describe the current approach to extravasations injury (EI) prevention and
management in Neonatal Intensive Care Units (NICUs) in Australia and New
Zealand. The survey received a 96% response rate. Approximately two thirds of
Australian and New Zealand NICUs have written protocols for prevention and
management of extravasations injury. Considerable practice variation was seen
for both prevention and treatment of EI. 92% of units had experienced cases of
significant EI. We recommend that neonatal staff should remain vigilant,
ensuring that guidelines for the prevention and treatment of EI are available, and
rigorously followed. A written policy for the prevention and recognition of EI
was used by 69% (18/26) of units. A further 23% (6/26) had no written policy
but utilized a standard practice. 8% (2/26) of units had no written policy or
19
standard practice. Broken down by country, 83% (5/6) of the New Zealand units
had a written policy, compared to 65% (13/20) of Australian units.
Sharathkumar. V et. al., (april2009)had conducted correlation study on
“Nurses performance of peripheral intravenous therapy with their nursing
experience and their level of educational preparation.” correlation study was
conducted to examine the impact of nurses performance of peripheral
intravenous therapy with their nursing experience and their level of educational
preparation. Peripheral intravenous therapy assessment tool was developed.
Statistical analysis model was used for statistical analysis. To find the association
between nurses performance of peripheral intravenous therapy with nursing
experience and level of education, hierarchical multiple regression was used.
Results showed that patients demographic variables (age, gender, first language,
and day, impatient status of patient) did not significantly predict overall rating of
intravenous therapy F(426)=1.20 ; p>0.05. Nurses year of experience and level
of educational preparation significantly predicted overall ratings of intravenous
therapy F(1218) =3.97; p<0.01.
Giancarlo. C et. al., (2007)had conducted non experimental study on
universal hospital, Italy aimed to investigate the most suitable location of
peripheral venous therapy to reduce the incidence of thrombophlebitis”. An
observational survey carried out with 427 neonates in one Italian hospital. A
standardized protocol was used to survey the frequency of thrombophlebitis and
the relationship of location and size of peripheral intravenous therapy. The
20
variables evaluated were age, gender, term of birth, weight of baby, therapy size
and site of therapy location. The study shows that the frequency of peripheral
intravenous therapy thrombophlebitis was higher in weight of the baby
(P < 0·006). The highest incidence was found in neonates with therapy inserted
in the dorsal side of the hand veins compared to those with therapy inserted in
cubital fossa veins (P < 0·001). The use of cubital fossa veins rather than forearm
and hand veins should be encouraged to reduce the risk of thrombophlebitis in
neonates with peripheral.
Saxena .A et. al.,(2009)had conducted experimental study on “To assess
whether intravenous care conformed to the hospital policy”. The study was done
on 131 neonates with 155 peripheral IV lines in St Luke’s Hospital,
Pennsylvania. The peripheral line assessment revealed those 87 sites (56%) < 72
hours old, 4 sites (3%) > 72 hours old and 64 sites (41%) that were not recorded.
The researcher suggested need for improvements which included the need to date
all dressings/ infusion tubing, proper labeling of all bottled/bags and efforts to
ensure that neonates wear an identification bracelet.
Roberts .Set al., (2007) had conducted non experimental study on “A
point survey of all in patients at Auckland City Hospital.” to define the
utilization of the intravascular devices and to measure the prevalence of
infectious complications from this device. 376 out of 830 patients had
intravenous devices and 25 of them had either confirmed infection or showed
signs of infection. The study concluded that the health workers require ongoing
21
education to ensure prompt removal of devices that are not required for patient
care.
Jerassy. P et. al., (2006) had conducted non experimental study on
“Nine-point prospective surveillance of phlebitis associated with peripheral
intravenous catheters on all the hospitalized” neonates with peripheral
intravenous cannula. In between these surveys, findings and guidelines for
improvement were distributed among the staff. During the surveys, 40% ± 8% of
hospitalized neonates had peripheral intravenous cannula. The rate of peripheral
intravascular catheter- associated phlebitis decreased from 12.7% (20/157) in
1998 to 2.6% (5/189) in 2003 (P < .01) throughout the study period.
Amita peter. Ret. al., (2005)had conducted comparative study on
compare catheter-related complications rates in patients who had infusion
devices placed by infusion nurses with complication rates in neonates who had
devices placed by generalist nurses. The data demonstrated that peripheral
infusion devices placed by infusion nurses exhibited a statistically
significant(p<0.001) intravenous injection without antibiotic lower rate of
leakage, phlebitis, and infiltration complications and remained in the vein
significantly longer than those placed by generalist nurses. However,
significance was not achieved with pain complication rates between the two
groups.
22
CONCEPTUAL FRAMEWORK
LYDIAHALL’S CORE, CARE, CURE , THEORY
“Conceptual framework means the interrelated concepts or abstractions”
that are assembled together in some rationale scheme by virtue of their relevance
to a common.
- Polit&hungler(2006)
THEORY OVERVIEW:
 Theory developed in late 1960’s Nursing care can be delivered on three
interlocking levels Care = Hands on bodily care. Core = Using self in
relationship to patient. Cure = The disease applying medical knowledge.
CORE CIRCLE:
According to the theory ,the core refers to patient care is based on social
sciences Therapeutic use of self Helps patient learn their role is in the healing
process Patient is able to maintain who they are Patient able to develop a
maturity level when nurse listens to them and acts as sounding board Patient able
to make informed decisions.
Nurses have to be especially compassionate when taking care of patients
in the NICU. Not only do the babies need gentle care but nurses have to be
prepared to work with the parents and families, who are scored and worried and
need comforting, as well.
23
In this study, the core circle refers to staff nurse, investigator, student
nurses having therapeutic relationship with each other for discussing about the
preventive aspects of intravenous therapy related complications and providing
protocol base nursing intervention for neonates admitted in NICU.
CARE CIRCLE :
According to the theory, the care refers to nurturing component of care It
is exclusive to nursing “Mothering” Provides teaching and learning activities
Nurses goal is to “comfort” the patient patient may explore and share feelings
with nurse Care
In the present study the investigator administering protocol for
intravenous therapy administration among neonates to prevention of
complications. Before start intravenous therapy proper hand wash, strict aseptic
technique when starting intravenous therapy, clean the site before insertion
intravenous infusion using an alcohol swab( wipe and allow to dry), avoid joints
when selecting a site, Avoid veins over joint flexion, Proper supportive measured
use in splint, Assess the intravenous site frequently, intravenous site with sterile
dressing, utilizes single –use intermittent medication tubing, inspect access site
and equipment regularly, change administration set and solution according to
patient care, maintain prescribed flow rate with regular patient assessment,
monitor vital signs.
24
CURE CIRCLE:
According to the theory, the cure refers to Care based on pathological and
therapeutic sciences Professional nurse helps patient through the rehabilitative
phase of care Nurse is patient advocate in this area Nurses role changes from
positive quality to negative quality Cure.
In this study status of neonates was prevention of intravenous related
complications during their stay in NICU by giving prompt nursing intervention.
25
CHAPTER III
RESEARCH METHODOLOGY
Research methodology is a way to solve the problems systematically. It
indicates the general pattern of organizing the procedures for gathering the valid
and reliable data for the purpose of investigation.
This chapter deals with the methodology adopted to assess the
effectiveness of standardized protocol for nursing care intervention on
admitted in NICU at SMVMCH, puducherry.
It includes, research approach, research design, setting, population,
Sample and Sampling technique, selection and development of tool, description
of the tool, data collection techniques and plan for data analysis.
RESEARCH APPROACH:
A research approach tell the researcher, what data to collect and how to
analysis it, it also suggest possible to be drawn from the data.
RESEARCH DESIGN:
The research design refers to the researcher’s overall plan for testing the
research hypothesis. The research design helps the researchers in the selection of
the subject’s manipulation of experimental variable, procedure of data collection
and type of statistical analysis to be used to interpret the data.
A pre experimental one group post test only design.

24
RESEARCH METHODOLOGY
Research Approach
Quantitative Approach
Research Design
Quasi experimental post test only design
Target Population
All neonates admitted in NICU
Accessible
theD.T.Ed students studying Population
in District Institute of Education and
Neonates admitted in NICU inSMVMCHwith intravenous infusion
Training at Puducherry
Sampling Technique
Conveniente Sampling Technique
Experimental Group 60 neonates
Administration of protocol based IV therapy among

neonates neonates
Post test assessment of intravenous related

complications by using
- Tool observational check list
- Check list for staff nurse
-
Data Analysis
Descriptive Statistics: Frequency distribution, Mean, Standard Deviation
Inferential Statistics: Chi Square test, Paired‘t’ test
Result
Positive outcome of nursing intervention in terms of
prevention of intravenous related complications
FIG:2SCHEMATIC REPRESENTATION OF THE RESEARCH DESIGN
25
POPULATION:
The term population refers to the aggregate (or) totality of all subject (or)
numbers that confirm to the set of specification.
Target populations were all neonates admitted in NICU.
SETTING OF THE STUDY:
Setting is the physical location and condition in which data collected takes
place.
The study was conducted in NICU at SMVMCH, multi specialty hospital
located in kalitheerthalkuppam, puducherry,
SAMPLE:
Sample refers to the Subject of the population that is selected for a study.
In this study, sample consists of neonates who fulfill the inclusion criteria.
SAMPLE SIZE:
 Sample is the subset of population.
 In this study sample size consists of 60 neonates
SAMPLING TECHNIQUES:
It refers to the selecting a population to represent the entire population.
Convenience sampling: subject in the study who happened to be in right place
at the right time, with addition of available subjects until the desired sample size
is reached.
Convenience sampling technique is selected for the present study.
26
CRITERIA FORSAMPLE SELECTION:
Inclusion criteria:
 Neonates who are admitted in NICU.
 Neonates for whom intravenous therapy prescribed.
 Neonates to whom the intravenous therapy started at first day.
 Both male and female neonates.
Exclusion criteria:
Neonates already present with intravenous therapy.
VARIABLES:
Variable is defined as an attribute of a person or object that varies (or)
takes different values (Aballah and levine, 1979).
The term variables are concepts at different level of abstraction that are
concisely defined to promote their measurement (or) manipulated with in a
study.
Dependent variable: Intravenous therapy related complication
Independent variable: Standardized intravenous protocol for nursing
intervention
Extraneous variable: Catheter material, duration of catheter, mechanical
complications, kinking of intravenous tubing, right of solution amount of
solution reaming encounter.
27
INFLVENCE ING VARIABL
 Age of days
 Sex
DEPENDANT VARIABLE
INDEPENDENT
 Term of birth VARIABLE
Prevention of intravenous
 Type of delivery
therapy related -Standardized
 Wight of the baby protocol for nursing
complications
intervention
 Duration of IV therapy
 Site of IV cannula
 Type of IV fluid
 IV injection with and without
antibiotic
EXTRANEOUS VARIABLE
-catheter material
-duration of catheter
-mechanical complications
-kinking of intravenous tubing
-right of solution amount of solution

reaming encounter
FIG:3 RELATIONSHIP OF THE VARIABLES

-history of mother with GDM
-History of activity of child
-GDM
24
DESCRIPTION OF THE TOOL:
Description of the tool with the investigators personal and professional
experiences and with the extensive review of literature and discussion with
experts tool was administration to neonates.
Section A: Demographic variables such as age, sex, term of baby, type of
delivery, duration of intravenous fluid, site of intravenous
infusion, size of intravenous set, type of intravenous fluid,
intravenous injection with and without antibiotic, indication of
intravenous therapy.
Section B: observational check list with 10 items.
Section C: observational check list for staff nurse which is 10 items not
included for statistics analysis.
SCORING: Items are scored as follows:
1-10- no complications.
11-20 mild complications.
21-30 moderate complications.
31-40 sever complications.
25
CONTENT VALIDITY
Validity is the essential characteristics of the entities, procedures or
devices actually to measure the dimensions that they meant to measure.
The contents of the tool were evaluated by five experts from Child Health
Nursing Department. A criterion rating scale for validation of the tool was
developed experts were asked to give opinion and suggestion about the content
of the tool modification was made as per the experts opinion.
This modification was incorporated in the final preparation of the tool.
RELIABILITY:
The reliability of the tool was established by using split of method (r=0.5).
It shows that the tool is reliable for main study.
PILOT STUDY:
A pilot study is a trail run for the main study to test the practicability,
appropriateness of the instrument and feasibility of the study.
The investigator visited SMVMCH, NICU in Pediatric Department,
obtained permission to conduct the study. After a formal approval from the HOD
of Pediatric department, the investigator conducted a pilot study, to test the
feasibility and practicability. The investigator approach the NICU staff nurses
and informed regarding the objectives of the study and obtained the consent from
them then intravenous therapy protocol been implemented.
26
For 10 neonates investigator assessed for intravenous therapy
complications by means of observational check list on 7th day of infusion. The
result of the pilot study revealed that the study was feasible and practicable and
modification was made in the tool after pilot study in the aspect of protocol. And
observational checklist was prepared for staff nurses. Suggested by the experts.
DATA COLLECTION PROCEDURE:
The study was conducted in NICU, at SMVMCH it is a 900 bedded
multispecialty hospital located in kalitheerthalkuppam, puducherry, Formal
permission were obtained from the hospital authority. Sample was selected based
on inclusion criteria through convenient sampling. The investigator standardized
protocol for nursing intervention on prevention of complications related to
intravenous therapy. The procedure was implemented on the basis of prepared
protocol for nursing intervention on prevention of intravenous complications. Per
day 4 babies were selected at the end of the 7thdaylevel of intravenous therapy
related complications was assessed by the investigators.
27
PLAN FOR DATA ANALYSIS:
The data obtained was analyzed in terms of the objective of the study
using descriptive and inferential statistics. The plan of data analysis was as
follows.
 Descriptive statistics: Frequency, percentage distribution, mean,
mean percentage and standard deviation.
 Inferential statistics: Paired ‘t’test, chi square test in the form of
tables and figures.
28
CHAPTER IV
DATA ANALYSIS AND INTERPRETATION
This chapter deals with analysis and interpretation of the information
collected from 60 neonates selected hospital SMVMCH at puducherry. The
present study is designated to assess the effectiveness of standardized protocol
for nursing intervention on prevention of therapy related complications among
neonates admitted in NICU at SMVMCH, puducherry.
Analysis is a method of formulating data in such a way that the research
question can be answered.
The collected data was obtained, organized, analyzed and interpreted
using inferential statistics. Analyzed and interpreted data are based on the
objectives of the study data presented under the following headings.
Table 1:Distributionof selected demographic variable of neonates
Table 2:Distribution of mean, SD, post tests core on standardized protocol for
neonates.
Table 3:Distribution level of complications related to intravenous therapy for
neonates.
Table 4:Association between the levels of complications related to intravenous
therapy on standardized protocol of neonates with selected
demographic variable.
29
Table 1: Distribution of selected demographic variable of neonates
S.No Demographic variables Frequency Percentage

1. Age in days:
1-6 days 34 56.67
7-15 days 10 16.67
16-28 days 16 26.66
2. Sex :
Male 34 56.67
Female 26 43.33
3. Religion:
Hindu 39 65
Muslim 13 21.67
Christian 8 13.33
4. Term of Birth:
Term baby 53 88.33
Pre term baby 2 3.33
Post term baby 5 8.33
5. Type of delivery :
Vaginal Delivery 45 75
Elective LSCS delivery 10 16.67
Forceps delivery 5 8.33
6. Weight of baby :
1.3-2.3kg 2 3.33
2.4-3.3kg 27 45
>3.3kg 31 51.67
7. Duration of IV therapy:
6-10days 45 75
>10 days 15 25
8. Site of IV CANNULA:
Digital vein 40 66.67
Basilic vein 15 25
Cephalic vein 5 8.33
9. Type of IV fluid :
Hypertonic 25 41.67
Isotonic 35 58.33
10. IV Injection with and without antibiotic:
Yes 37 61.67
No 23 38.33
11. Indication of IV therapy:
Respiratory disorders 16 26.67
Neonatal infection 12 20
Electrolyte imbalance 10 16.67
Baby with physiological and pathological 17 28.33
jaundice
metabolic disorders 5 8.33
30
Inference:
Distribution of selected demographic variable of neonates with
intravenous therapy regarding the Age of neonates 34 (56.67%),of them were 1-
6days,10 (16.67%) of them were 7-15days, and remaing16 (26.66%),of them
were belong to 16-28 age in days.
Regarding sex of the neonate 34 (56.67%) of them were male neonates,
and 26 (43.33%) were female.
Regarding Term of birth53 (88.33%) of neonates were born in term2
(3.33%) of them were born in preterm 5 (8.33%) of them were post term baby.
Regarding Type of delivery of neonates45 (75%) of them were vaginal
delivery,10 (16.67%)of them were elective LSCS, 5 ( 8.33%) of them were
forceps delivery.
Regarding weight of baby 2 (3.33%) of them were belong to (1.3-
2.3Kg), 27 (45%) of the them were belong to(2.4-2.3Kg),31 (51.67%) of them
were belong to (>3.3Kg).
Regarding duration of intravenous therapy 45 (75%) of them were
received (6-10days),15(25%) of them were received(>10days).
Regarding the site of intravenous cannula 40 (66.67%) of them were
belong to (digital vein), 15 (25%) of them were belong to (basilic vein), 5
(8.33%)of them were belong to (cephalic vein).
Regarding the type of intravenous fluid 25(41.67%)of them were received
the (hypertonic fluid), 35 (58.33%) of them were received the (isotonic fluid).
31
Considering the Intravenous injection with and without antibiotic of
neonates 37 (61.67%) of them were received the antibiotic, 23 (938.33%) of
them not received antibiotic.
32
Term baby
Pre term baby
Post term baby
88.33%
100
80
60
40
20 3.33% 3.33%
0
Term baby
Pre term
Post term
baby
baby
Fig.4:Distribution of term of birth of neonates
33
6-10 days
>10 days
25%
75%
Fig.5:Distribution of duration of intravenous cannula. of neonates
34
Digital vein
Basicila vein
66.67%
Cephalic vein
70
60
50
40 25%
30 8.33%
20
10
0
Digital vein Basicila vein Cephalic vein
Fig.7: Distribution of site of intravenous cannula of neonates.
35
Yes
No
58.33% 41.67%
Fig. 8 distribution of intravenous injection with antibiotic and with

out antibiotic of neonates
36
Table-2: Distribution of mean post test score of standardized protocol among
neonates.
Area Max. Range Mean SD Mean%
score
Overall 40 10-14 10.47 0.947 26
Inference:
Table 2: the above table shows that mean post test score for
standardized protocol for nursing intervention on prevention of complications of
intravenous therapy mean value is 10.47 and the standard deviation is 0.947.
37
Table -3: Distribution of level of complications related to intravenous
therapy for neonates.
Level of Post test
complications F %
No 44 73.33
complications
Mild 16 6.67
Moderate - -
Severe - -
Total 60 100
Inference:
Table 3: The above table shows that distribution of level of complications
related to intravenous therapy among neonates are classified as four level such as
no complications, mild complications, moderate complications, sever
complication. Post test score shows44 neonates had (73.33%) no complications,
16 neonates (26.67%) had mild complications and no neonates are affected with
mild and moderate complications.
38
73.33%
80 No Complications
70 Mild
60 Moderate
50 Severe
Percentage
40 26.67%
30
20
10 0% 0%
0
No Complications Mild Moderate Severe
Level of complications
Fig:9.Distribution of level of complications related to intravenous therapy among neonates .
39
Table 4: Association between the level of complications of intravenous therapy
among neonates with selected demographic variable.
S. No No complications Mild
Demographic variables complications χ2 p-value
F % F %
1. Age in days:
1-6 days 25 41.67 9 15
7-15 days 8 13.3 2 3.3 0.39 0.001**
16-28 days 11 18.3 5 8.3 (df=2)
2. Sex :
Male 26 43.3 8 13.3 0.39 0.001**
Female 18 30 8 13.3 (df=1)
3. Religion:
Hindu 28 46.7 11 18.3 1.37 0.468
Muslim 11 18.3 2 3.3 (df=2)
Christian 5 8.3 3 5
4. Term of Birth:
Term baby 39 65 14 23.3
Pre term baby 2 3.3 0 0 1.18 0.01*
Post term baby 3 5 2 3.3 (df=2)
5. Type of delivery :
Vaginal delivery 35 58.3 10 16.7 3.35
Elective LSCS delivery 7 11.7 3 5 (df=2) 0.187
Forceps delivery 2 3.3 3 5
6. Weight of baby :
1.3-2.3kg 2 3.3 0 0
2.4-3.3kg 20 33.3 7 11.7 0.82 0.001**
>3.3kg 22 36.7 9 15 (df=2)
7. Duration of IV therapy:
6-10days 32 53.3 13 21.7 0.45 0.001**
>10 days 12 20 3 5 (df=1)
8. Site of IV Cannula:
Digital vein 32 53.3 8 13.3 0.256
Basilic vein 9 15 6 10 2.73
Cephalic vein 3 5 2 3.3 (df=2)
9. Type of IV fluid :
Hypertonic 21 35 4 6.7 2.49 0.146
Isotonic 23 38.3 12 20 (df=1)
10. IV Injection with and

without antibiotic:
Yes 28 46.7 9 15 0.278
No 16 26.7 7 11.6 (df=1) 0.06**
40
Indication of IV
therapy:
11. Respiratory disorders 13 21.7 3 5
Neonatal infection 9 15 3 5 3.51 0.476
Electrolyte imbalance 5 8.3 5 8.3 (df=4)
Baby with physiological 13 21.7 4 6.7
and pathological
jaundice
Metabolic disorders 4 6.7 1 1.7
*-p<0.05 significant, ** -p<0.01 & ***-p<0.001 highly significant
S-Significant, NS-Non significant ,DF-Degree of freedom
41
Inference:
Table-4: The above table shows that calculated value of x2 is significant
at 1% level of significant shows that age in days(p<0.001), sex (p<0.001), term
of birth (p<0.01), weight of baby (p<0.001), duration of intravenous therapy
(p<0.001), intravenous injection with and without antibiotic (p<0.06). It all shows
that statistically highly significant.
There is no association between the post test score x2 value with
demographic variable like Religion, type of delivery, site of intravenous cannula,
type of intravenous fluid, Indication of intravenous therapy.
42
V. CHAPTER
DISCUSSION
The goal of the study was “A study to evaluate the effectiveness of
nursing intervention on prevention of intravenous therapy related complications
among neonates admitted in NICU at SMVMCH, puducherry. The discussion of
the present study is based on the findings obtained from statistical analysis of
collected data.
A total number of 60 neonates were selected for the study. The
effectiveness was assessed by modified visual complications score scale for
observation check list and observation check list for staff nurse to assess the
level complications among neonates. According to the score, I have assessed the
effectiveness of standardized protocol for nursing intervention on intravenous
therapy. In that result shows that 44 neonates (73. 33%) had no complications of
intravenous therapy, 6 neonates (26.67%) had mild level of intravenous therapy
related complications and no neonates are affected with moderate and sever
complications.
I. To prepare a standardized protocol for nursing intervention on
prevention of intravenous therapy related complications among neonates.
Table 1: Reveal that the level of complications in intravenous therapy is
assessed by modified visual complications score scale among neonates admitted
in NICU were mostly lies between the age group of 1-6 days (56.67%).when
coming to the gender male neonates are more common 34(56.67%) .Most of the
43
neonates belong to Hindu religion 39 (65%). Most of the babies term of birth 53
(88.33%). 6-10 days of duration of intravenous therapy is prescribed 45
(75%).Isotonic intravenous fluid was prescribed for 35 (58.33%) neonates. 37
(61.67%) were prescribed with antibiotic intravenous injection.17 (28.33%)
neonates were admitted in NICU ,with complaints of physiological and
pathological jaundice.
Based on the finding it is clear that most of the neonates admitted in
NICU are prompt to get intravenous infusion based in their illness.
Lawson .SL et.al.(2012)In this study was supported by an “ A cross
sectional survey was carried out to evaluate the outcome of implemented
evidence based clinical guidelines in handling of peripheral intravenous
therapy.” A structured observation protocol was developed. Results
demonstrated that “no signs of thrombophlebitis” (degree0) were reported in2
%(p<0.01) and number of thrombophlebitis episodes(degree 1-3 ) are lower
(p<0.001). The use of 0.8mm size cannula had increased by 22% (p<0.001). The
study also showed that the documentation had increased (p<0.001) after
implementation of structured observation protocol for on this finding it is clear
that most of the neonates admitted in NICU are prompt to get intravenous
infusion based on their illness.
44
Batten.Ret.al. (1996) In this study was supported by an For most IV
infusion in neonates, an over-the-needle 24 –gauge catheter may be used if
therapy is expected to last less than 5 days. The length of the catheter may be
directly related to infection and embolus formation. The shorter the catheter, the
fewer the complications. Determining the best catheter for the patient early in the
therapy provides the best chance of avoiding catheter related complications.
II. To evaluate the effectiveness of a standardized protocol for
Table 3: Represents 44 (73.33%) of neonates does not develop any IV
complications only 16 (26.67%) of neonates developed only mild complications.
There is no complications of moderate and sever complications.
S.Sivaram. et,al. (2012) Jawaharlal Institute of Postgraduate Medical
Education and Research, Puducherry, India.“Experimental study conducted
by in Department of pediatric, peripheral venous therapy thrombophlebitis is a
common complications of intravenous cannulation, occurring in about 30% of
patients. They evaluated the effect of elective re-sitting of intravenous cannula
every 48 hours on the incidence and severity of peripheral venous catheter in
neonates receiving intravenous fluids/drugs. Elective re-sitting of intravenous
cannulae every 48 hours results in a significant reduction in the incidence and
severity of peripheral venous catheter.
Giancarlo Cicolini, et ,al., (2007)had conducted a study on “ universal
hospital, Italy aimed to investigate the most suitable location of peripheral

45
venous therapy to reduce the incidence of thrombophlebitis”. An observational
survey carried out with 427 neonates in one Italian hospital. A standardized
protocol was used to survey the frequency of thrombophlebitis and the
relationship of location and size of peripheral intravenous therapy. The variables
evaluated were age, gender, term of birth, weight of baby, therapy size and site
of therapy location. The study shows that the frequency of peripheral intravenous
therapy thrombophlebitis was higher in weight of the baby(P < 0·006). The
highest incidence was found in neonates with therapy inserted in the dorsal side
of the hand veins compared to those with therapy inserted in cubitalfossa veins
(P < 0·001). The use of cubital fossa veins rather than forearm and hand veins
should be encouraged to reduce the risk of thrombophlebitis in neonates with
peripheral.
III. To associate the effectiveness of nursing intervention on
with their selected demographic variable.
Table 4:Association was found by using chi-square test indicate that there
was an association between the age of child term of birth duration of intravenous
therapy, intravenous therapy injection with antibiotics without antibiotics with
the level of complication of intravenous therapy finding revels that neonates with
less age and duration of intravenous therapy causes a complications due to any
extraneous variable like gestational diabetics mellitus, illness of the baby,
delicate vein.
46
Wilkinson. Ret.al.LadyHardinge Medical College and Associated
Kalawati Saran Hospital.(2005) In this supported by an “Lady Hardinge
Medical College and Associated Kalawati Saran Hospital.”A Randomized
Controlled Trial on factors Affecting Complications and Patency of peripheral
IVs. This prospective interventional study was conducted over a period of 6
months in a general ward .This sample was composed of 88 patients, from
neonates to 12-year-olds, on whom a total of 377 catheters were started.
Intravenous cannulation 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 (p<0.001) in the duration of intravenous therapy
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.
Amita peter. Ret,al. (2010) A study conducted on compare catheter-
related complication rates in patients who had infusion devices placed by
infusion nurses with complication rates in neonates who had devices placed by
generalist nurses. The data demonstrated that peripheral infusion devices placed
by infusion nurses exhibited a statistically significant(p<0.001) intravenous
injection without antibiotic lower rate of leakage, phlebitis, and infiltration
complications and remained in the vein significantly longer than those placed by
generalist nurses. However, significance was not achieved with pain
complication rates between the two groups.
47
SUMMARY
The focus of the study was to determine the effectiveness of standardized
protocol for nursing intervention on prevention intravenous complications an
extensive review of literature, professional experience and expert guided lead the
investigator to design methodology.
The conceptual frame work developed for the study was based on the
“Lydia hall (1960).
The population 60 neonates of the study was considered as neonates who
admitted in NICU and to samples were selected for the study.
Convenient samples techniques was adopted one group post test only
design was used.
The data was collected by using VIP complications scale which includes
demographic variable observational checklist to assess the intravenous
complications likes’ pain edema, hematoma, infiltration, thrombophlebitis.
Various expert child health nursing department obtained the content
validity of tool. The pilot study was conducted with 10 neonates at SMVMCH,
puducherry.
The ethical aspect of research was maintained throughout the period from
the authority. Investigator initiated intravenous injection by following
48
standardized protocol and assessed for intravenous complications based on the
duration of intravenous canula site.
MAJOR FINDINGS IN THE STUDY
The post test assessment of intravenous therapy related complications
based on standardized protocol reveals that distribution of level of complications
44 neonates (73.33%) had no complications of intravenous therapy, 16 neonates
(26.67%) had mild level of complications of intravenous therapy and no
neonates are affected with moderate and sever complications.
The over all mean value is 10.47% and SD level of 0.947 there is
association at 1% level of significant of post test level of complications with
selected demographic variable, such as age in day, sex, term of birth, weight of
baby, duration of intravenous therapy, intravenous injection with and without
antibiotic. It shows that highly significant.
49
CONCLUSION
The study was conducted among 60 neonates to find the effectiveness of
standardized protocol for nursing intervention on intravenous therapy related
complications at puducherry. The result shows there is 44 neonates did not
develop no complications, 16 neonates have mild complications and no neonates
are affected with moderate and sever complications. So the standardized protocol
is effectiveness there is association of selected demographic variable like, Age in
days, sex, term of birth, weight of baby, duration of intravenous therapy,
intravenous injection with and without antibiotic. It shows that highly significant
with post test score of level of complications.
NURSING IMPLICATIONS
1. The present study can help nurses to enrich their knowledge skill, practice
by using standardized protocol in order to prevent intravenous therapy
The following protocols are:
a) Before injecting intravenous infusion proper hand washing should be
done because it is one of the universal procedure. (Mainly in order to
prevent infection).
b) Strict aseptic techniques should be followed to avoid high risk
infection.
c) Avoid joint when selecting a site in order to prevent edema, swelling,
thrombosis then others complications
50
d) In order to maintain proper position splint should be used because it is
one of safety support for neonates for maintain intravenous site.
e) Injured site should be secured with sterile dressing.
f) According to doctor order flow rate should be maintain properly for
the neonates in order to prevent overload and inadequate fluid.
g) Every hour vital signs should be monitored and recorded in an
appropriate manner.
If we follow these standardized protocols a nurse can prevent intravenous related
complications among neonates, if she implement in an effective manner. If nurse
practice this standardized protocol daily in their clinical setup she’s become well
expert with good knowledge, skill, practice, to prevent intravenous related
complications among neonates in the future also.
NURSING EDUCATION
1. Efforts should be made to improve and expand nursing curriculum to provide
to more content in the area of nursing intervention like prevention of
complications related intravenous therapy.
2. Standardized Protocol for nursing intervention among neonates by insertion
of intravenous cannula to prevent of complications related intravenous
therapy.
3. Nurse should be provided with adequate opportunities in developing skills in
handling such clients and how to identify their difficulties and help them to
promote comfort and wellbeing.
51
4. As nursing educator, need to strengthen the evidence based nursing practices
about intravenous therapy among the UG and PG nursing students.
NURSING PRACTICE
1. Nurses working in NICU should have enough knowledge and special skills
to identify the level of intravenous complications as early as possible and to
take immediate action and take care of neonates.
2. Nurse should follow these standardized protocols in effective manner
intravenous therapy complications can be prevented among neonates.
3. Nurses play a vital role in caring neonates’ intravenous insertion therapy by
following this protocol for nursing intervention.
4. This can be followed as a routine care in NICU. It has to establish as a
evidence based nursing practice.
NURSING ADMINISTRATION
1. Nurse Administrator can make necessary policies to implement the protocol
for nursing care services related to intravenous insertion therapy.
2. Nurses Administrator can organize in service education program for staff
nurse (NICU) regarding standardized protocol for intravenous therapy.
3. Nurse Administrator should select the staff nurses with good knowledge,
practice, skill in their clinical set ups.
4. Nurse Administrator should arrange live demonstration related to protocol
for nursing intervention followed by insertion of intravenous therapy among
neonates.
52
5. The nursing administrator should take initiative in organizing the continuing
nursing education programs and on newly devised strategies such as protocol
for nursing care followed by using insertion of intravenous therapy.
NURSING RESEARCH
1. The findings of the study help the nurses and students to develop the inquiry
by providing baseline. The general aspect of the study result can be made by
further replications of the study.
2. A Nurse Researcher can provide supportive care measures which may
improve the physical well being for neonates.
3. Nursing researcher should encourage clinical nurses to implement the
innovative research findings in their nursing care to avoid complications of
intravenous therapy among neonates.
4. The researcher should disseminate the findings through publications in
journals and in the World Wide Web.
LIMITATIONS
 The study was limited the neonates only admitted in NICU at SMVMCH.
 The study was limited to standardized protocol for nursing care
intervention on prevention of intravenous therapy related complications.
 A study was limited to 6 weeks duration.
53
RECOMMENDATION
Based on findings of the present study, the following recommendations have
been made,
 Similar study can be conducted in other areas with a large sample.
 The same study can be conducted in different settings.
 The same study can be conducted with true experimental research
design.
 The study can be replicated with larger samples for better
generalization.
 The study can be done as a longitudinal study.
 The study can be replicated with bio-physical parameters.
 A comparative study can be conducted between pharmacological and
non Pharmacological intervention.
 The standardized protocol should be used for the adult also.
54
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64
APPENDIX-I
RESEARCH TOOLS
SECTION:A-DEMOGRAPHIC DATA
Sample no:
Procedure started date:
Procedure ended date:
1.AGE IN DAYS:
A. 1-6 days
B. 7-15 days
C. 16-28 days
2.SEX :
A. Male
B. Female
3.RELIGION:
A. Hindu
B. Muslim
C. Christian
4.TERM OF BIRTH:
A. Term baby
B. Pre term baby
C. Post term baby
5.TYPE OF DELIVERY:
A. Vaginal delivery
B. Elective LSCS delivery
C. Forceps delivery
6.WEIGHT OF BABY :
A. 1.3-2.3kg
B.4-3.3kg
C.>3.3kg
7.DURATION OF IV THERAPY:
A. 6-10days
B. >10 days
65
8.SITE OF IV CANNULA:
A. Digital vein
B. Basicilic vein
C. Cephalic vein
9.TYPE OF IV FLUID :
A. Hypertonic
B. Isotonic
10. IV INJECTION WITH AND WITHOUT ANTIBIOTIC:

A. Yes
B. No
11.INDICATION OF IV THERAPY:
A. Respiratory disorders
B. Neonatal infection
C. Electrolyte imbalance
D. Baby with physiological and pathological
E. Jaundice
F. Metabolic disorders
66
SECTION: B-MODIFIED VISUAL COMPLICATIONS SCORE
SCALE
COMPLICATIONS:
1.Pain near the IV side by using facial grimace scale
a. No pain(1)
b. Mild pain (2)
c. Moderate(3)
d. Sever(4)
2.Infiltration:
a. Absent(1)
b. Inflammation near the insertion site(2)
c. Skin blanched(3)
d. Slowed (or)stopped infusion (4)
3. Hematoma:
a. Absent(1)
b. Edema(2)
c. Redness(3)
d. Skin discoloration(4)
4. Thrombosis:
a. Absent(1)
b. Swelling (2)
c. Tenderness(3)
67
d. Obstruction of flow(4)
5.Thrombophlebitis:
a. Absent(1)
b. Erythematic(2)
c. Low grade fever(3)
c. Palpable cords(4)
6.Pulmonaryemboliusm:
a. Absent (1)
b. Dyspnea(2)
c. Cough(3)
d. Hemoptysis(4)
7.Air embolism:
a. Absent(1)
b. Pain(2)
c. Dizziness(3)
d. cardiac arrest(4)
8. Septicemia:
a. Absent(1)
b. General malaise and high greade fever(2)
c. Flushed skin(3)
d. Tachycardia(4)
68
9.Pulmonary edema:
a. Absent(1)
b. Restlessness(2)
c. Shortness of breath(3)
c. Hypoxia(4)
10.Speed shock:
a. Absent(1)
b. Hypotension(2)
c. weak (or)absent pulse(3)
d. Cold (or) blue extremities(4)
COMPLICATIONS SCORE:
1. 1-10-No complications
2.11-20 Mild complications
3.21-30 Moderate complications
4.31-40 Sever complications
69
SECTION: C-OBSERVATIONAL CHICK LIST FOR
STAFF NURSE
S.NO COMPLICATIONS YES NO

1. Pain near the IV side by using facial grimace
scale:
no pain/mild pain /moderate pain/ sever pain.
2. Infiltration:
Absent/inflammation near the insertion site/skin
blanched slowed (or)stopped infusion.
3 Hematoma:
absent /edema/redness/skin discoloration.
4 . Thrombosis:
Absent/swelling /tenderness/obstruction of flow.
5 Thrombophlebitis:
Absent/erythema/low grade fever/palpable cords.
6 Pulmonary emboliusm:
absent /dyspnea/cough/ hemoptysis.
7 air embolism:
absent/pain/dizziness/ cardiac arrest.
8 septicemia:
absent/general malaise and high greade
fever/flushed skin/tachycardia.
9 pulmonary edema:
absent/restlessness/shortness of breath/hypoxia.
10 speed shock:
absent/hypotension/ weak (or) absent pluse/cold
(or) blue extremities.
70
APPENDIX-II
LETTER SEEKING PERMISSION TO CONDUCT STUDY
FROM:
S.ASWINI
MSC, NURSING (II-YEAR),
TO:
THE MEDICAL SUPERINDENTENT,

PUDUCHERRY.
Respected sir,
sub: Request to accord permission for conducting research project
As a part of our curriculum requirement I am s. ASWINI studying MSC,

Nursing (II-year) at Sri ManakulaVinayagar Nursing College would like to conduct a
research project on “A study to evaluate the effectiveness of nursing intervention
on prevention of intravenous therapy related complications among neonates
admitted in NICU at SMVMCH, puducherry”.Under the guidance of Dr, R.
Danasu,Principal, Sri ManakulaVinayagar Nursing College. Here by I request your kind
self to grand permission to collect data at your esteemed institution in the area of
Neonatal intensive care unit (pediatric department ) with the effect from (25.09.2013) to
(11.11.2013) six weeks of period. Kindly request to consider and grant me a
permission.
Thanking you
Yours Faithfully
S.ASWINI
71
LETTER SEEKING PERMISSION FOR CONDUCTING THE
STUDY
Date: 27.09.2013
TO:
The Medical Superintendent,
Sri ManakulaVinayagar Medical College And Hospital,
Puducherry.
Sir,
Sub: Letter requesting permission for conducting data collection
Miss.ASWINI.S is a bonafide postgraduate student of our institution. She has

selected the topic for her research project and has to go four weeks period of data
collection.
TOPIC:“A study to evaluate the effectiveness of nursing intervention on
admitted in NICU at SMVMCH, puducherry.”
Regarding this project data collection she is in need of your esteemed help
and co-operation. I request you to kindly permit her to conduct proposed data
collection. Kindly do the needful.
Thanking you,
Yours sincerely,
PRINCIPAL.
72
APPENDIX – III
LIST OF EXPERTS
1. MRS.SUMATHI,
PROFESSOR IN CHILD HEALTH NURSING,
KGCON,
PUDUCHERRY.
2. MRS.ROSE RAJESH,
PIMS,
PUDUCHERRY.
3. MRS.V.SASI,
VMCON,
PUDUCHERRY.
4. MRS.SUJATHA,
PIMS,
PUDUCHERRY.
5. MRS.BARANI,
HOD IN CHILD HEALTH NURSING,
RAAK,
PUDUCHERRY.
73
APPENDIX – IV
LETTER FOR VALIDATION OF TOOL
From
Ms.ASWINI.S ,
M.Sc, (Nursing) II year,
Kalitheerthalkuppam.
To
Through the Proper Channel
Respected Sir/Madam,
Sub: Requesting the Experts opinion and suggestions for establishing the content
validity.
I, Aswini.S, M.Sc Nursing II year student of Child Health Nursing

Department at Sri ManakulaVinayagar Nursing College, Kalitheerthalkuppam,
Puducherry, conducting a study on “A study to evaluate the effectiveness of
nursing intervention on prevention of intravenous therapy related complications
among neonates admitted in NICU at SMVMCH, puducherry.”Hence ,I humbly
request you to validate the tool and give your valuable suggestions regarding the
appropriateness of the tool.
Thanking You,
Yours faithfully.
(ASWINI.S)
Enclosures:
1. Research tool
2. Certificate of validation
3. Evaluation check list
74
CHECK LIST FOR VALIDATION OF TOOL
Introduction
The expert is requested to go through the following criteria for evaluation
of check list. Three columns are given for response and a column for remarks.
Kindly place tick mark in the appropriate column and give remark,
Interpretations of columns
Column I - Meets the criteria
Column II - Partly meets the criteria
Column III - Does not meet the criteria
S.NO CRITERIA I II III REMARKS

1. Scoring
Appropriateness
Adequacy
Accurateness
Clarity
Simplicity
2 Brief description of assessment
tool
Clarity
Adequacy
Appropriateness
Relevance
3 Content
Organization
Adequacy
Appropriateness
Practicability
Any other suggestions ___________________________________________
Signature :
Name, Designation :
Address :
75
CERTIFICATE OF VALIDATION
I hereby certify that I have validated the tools prepared by
Ms.ASWINI.S, II Year, M.Sc (Child Health Nursing) student of Sri Manakula
Vinayagar Nursing College, Puducherry who has undertaken study field title of
“A study to evaluate the effectiveness of nursing intervention on prevention
of intravenous therapy related complications among neonates admitted in
NICU at SMVMCH, puducherry”.
SIGNATURE OF THE EXPERT
Name :
Designation :
Date :
76
APPENDIX-V
CERTIFICATE OF ENGLISH EDITING
This is to certify that the project entitled “A study to evaluate the
effectiveness of nursing intervention on prevention of intravenous therapy
related complications among neonates admitted in NICU at SMVMCH,
puducherry” is corrected for English language appropriateness by me.
SIGNATURE
DATE :
PLACE :
77
APPENDIX-VI
INFORMANT CONSENT
I Mr/Mrs/Miss State that, my self
Voluntarily take active participation in the conducted study conducted by Miss.
ASWINI.S M.SC Nursing II nd year, on the topic.“A study to evaluate the
effectiveness of nursing intervention on prevention of intravenous therapy related
complications among neonates admitted in NICU at SMVMCH, puducherry. ”
SIGNATURE
78
APPENDIX-VII
DATE COLLECTION SCHEDULE
DATE OF T
DATA TIME ACTIVITIES/ PROCEDURE
COLLECTION
25/9/2013 to 7am to 7pm -First day I assessed the child condition and then I
1/10/2013 Checked the physician order.
-Before injecting hand washing done.
- Selected the site by avoiding the joint areas.
-Clean the site with alcohol swab (wipe and allow
to dry).
- Select the appropriate size of venflon ,prepare
few Strip of adhesive tapes and keep ready for use.
- Apply tourniquet firmly 6 to 8 inches proximal
to the venipuncture site.
-Inserted needle into the vein by holding the
needle at a 30 degree angle with the bevel, pierce
the skin lateral to the vein, when back flow of
blood occurs into the needle and tubing, insert the
needle further up into the vein about ¾ or 1 inch,
release the tourniquet.
-Secured venflon H method or crises cross
method.
-Supportive the site with splint.
-Then connected with the intravenous tubing.
-The pattern of tubing maintaining still 7am to
7pm.Then after that 7pm to 7am hand over to the
staff nurse to maintain patency.
-Observational check list was given to the staff
nurse.
-To was assess the complications among neonates.
79
7am to7pm -Second day I assessed the intravenous line.
-Check for flow rate overload or inadequacy is
beassessed.
-Check for the movement of hand, assessed the
baby activity assessed intravenous site.
-Secured with sterile dressing.
-Change intravenous site dressing if necessary,
then monitored the vital signs.
7am to 7pm -In third day I assessed the intravenous site.
-If any other complications occurs means I was
removed intravenous line.
-Again restart the new intravenous line therapy
by using standardized protocol infusion.
7am to 7pm -In fourth day I assessed the intravenous line.
-If the child condition is good recovered means,
safely removed the intravenous therapy.
7amto7pm -In fifth and six days I followed same routine
standardized protocol for nursing intervention for
neonates.
7am to 7 -In seventh days I observed the VIP intravenous

pm infusion complications.
-Observational check list finally it was given to
the staff nurse to assess the level of
complications among neonates and it should be
reported to me.
80
APPENDIX- VIII
INTRAVENOUS PROTOCOL MODULES
PROTOCOL FOLLOWED FOR NURSING INTERVENTION ON
PREVENTION INTRAVENOUS THERAPY COMPLICATIONS
Step-1
Proper hand washing
Step-2
Avoid joints when selecting a site
Step-3
Clean the site before insertion using an alcohol

swab (wipe and allow to dry)
Step-4
Strict aseptic technique followed.
81
Step-5
Proper supportive measured used
Step-6
Assess the IV site frequently
Step-7
Joint flexion Avoid veins over
82
S.NO FOLLOWED PROTOCOL FOR NURSING INTERVENTION ON
PREVENTION OF INTRAVENOUS THERAPY COMPLICATIONS
1. Before injecting iv infusion proper hand washing
2. Avoid joints when selecting a site
3. Clean the site before insertion iv infusion using an alcohol swab (wipe and allow to
dry)
4. Strict aseptic technique when starting iv
5. Proper supportive measured use in splints
6. Assess the iv site frequently

7. Avoid veins over joint flexion
8. Do not reapply tourniquet to the same limb after an unsuccessful start
9. IV site secured with sterile dressing
10. Change IV site dressing if necessary
11. Utilize single-use intermittent medication tubing
12. Thoroughly inspect medication and solution containers prior to use
13. Inspect access site and equipment regularly
14 Change administration set and solution according to Patient Care Guideline
15 Utilize single-use intermittent medication tubing
16 Maintain prescribed flow rate with regular patient assessment
17 Monitor vital signs
83
PROTOCOL FOLLOWED NURSING INTERVENTION ON
COMPLICATIONS AMONG NEONATES
INTRODUCTION:
Intravenous cannulationis now an integral part the majority of nurses’

professional practice. It is theintroduction of the drug directly into a vein by
means of a cannula. A cannula is a flexible tube containing a needle which may
be inserted into a blood vessel. Any nurse who performing intravenous line
cannulation must be competent in all clinical aspects of intravenous therapy and
have validated competency in clinical practice in accordance with hospital
protocol. Training and assessment should include the care of intravenous line
cannula care in order to avoid possible complication.
AIM OF PROTOCOL:
To provide a guide to peripheral intravenous line cannulation and advice

on continuing care of babies with such devices in place.
OBJECTIVE OF THE PROTOCOL:
Each nursing personal will able to

 Decide the size of intravenous line cannula to be used
 Choose an appropriate insertion site
 Prepare the appropriate equipments
 Complete the procedure safety
 Conclude the care episode with removal of intravenous line
1
cannula
DEFINITION OF INTRAVENOUS LINE CANNULATION:
Intravenous line cannulation is the insertion of tube into a vein to provide

access to the circulation for the administration of short term intravenous therapy
thatincludes blood, blood products, isotonic fluids and drugs.
INDICATION OF INTRAVENOUS LINE CANNULATION:
Cannulation may be used to
 Administer drugs
 Maintain correct hydration
 Transfuse blood and blood products
 Keep vein patent
PRINCIPLES TO ADOPT PRIOR TO INTRAVENOUS LINE
CANNULATION:
 cannulate veins in the lower arm and hand first, if no success, select legs
 No more than 3 attempts at cannulation shall be made by one individual.
After 3 unsuccessful attempts additional attempts shall be made by some
one with more experience
 use sterile equipment and apply principles of asepsis
 ensure correct identification of patient prior to procedure
 decontaminate hands prior to procedure
 cleanse babies skin using surgical spirit swabs and allow 30 second to dry
prior to insertion of cannula
 the volume of intravenous fluid for administration should be calculated
 accurate labeling of additives to the intravenous fluid is essential
SELECTION OF APPROPRIATE INTRAVENOUS LINE CANNULA:
The following should be considered
2
 the cannula length should correspond approximately to the length of
straight vein to be used
 expected duration (short length and small gauge permit better blood flow)
 infusion rate
DIFFERENT SIZES OF INTRAVENOUS LINE CANNULA:
GUAGE COLOUR CODE CATHETER WATER

LENGTH(mm) FLOWRATE
ml/min
14G Orange 45 270
16G Grey 45 172
18G Green 45 76
20G Pink 33 54
22G Blue 25 31
24G Lime(yellow) 19 14
3
SELECTION OF SITE INTRAVENOUS LINE CANNULATION:
o Always allow adequate time for assessment of appropriate vein

o Use veins on babies’ less dominant side
o Distal veins should be used first with subsequent vein punctures proximal to
previous site
o Choose the areas without joint flexion
o Select a site with no sign of edema, dermatitis, cellulites, av fistula, wounds,
skin graft, fractures, shock or previous cannulation.
NURSES RESPONSIBILITYU IN CARING A PATIENT WITH
INTRAVENOUS CANNULA:
 Prepare the intravenous fluid aseptically and safely, checking the container
for color, clarity expiry date and leakage , and prepare immediately prior to
administration
 Check order and identify the baby before intravenous line cannulations
 Check and maintain patency of the intravenous line cannula regularly
 Inspect the site of intravenous line cannula and managing and reporting
complication where appropriate
 Control the flow rate of infusion as per calculation
 Monitor the condition of the baby intermittently
 Make clean and immediate records of all intravenous cannula care
procedure.
PROCEDURE:
Preliminary assessment:
 identify the baby

 Check general condition of the baby
 Review the physician order
Preparation of articles
4
Sterile tray contains
a. Intravenous line cannula kit containing stainless steel bowl (1) sterile
cotton swabs (3) sterile towel(1)
b. Sterile gloves
Clean tray contains
1. Soap with soap dish

2. Clean mackintosh and towel
3. Tourniquet
4. Surgical spirit – bottle
5. Venflon with covering
6. Easy fix plaster
7. Intravenous solution( sterile clear) ready for use
8. Intravenous set
9. Kidney tray
I.V stand
In the nurses station
1. Wash hands
5
2. Arrange all articles in nurse station
3. Check the intravenous solution (color, clarity, expiry date, leakage)
4. Open the infusion set, maintaining sterility of both ends of tubings
5. Clean the top of the solution bottle with a spirit swab
6. Insert infusion set in the fluid bottle and close the roller clam fill
drip chamber
7. Release slowly the roller clamp to allow the fluid travel from drip
chamber to tubing with out air bubble
8. Replace the tubing cap at the end of the tube
Preparation of the baby:
1. Explain the procedure to the mother

2. Bring the prepared articles nearby the baby and hang the intravenous fluid at
18 – 24 inches from the cannula site in IV – stand
3. Identify the accessible vein for intravenous line cannula insertion
4. Place the site of intravenous line cannula insertion lower that baby heart
5. Place a clean mackintosh and a clean towel under the side of cannula
insertion
6. Cleanse the insertion site with a spirit swab one inch from the centre to the
periphery as a circle
6
Insertion of intravenous line cannula:
1. Wash hands and wear the gloves

2. Take the cannula from the protective cover
3. Use non dominant hand to pull the shin taut below the entry site
4. Hold the cannula at 15 – 30 degrees with bewel up and insert it through
the skin
5. Once the needle entered the skin lower the angle of the needle so that it
would become parallel with the skin and enter vein
6. When back flow of the blood occurs into the tubings insert the needle
about one inch and loosen the tourniquet
7. Remove the stillette slowly
8. Stabilizes the cannula by applying a gentle but firm pressure at the site of
the tip of cannula with non dominant hand
9. Quickly connect the end of IV tubing to cannula
10. Release the roller clam slowly to flow the fluid
11. Remove the gloves and the tourniquet
12. Secure the cannula by a readymade easy fix plaster
13. Adjust the flowrate
Aftercare of baby and articles
1. Collect all used articles washed, cleaned and replaced and dispose the
waste appropriately
2. Wash hands
3. Observe the client for adverse reaction at the site of cannula insertion,
such as pain, infliltration, allergic reaction etc.
4. Ask the baby mother (or) relatives to report if any unfavorable signs such
as fever, chills, etc. occur
5. Document the procedure with date, time, type of intravenous fluid and
drops per minute, with signature
7
DAILY CARE OF INTRAVENOUS LINE CANNULA:
1. Provide information to baby mother regarding intravenous cannula care

2. Wash hands
3. Prepare all the articles for the care of intravenous line cannula care
Clean tray with
1. Soap and soap dish

2. Normal saline (0.9%) – 1 bottle with top covering
3. Sterile syringe with protective covering
4. Kidney tray (1)
5. Steel bowl with cotton swabs(2)
6. Check the cannula insertion site is clean and dry without soiled
7. Check all the intravenous line connection such as leurlockplug, roller clamp.
IV tubing insertion site etc for tightness when not in use
8
8. Inspect the site of cannula insertion for adverse reaction such as pain,
thrombophlebitis etc,
9. Take 2 ml of normal saline (0.9%) from the IV bottle in aseptic manner in a
sterile 5 ml syringe
10. Flush the intravenous line cannula with 2 ml normal saline (0.9%) twice
(morning & evening ) within a minute (except for intravenous normal saline)
11. Instruct the patient (or) caretaker to report if any chills, fever, edema, etc.
12. Collect all the used articles, replaced properly and dispose the waste
appropriately.
13. Wash hands.
14. Document the procedure (date, time, condition of vein) with signature.
REMOVAL OF INTRAVENOUS LINE CANNULA
1. Provide the information to the baby mother about the removal of cannula
2. Wash hands
3. Prepare and then arrange all the articles for the intravenous cannula removal
nearby baby bedside in a clean stool.
Sterile tray with
9
a.Intravenous line cannula care kit containing
Steel bowl – 1
Swabs – 2
Sterile towel – 1
Sterile gloves
Clean trey with
 Soap with soap dish

 Adhesive plaster with scissors
 Kidney tray – 1
 Surgical spirit
 Mackintosh, towel
1. Place a clean mackintosh and a clean towel under the intravenous line
cannula insertion site
2. Loosen the adhesive slowly from the surrounding s towards cannula
insertion site by applying counter traction to the skin
3. Hold a spirit swab over the venipuncture site
4. Withdraw the cannula by keeping it parallel to skin
5. Apply firm pressure for 2 to 3 minutes and hold the extremity above the
level of heart
6. Place sterile cotton over vein puncture site with adhesive tape
7. Examine catheter to see if it is intact and report if any part is missing
8. Check the site for any adverse reaction such as bleeding, pain etc.
9. Collect all the used articles for removal of intravenous line cannula,
washed, replaced and dispose the waste appropriately
10. Wash hands
11. Document the procedure (date, time and action of cannula insertion site)
with signature.
10
COMPLICATIONS OF INTRAVENOUS LINE CANNULATION
Local complications
 vein roll : rolling of vein cause multiple attempts

 haematoma : formed by leakage of blood from vein to surrounding tissuse
due to inappropriate vein puncture
 Infiltration: occurs when irritant solution (or) medicine enters the
subcutaneous tissue rather than the vein Eg. I.V fluids
 Extravasation : occurs when irritant solution (or) medicine enters to
surrounding tissues.
 Thrombo phlebitis : inflammation of vein due to septic measures and
mechanical (or) chemical irritation (or) infection
 Thromboembolism : occurs when a blood clot on catheter (or) vein wall

bedetached and is carried by the venous flow to heart and pulmonary
circulation
 Clotting : occurs when infusion is not flushed appropriately
11
SYSTEMIC COMPLICATIONS:
 fluid over load : due to on non adjustment of fluid rate (or) drops
 air embolism : a possible hazard during all forms of intravenous therapy
due to careless administration without expelling air in tube
 infection:
 nerve damage : due to improve placement of arm (or) too tight tying of
arm board (or) splint
SELF PROTECTION MEASURES FOR NURSES
 The use of protective sterile glove is advised for this procedure

 Nerve resheath needle to prevent stick injury. In the event of a needle stick
injury, squeeze and expresses blood and wash hands under running water
and take remedial measure soon.
CONCLUSION:
Intravenous line cannulation is increasing being performed by nurse in a

variety of clinical settings. To undertake this procedure successfully, a range of
knowledge and skill is required. Also in most institution policies and procedures
are there is order to avoid complications.
12
13
Neonates admitted in NICU. Arrange all articles in nurse station
14
Assessment and identification of vein Administering intravenous cannula
15
Observation of any complications. Proper replacement of articles
16
Adjust the flow rate
17
18

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EFFECTIVENESS OF NURSING INTERVENTION ON

PREVENTION OF INTRAVENOUS THERAPY RELATED

Dissertation submitted to the Pondicherry University, Pondicherry in

Master of Science in Nursing

Under the guidance of

Mrs .SARASWATHI.L. Msc, NURSING

HOD (cum) Professor

SRI MANAKULA VINAYAGAR NURSING COLLEGE,

NAME OF THE CANDIDATE : ASWINI.S

REGISTER NUMBER : 12MSN302

NAME OF THE GUIDE :Mrs.L.SARASWATHI, MSC(N)

Head of the Department

NAME OF THE CO-GUIDE :Mrs.D.VASANTHAKUMARI, MSC(N)

DEPARTMENT : CHILD HEALTH NURSING

Signature of the Signature of the

Approved By Dissertation Committee in July 2014

PROFESSOR IN NURSING RESEARCH:

DR.R. DANASU, M.Sc. (N) MA (Socio), M.Phil., Ph.D.(N)

Principal, College of Nursing

Sri ManakulaVinayagar Nursing College,

PROFESSOR IN CLINICAL SPECIALITY AND GUIDE:

Mrs.L, SARASWATHI. M.Sc. (N),

Head of the Department,

A DISSERTATION SUBMITTED TO THE PONDICHERRY

ENDORSEMENT BY THE PRINCIPAL/ HEAD OF THE

This is to certify that the dissertation titled “ASTUDY TO

SIGNATURE OF HEAD OF THE INSTITUTION

DR.R. DANASU, M.Sc. (N) MA (Socio), M.Phil., Ph.D.(N)

CERTIFICATION BY THE GUIDE

This is to certify that the dissertation titled “A STUDY TO EVALUATE

THE EFFECTIVENESS OF NURSING INTERVENTION ON

PREVENTION OF INTRAVENOUS THERAPY RELATED

COMPLICATIONS AMONG NEONATES ADMITTED IN NICU AT

SMVMCH PUDUCHERRY” in partial fulfillment of the requirement for the

degree of Master of science in Nursing in Child Health Nursing.

SIGNATURE OF THE GUIDE

HODCHILD HEALTH NURSING,

SRI MANAKULA VINAYAGAR NURSING COLLEGE,

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation/thesis titled “A STUDY TO

EVALUATE THE EFFECTIVENESS OF NURSING INTERVENTION

ON PREVENTION OF INTRAVENOUS THERAPY RELATED

COMPLICATIONS AMONG NEONATES ADMITTED IN NICU AT

SMVMCH PUDUCHERRY.” is a bonafide and genuine research work carried

out by me under the guidance of Dr.R. DANASU, Principal Sri Manakula

Vinayagar Nursing College, Kalitheerthalkuppam, Puducherry.

SIGNATURE OF THE CANDIDATE

DECLARATION BY THE CANDIDATE

I hereby declare that the Pondicherry University, Puducherry shall have

electronic format for academic/ research purpose.

SIGNATURE OF THE CANDIDATE

I extremely thankful to the Sri Manakula Vinayagar Medical College and

Hospital for giving me an opportunity to accomplish this project work in their

I am grateful to Shri.N.Kesavan, (Late)former Chairman and founder

of Sri ManakulaVinayagar educational trust, for the facilities offered in this

I express my appreciation to Shri. M.Dhanasekaran, chairman cum

Managing Director, who extended the opportunity for this endeavor.

I wish to extend my heartfelt thanks to Shri.S.V.Sugumaran,Vice

chairman , Sri Manakula Vinayagar educational trust for his support.

I express my sincere thanks and heartiest gratitude to principal

Dr.R. Danasu, Principal, of Sri ManakulaVinayagar Nursing College, for lay

helped me to accomplish this study.

It is my great pleasure and privilege to express my deep sense of gratitude