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Abstract
RIASSUNTO L'esecuzione da parte degli infermieri di un accurato accertamento vascolare all'inizio e per tutta la durata della terapia infusiva, insieme all'individuazione del dispositivo più adatto al paziente, può aumentare la soddisfazione del paziente, diminuire le complicanze, preservare le vene periferiche, diminuire o eliminare il tempo impiegato dagli infermieri a reperire accessi venosi improbabili, ridurre i costi associati alla terapia infusiva. Gli obiettivi sono stati di indagare la presenza di una procedura per la scelta del dispositivo venoso più adeguato al paziente, descrivere i criteri utilizzati per la valutazione del letto vascolare, identificare il momento in cui gli infermieri eseguono la valutazione del letto vascolare. E' stato svolto uno studio descrittivo con campione di convenienza composto da 290 infermieri. Lo strumento di raccolta dati utilizzato è un questionario anonimo. I questionari somministrati, restituiti e ritenuti validi sono stati 227. Il 14% del campione afferma che è in uso una procedura per valutare il dispositivo venoso più adatto per ogni paziente mentre, il 70% dichiara che non è in uso e il 16% che non sa se c'è una procedura. I risultati dello studio mostrano che nelle unití operative appartenenti al campione (1) non è in uso una procedura per la scelta del dispositivo più adeguato al paziente, (2) che gli infermieri non hanno chiari i criteri per effettuare la valutazione del letto vascolare, (3) che essi effettuano la valutazione del letto vascolare in momenti differenti del processo infusivo.
Parole Chiave: accertamento vascolare, selezione dispositivo venoso, accesso vascolare, terapia infusiva, linee guida pratiche
The accurate vascular monitoring by nurses both at the beginning and during infusion treatment, in addition to the selection of the best device for each patient, can increase patient satisfaction, reduce complications, preserve peripheral veins, reduce or eliminate time used to find unlikely vein access, reduce hospital stay length and reduce the costs associated with infusion treatment. Aims of study are to ascertain the presence of a procedure for choosing the most suitable venous device for each patient, to identify nurses' criteria to make a vascular assessment, and to describe when nurses make a vascular assessment. A descriptive study with convenience sample of 290 nurses. The data collection instrument is an anonymous questionnaire. The questionnaires administered, returned, and considered valid were 227. 14% of the sample states that within their ward there is a a procedure to evaluate the most suitable device, while 70% states the opposite and 16% of the sample states that "they do not know". The results show fairly clearly that in the wards considered there is no procedure currently in use in order to choose the most suitable device for each patient, that nurses do not have clear criteria to make a vascular assessment, that they carry out vascular assessment at different times of the infusion's process.
Key words: vascular assessment, venous device selection, vascular access, infusion therapy, practice guidelines
Dettagli dell'articolo
Riferimenti
- Barton, A., Danek, G., Johns, P., & Coons, M. (1998). Improving patient outcome through CQI: Vascular access planning. Journal of Nursing Care Quality, 13 (2), 77-85.
- Bowen Santolucito, J. (2001). A retrospective evaluation of the timeliness of physician initiated PIC referrals. Journal of Vascular Access Devices, fall, 20-26.
- Galloway, M. (2002). Using benchmarking data to determine vascular access device selection. Journal of Infusion Nursing, 25 (5), 320-325.
- Lundgren, A., & Ek, A.C. (1996). Factors influencing nurses' handling and control of peripheral intravenous lines - an interview study. International Journal of Nursing Studies, 33, 131-42.
- Kagel, E.M., & Rayan, G.M. (2004). Intravenous catheter complications in the hand and forearm. The Journal of Trauma, 56 (1): 123-27.
- Maki, D.G., Kluger, D.M., & Crnich, C.J. (2006). The risk of bloodstream infection in adult with different intravascular device: a systematic review of 200 published prospective studies. Mayo Clinic Proceedings, 81 (9), 1159-71.
- Tagalakis. V., Kahn, S.R., Libman, M., & Blostein, M. (2002). The epidemiology of peripheral vein infusion thrombophlebitis: a critical review. American Journal of Medicine, 113 (2): 146-51.
- Myrianthefs, P., Sifaki, M., Samara, I., & Baltopoulos, G. (2005). The epidemiology of peripheral vein complication: avaluation of the efficiency of differing methods for the manteinance of catheter patency and thrombophlebitis prevention. Journal Evaluation of Clinical Practice, 11 (1): 85-89.
- Maki, D.G., & Ringer, M. (1987). Evaluation of dressing regimens for prevention of infection with peripheral intravenous catheters. Gauze, a transparent polyurethane dressing, and an iodophor-transparent dressing. JAMA, 258 (17), 2396-2403.
- Smith, B. (2006). Peripheral intavenous catheter dwell times: a comparison of 3 securement methods for implementation of 96-hour scheduled ch'ange protocol. Journal of Infusion Nursing, 29(1), 14-17.
- Kokiotis, K. (2001). New trends in vascular access therapy. Journal of Vascular Access Device, Summer, 7-17.
- Smith Higuchi, K.A., Edwards, N., Danseco, E., Davies, B., & McConnel, H. (2007). Development of an evaluation tool for clinical practice guideline on nursing assessment and device selection for vascular access. Journal of Infusion Nursing, 30 (1), 45-54.
- Registered Nurses Association of Ontario (2004). Assessment and device selection for vascular access with 2008 supplement. Toronto, Ontario. Data accesso 14 maggio, 2012. da http://www.rnao.org/Page .asp?PageID=924& ContentID=718
- Royal College of Nursing (2010). Standards for infusion therapy. Third Edition, January 2010. London. Data accesso 14 maggio, 2012. da http://www.rcn.org.uk/__data/assets/pdf_file/0005/78593/002179.pdf
- Centers for Disease Control and Prevention (2002). Guidelines for the prevention of intravascular catheter-related infections. Morbidity and Mortality Weekly Report 51 (RR-10), 1-32. Data accesso 14 maggio, 2012. da http://www.cdc.gov/mmwr/indrr_ 2002.html
- Karadeniz, G., Kutlu, N., Tatlisumak, E., & Ozbakkaloglu, B. (2003). Nurses' knowledge regarding patients with intravenous catheter and phlebitis interventions. Journal of Vascular Nursing, 21 (2), 44-49.
- Larsen, P., Eldridge, D., Brinkley, J., Newton, D., Goff, D., Hartzog, T., Saad, N.D., & Perkin, R. (2010). Pediatric peripheral intravenous access: does nursing experience and competence really make difference?. Journal of Infusion Nursing, 33 (4), 226-35.
- Stranz, M. (2002). Adjusting pH and osmolarití levels to fit standards and practices. Journal of Vascular Access Devices, fall, 12-17.
- Ryder, M. (1995). Peripheral access options. Surgical Oncology Clinics of North America, 4 (3), 395-427.
Riferimenti
Barton, A., Danek, G., Johns, P., & Coons, M. (1998). Improving patient outcome through CQI: Vascular access planning. Journal of Nursing Care Quality, 13 (2), 77-85.
Bowen Santolucito, J. (2001). A retrospective evaluation of the timeliness of physician initiated PIC referrals. Journal of Vascular Access Devices, fall, 20-26.
Galloway, M. (2002). Using benchmarking data to determine vascular access device selection. Journal of Infusion Nursing, 25 (5), 320-325.
Lundgren, A., & Ek, A.C. (1996). Factors influencing nurses' handling and control of peripheral intravenous lines - an interview study. International Journal of Nursing Studies, 33, 131-42.
Kagel, E.M., & Rayan, G.M. (2004). Intravenous catheter complications in the hand and forearm. The Journal of Trauma, 56 (1): 123-27.
Maki, D.G., Kluger, D.M., & Crnich, C.J. (2006). The risk of bloodstream infection in adult with different intravascular device: a systematic review of 200 published prospective studies. Mayo Clinic Proceedings, 81 (9), 1159-71.
Tagalakis. V., Kahn, S.R., Libman, M., & Blostein, M. (2002). The epidemiology of peripheral vein infusion thrombophlebitis: a critical review. American Journal of Medicine, 113 (2): 146-51.
Myrianthefs, P., Sifaki, M., Samara, I., & Baltopoulos, G. (2005). The epidemiology of peripheral vein complication: avaluation of the efficiency of differing methods for the manteinance of catheter patency and thrombophlebitis prevention. Journal Evaluation of Clinical Practice, 11 (1): 85-89.
Maki, D.G., & Ringer, M. (1987). Evaluation of dressing regimens for prevention of infection with peripheral intravenous catheters. Gauze, a transparent polyurethane dressing, and an iodophor-transparent dressing. JAMA, 258 (17), 2396-2403.
Smith, B. (2006). Peripheral intavenous catheter dwell times: a comparison of 3 securement methods for implementation of 96-hour scheduled ch'ange protocol. Journal of Infusion Nursing, 29(1), 14-17.
Kokiotis, K. (2001). New trends in vascular access therapy. Journal of Vascular Access Device, Summer, 7-17.
Smith Higuchi, K.A., Edwards, N., Danseco, E., Davies, B., & McConnel, H. (2007). Development of an evaluation tool for clinical practice guideline on nursing assessment and device selection for vascular access. Journal of Infusion Nursing, 30 (1), 45-54.
Registered Nurses Association of Ontario (2004). Assessment and device selection for vascular access with 2008 supplement. Toronto, Ontario. Data accesso 14 maggio, 2012. da http://www.rnao.org/Page .asp?PageID=924& ContentID=718
Royal College of Nursing (2010). Standards for infusion therapy. Third Edition, January 2010. London. Data accesso 14 maggio, 2012. da http://www.rcn.org.uk/__data/assets/pdf_file/0005/78593/002179.pdf
Centers for Disease Control and Prevention (2002). Guidelines for the prevention of intravascular catheter-related infections. Morbidity and Mortality Weekly Report 51 (RR-10), 1-32. Data accesso 14 maggio, 2012. da http://www.cdc.gov/mmwr/indrr_ 2002.html
Karadeniz, G., Kutlu, N., Tatlisumak, E., & Ozbakkaloglu, B. (2003). Nurses' knowledge regarding patients with intravenous catheter and phlebitis interventions. Journal of Vascular Nursing, 21 (2), 44-49.
Larsen, P., Eldridge, D., Brinkley, J., Newton, D., Goff, D., Hartzog, T., Saad, N.D., & Perkin, R. (2010). Pediatric peripheral intravenous access: does nursing experience and competence really make difference?. Journal of Infusion Nursing, 33 (4), 226-35.
Stranz, M. (2002). Adjusting pH and osmolarití levels to fit standards and practices. Journal of Vascular Access Devices, fall, 12-17.
Ryder, M. (1995). Peripheral access options. Surgical Oncology Clinics of North America, 4 (3), 395-427.