الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Peripheral vascular catheter (PVC) care bundle is a high impact intervention used to
reduce the incidence of PVCs complications among the critically ill patients. This care
bundle is based on the guidelines, expert advice and other national infection prevention and
control guidance. The PVC care bundle has been established as a vital component of
successful nursing management especially among the critically ill patients. Because they
require high-intensity care and may be at considerable risk of iatrogenic injury due to the
severity of their illness and the frequent need for high-risk interventions. The care bundle
is a collection of excellent practices combined together by empirical evidence into a single
package, which standardizes administration and monitoring practices, and results in better
patient care. According to the literature, the care bundle decreases complications, length of
hospital stay and the economic burden for both patients and hospital.
Aim of the study
The present study aimed to assess the effect of implementing peripheral vascular
catheter care bundle on occurrence of catheter –related complications among critically ill
Patients.
Materials and method:
A quasi experimental research design was used to conduct this study at the Coronary
Care Unit ”CCU”, Recovery Care Unit of Damanhur Medical National Institute and the
CCU of Kafr El - dawar hospital. Seventy adult patients of either sex were selected
according to the inclusion criteria (Critically ill adult patients attached with PVC at first
day of admission, conscious and able to communicate). One tool „peripheral vascular
catheters assessment record‟ was used to collect data of the present study. Part I and II of
the tool was developed by the researcher to collect patients, socio-demographic (age, sex,
date of admission, diagnosis) and PVC related data (catheterized limb, catheter sites,
catheter size, insertion date and time, removal date and time). Part III was adopted from
Sriupayo et.al. (2014) for infiltration and phlebitis scales, extravasation scale was adopted
from Chiu et.al. (2016) and pain scale was adopted from Morton et.al. (2013). The
presence of local skin infection assessed by appearance of signs and symptoms of infection
and PVC tip culture after removal. The third part was used to assess the occurrence of PVC
complications (infiltration, phlebitis, extravasation, local skin infections, pain and catheter
dislodgement).
Patients who met the inclusion criteria were randomly assigned into two groups:
group A “the control group” and group B “the bundle group”. Each group included thirtyfive
patients. For both groups; Patients, socio-demographic and PVC related data were
recorded on admission. The patients were assessed for the occurrence of PVC
complications once a day in the morning shifts for three days after PVC insertion. The
occurrence of infiltration, phlebitis, extravasation and pain were assessed by the infiltration
scale, phlebitis scale, extravasation scale and pain scale respectively. Presence of local skin
infection was assessed by the appearance of signs and symptoms of PVC related infection
and PVC tip culture after removal. For bundle group; The PVC care bundle was applied
by the researcher. This bundle included two parts. Part I „Peripheral vascular
insertion technique‟ and part II „Peripheral vascular catheter ongoing care‟. Comparison
between the two groups regarding the occurrence of complications was done using
appropriate statistical analysis.
Results
The results of the present study revealed that nearly two thirds of patients were male
in two groups. The mean age of control group was 54.17±13.15 and 53.20 ±10.87 for
bundle group. The most common diagnosis in both groups was related to cardiovascular
disorders followed by neurological disorders. The majority of the bundle group had PVC
with 20 gauges in the forearm site in the left upper limb with retention time three days. The
majority of control group had PVC in the right upper limb, and about half of this group had
PVC with 20 gauge in the back of hand with retention time four days. More than half of
control group and nearly three quarters of bundle group patients receive drugs affect the
immune system.
Regarding the PVC complications occurrence, about one third (34.3 %) of control
group and nearly one quarter (22.9%) of bundle group had grade 1 infiltration through the
third day of PVC insertion. Minor percent of the control group had grade 2 and 3 (8.6% &
5.7% respectively), while grade 2&3 did not occur in the bundle group. The difference
between both groups was statistically significant. Concerning to extravasation grades,
about 25.7 % of patients in the control group and only 5.7% of the bundle group had grade
1 extravasation through the first day of PVC insertion with a significant difference between
the two groups.
As regards phlebitis occurrence, the more frequent phlebitis grades throughout the
study period was grade 1 phlebitis. There was a significant decrease in phlebitis occurrence
throughout the first day of PVC insertion and a highly significant decrease of phlebitis in
the second and third day of insertion among the bundle group compared to the control
group.
As regards pain occurrence, the more frequent pain degrees throughout the study
period was mild pain degree. There was a significant decrease in pain occurrence
throughout the first and second day of PVC insertion and a highly significant decrease of
pain in the third day of insertion among the bundle group compared to the control group.
Regarding to PVC local infection, no local skin infection was identified among the bundle
group, while the PVC local skin infection was identified among the control group with
about fifteen percent.
Conclusion
The study findings revealed that The PVCs complications were higher among the
control group who received the routine hospital care than the bundle group who received
the PVC care bundle. The results of the study also reported that the incidence of local
complications was increased within the third day of the PVC insertion. The study findings
indicated that infiltration, phlebitis and pain were the most common local complications of
the PVCs among the studied patients. Also the incidence of PVC local infection was higher
among the control group whose PVCs removed after four days.
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