الفهرس 
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Abstract
Vascular access is frequently required in hospitalized infants and neonates for a number of clinical conditions. Peripheral intravenous cannula (PIC) as a short-term vascular access is required for the delivery of intravenous fluids, medication, blood product administration, and for obtaining blood for laboratory analysis. Long-term vascular access is required for total parenteral nutrition, chemotherapy, and pharmacotherapy, e.g. antibiotics. Establishment of a reliable vascular access is potentially a life-saving procedure and a critical step in resuscitation during an emergency in infants and children (Moreal et al., 2021).
The choice of vascular access device depends upon the clinical condition, the likely duration and frequency of treatment, and the properties of the infusate, gestational age, birth weight, comorbidities, previous history of infusion therapy, and ability/resources available for inserting and maintaining the device. Therefore, sound knowledge of indications, contraindications, advantages, and disadvantages of different types of vascular access is required to provide the best care for the sick neonates (Chin et al., 2018).
Peripheral intravenous (PIV) catheters allow for the provision of life-saving medications and are commonly utilized for patients admitted to the pediatric intensive care unit (PICU). PIVs are at risk for failure and complications including extravasation with local tissue injury, especially in critically ill children. While most PIV complications are mild, severe extravasations can lead to significant morbidity including compartment syndrome. To minimize the risk of complications, PIVs must be assessed routinely to determine whether they remain intravascular. Implementation of hourly PIV assessment by nurses decreased the rate of extravasation at one pediatric hospital (Garland et al., 2017).
Neonatal nurses are often required to place intravenous lines in neonates and children as part of the routine care. Cannulation of a vein is one of the most important procedures that neonatal nurses need to perform with precision and minimal discomfort to the children. Cannulation not only involves placing the intravenous cannulas at an appropriate location but also requires the nurses to monitor and maintain access to the circulatory system (Morgaonkar et al., 2017).
Aim of the study:
The present study aimed to assess nurse’s performance regarding intravenous access for neonates in intensive care unit.
Research Questions:
What are the nurses’ knowledge regarding intravenous access for neonates in neonatal intensive care unit?
What are the nurses practice regarding intravenous access for neonates in neonatal intensive care unit?
What is the nurses attitude regarding intravenous access for neonates in intensive care unit?
Are there a relation between total nurses’ knowledge & practice and their attitude regarding intravenous access for neonates in neonatal intensive care unit?
Research design: A descriptive design was used to conduct this study.
Research Setting: This study was conducted at neonatal intensive care unit (NICU) at Menyat El Nasr hospital affiliated to Dakahliya Directorate of health.
Research Subject: A convenient sample included all available nurses at the NICU of the previous mentioned setting for 3 months regardless their age, qualifications, years of experience and attending training courses regarding intravenous access for neonates.
Three tools were utilized to collect the data during the study period:
I- Predesigned Questionnaire Format: It was designed by the researcher in a simple Arabic language after reviewing the related literature and consists of following parts:
Part I: characteristics of studied subject as the following:
a- characteristics of studied nurses include: age, qualification, years of experience, and attending training courses regarding intravenous access for neonates.
b- characteristics of studied newborns include: Gestational age, chronological age, duration of hospitalization in NICU by days, gender, birth weight, current weight, infant ranking in the family, diagnosis and type of delivery.
Part II: Assessment of nurses knowledge regarding intravenous access in intensive care unit include: importance of intravenous access, types, indications of each type, sites of insertion, appropriate size of cannula, advantages and disadvantages, repeating attempts, sings of infection, using transparent medical adhesive, duration of cannula removal after insertion and complications of peripheral venous cannula, moreover indications, contraindications of umbilical venous catheter, long duration of umbilicus is able to insert catheter, the difference between vein and artery, confirmation methods after insertion, the different sizes of the catheter and complications of umbilical venous catheter.
Scoring system: Nurses knowledge was determined by summing up the scores from responses to questions, and the whole number of each question was (0-1). Zero for wrong answer. One for right answer. The total questions of nurses’ knowledge were (19) questions, (4) of them were closed questions and the other (15) were multiple choice questions. The total score was (19) degree, each item equals one degree. The sum of scores at the end of questionnaire was categorized as good knowledge if score ≥14 point, also be considered average knowledge if score 11-14 point and poor knowledge when score <11 point.
II: An observational checklist:
There are three observational checklists, one of them on peripheral venous cannula, and others about umbilical venous catheter. The checklist of peripheral cannula was adapted from the children hospital at west mead (CHW) policy and procedure committee(McCallum and Higgins, 2017) and modified by the researcher to assess nurse’s practice regarding intravenous cannula for neonates in intensive care unit, while the other checklists of umbilical catheter was adopted from Royal Corn Hospital Neonatal clinical Guideline(2018)and used to assess actual assessment of insertion of umbilical venous catheter for neonates in intensive care unit.
1- The chick list of peripheral venous cannula consisted of (17 items) and the total score was (17 degree). Each item equals one degree. scoring system was followed to assess nurses’ practice regarding intravenous cannula was determined by the scores from the responses to the statements and the whole number of each statement was (0-1) - Zero for not done. -One mark for done. The sum of scores at the end of checklist was categorized as: Competent if score ≥ 90%. Incompetent if score <90%.
2- The checklist of umbilical venous catheter before insertion consisted of (14 items) and the total score was (14 degree). Each item equals one degree as following: Zero for not done. One mark for done. The sum of scores at the end of checklist was categorized as: Competent if score ≥ 90%. Incompetent if score <90%. 3-The checklist of umbilical venous catheter care after insertion consisted of (8items) and the total score was (8degree). Each item equals one degree as following: Zero for done. One mark for not done. The sum of scores at the end of checklist was categorized as: Competent if score ≥ 90%. Incompetent if score <90%.
III: Attitude assessment scale:
A modified Likert scale type rating scale was used to assess nurses attitude regarding intravenous access in the NICU (Bertram, 2010).
Scoring system: A scoring system was followed to assess nurses’ attitude toward neonatal intravenous access in the NICU consisted (16 item) and determined by summing up the scores from nurses’ responses and accordingly and the whole number was (1-3).1mark for agree, 2 marks for uncertain and 3 marks for disagree. The scores of all the scale statements was summed up and total scoring will be classified into 2 categories: Positive attitude if score ≥60%. Negative attitude if score<60%.
The present study shows that:
• The mean age of studied nurses is Mean ± SD 28 ± 9.77 with 65% of them aged 20 < 30 years, also regarding qualification 38.4% of them have are qualified in health technical institute.
• More over 45.0% of studied nurses have 5 < 10 year of experience and 83.3% of them attended training courses regarding intravenous administration for neonates, 70.0% of neonate their gestational age < 37 week, 68.3% of them their age on admission <10 days,
• Also 46.7 of them their length of stay in the unit 20≤ 30 days, more over 36.7% of them their birth weight is < 1500 grams, 38.3% of them their current weight was ≥3500 grams,
• Also 33.2% of them have hydrocephalus and 100.0% of them their type of birth is caesarean section, 68.3% of studied neonates are male, while 31.7 of them are female, 61.7% of studied neonates are the first in neonates ranking and 30% of them are second in neonates ranking, 33.2% of them have medical diagnosis of hydrocephalus and 25% of them have jaundice.
o Also, the present study reveals that 95.0% of studied nurses have right answer regarding “Using of the peripheral venous cannula”, “The appropriate sites for the insertion of peripheral venous cannula”, “The appropriate size for the peripheral venous cannula in neonates” “ Advantages of peripheral cannula in neonates” and “Repeating attempts of peripheral Cannula insertion increases the chances of infection”, While 91.7% of them of them have wrong answer regarding “Days which the peripheral cannula should be removed after insertion”
o 70.0% of them have wrong answer regarding “Disadvantages of peripheral venous cannula in neonates”, 78.3% of studied nurses have right answer regarding “Contraindications umbilical catheter insertion” and “Methods of confirmation after the umbilical catheter insertion”. While 45.0% of them have wrong answer regarding “Long duration of neonates’ umbilicus is able to insert catheter”,
o 71.70% of the studied nurses have good knowledge level regarding intravenous access in neonatal intensive care unit, while 21.70% of them have poor knowledge level,
o All of studied nurses carried out most of the steps related to peripheral cannula insertion, while 16.7 % of them not done two steps (6th & 17th). All studied nurses were done the “Full documentation of procedure and”, “Close monitoring of vital signs” and “Observing the catheter site and the area around it for any swelling or redness”. While 21.7% and 35.0% of them not carried out minimize handling of the line and using a transparent dressing respectively, 66.7% of studied nurses have competent level, while 33.30% of them have incompetent level regarding care of intravenous access for neonates.
o All studied nurses agree that they “ think that washing hands before inserting the peripheral cannula reduces the risk of infection”, “ see that continuous training in peripheral cannulation is necessary in neonatal intensive care units”, “ see that following infection control measures while changing the umbilical catheter prevents infection.” and “think that umbilical venous catheterization is necessary in blood exchange for neonate”, While 60.0% of them Uncertain that they “ think it is possible to use the peripheral cannula after 72 hours as long as no signs of infection appear”.
o On other hand 26.7% and 45.0% of them disagree that documentation of the insertion is not considered necessary and that umbilical venous catheter is important in neonates’ resuscitation respectively, 91.6% of studied nurses have positive attitude regarding intravenous access for neonates in intensive care unit, while 8.8% have negative attitude.
o There is a relation between nurse’s total knowledge regarding intravenous access and their qualification and years of experience with highly statistically significant difference (P<0.01). Also, there is no relation between total practices of studied nurses and their characteristics with no statistically significant difference.
o There is a relation between nurses’ total attitude regarding intravenous access and their qualification and years of experience with statistically significant difference (P<0.05).
o There is a positive correlation between total nurses’ knowledge and their total practices and total attitude regarding intravenous access for neonates.