Immediate and Continuing Care at the Surgical Department - Essay Example

Immediate and Continuing Care at the Surgical Department Introduction As a third year student in nursing, one of the most challenging and memorable experience I had took place at the Surgical Department. During the pre-operation, part of my duty is not limited in monitoring the vital signs of the patients but also identify the patients correctly and ensure that the patients’ IV line is properly regulated, implement a proper administration of pre-surgical medication based on the physician’s order, and make sure that the patients are free from any signs of allergies. During the post-surgical operation, part of my duty includes monitoring the patients for signs of shock, ensure that the patients’ surgical wound is free from infection, and manage the patients’ post-operative pain. At all times, surgical nurses should be able to deliver holistic care to the patients. It means that part of the duty of surgical nurses is to satisfy the pathophysiological, socio-economic, psychological and spiritual dimensions of healthcare. For this reason, it is equally important on the part of surgical nurses to carefully study and re-examine the health and socio-economic consequences of using a prolonged peripheral IV line and the possibility of generating avoidable infection out of using these devices. When I was assigned to care for Mr. Phillip, part of my duty was to regulate his IV line. While regulating his peripheral IV line, I started to wonder how often nurses should change their line to prevent the risk of IV line infection (ONE PROBLEM IDENTIFIED... Delete this part). Is it really safe to extend the patient’s peripheral IV catheter line for up to 96 hours? What does the NHS say about extending the patient’s peripheral IV catheter line from 72 to 96 hours? When exactly is the right time for surgical nurses to change the patients’ peripheral IV lines? To address these research questions, a literature review be conducted based on some peer-reviewed journals. Using search words and phrases like “health consequences of prolonged peripheral IV line journal”, “NHS peripheral IV line”, “hand washing IV line infection”, and “peripheral IV line 72 96 hours journal”, the researcher will gather evidenced-based journals directly from the databases of NCBI/Pubmed, Medline, and Pubmed Central. Based on the actual literature review, a proposed change will be highlighted in this study followed by describing its actual contribution to the nursing practice, the rationale underpinning the proposed change in patient care, alternative strategies and reasons underpinning the final choice of action, ways on how the proposed change in patient care can be evaluated, and its expected outcomes. Prior to the research study conclusion, the ethical and legal considerations behind the implementation of the proposed change will be tackled in details. Literature Review Intravenous catheterization is one of the most common invasive intravenous procedures being performed in patients who were admitted in a hospital. Basically, the main purpose of administering intravenous fluids on admitted patients is important in terms of promoting electrolyte balance in the human body, for rehydration purposes for patients who are dehydrated due to prolonged diarrhoea, to provide the patients with glucose (dextrose) to increase the body’s metabolism, and administration of water-soluble vitamins and other medications like antibiotics into intravenous line. (Morgan, Range, & Staton, 2007; Kozier et al., 2004, p. 1387). Since IV line insertion is invasive by nature, patients who are receiving IV fluids can be at risk of developing hospital-acquired infection. In most cases, the development of intravenous-related infection is related to the failure of health care professionals to apply a strict sterile technique when performing and managing the intravenous insertion and removal process (O’Grady et al., 2002). For instance: The inability of the surgical nurses to maintain the sterility of the dressing used over the catheter insertion site could result to preventable bacterial infection (Machado, Pedreira, & Chaud, 2008; Morgan, Range, & Staton, 2007, p. 20). Since the use of intravenous device is invasive by nature, nurses are responsible in practicing aseptic technique before and after touching the dressing of the patients’ intravenous line. Another major source of intravenous-related infection is the cannulation of peripheral intravenous devices. In line with this matter, several studies suggest that nurses should clean the intravenous cannulation carefully to reduce and prevent the patients from becoming infected (Morris & Heong Tay, 2008; Lavery & Ingram, 2006). Other factors such as the proper selection of the catheter type, insertion site, infusion type, insertion techniques, the length of the catheter placement, the type of dressing used in covering the insertion site, and the overall preparation procedure before the insertion of the intravenous lines can also contribute to the development of intravenous-related infection and the development of phlebitis (Machado, Pedreira, & Chaud, 2008). Several studies suggest that there is a need to replace peripheral IV catheters between 72 to 96 hours to prevent the patients from having the risk of developing infection and/or phlebitis (Machado, Pedreira, & Chaud, 2008; Maki, 2008; Webster et al., 2008; Smith & Royer, 2007). Depending on the protocols in each hospital, some health care providers would replace the IV lines every 72 to 96 hours from the time of IV insertion whereas other health care providers may leave the IV lines until there is a clinical signs that the IV line should be replace. Despite the health benefits the patients can receive out of IV catheterization, it remains a fact that the infusion of peripheral IV lines into a patients’ body is highly associated with the development of infectious and non-infectious adverse situations. Among the common catheter-related complications includes: (1) the development of infections due to the alteration of the skin integrity; (2) blockage; (3) infiltration or dislodgement of the needle causing phlebitis; and (4) the presence of tissue extravasation (Machado, Pedreira, & Chaud, 2008; Maki, 2008; Webster et al., 2008). It is also possible for the patients to experience unknown cause of fever (Webster et al., 2008). With regards to the prolonged use of IV line, Gilles et al. (2008) revealed that there are no sufficient clinical evidences that can prove that changing the IV administration set more frequently can effectively reduce the incidence of bloodstream infection in patients. In fact, the use of IV administration set that does not have any blood or lipids and can be safely use even up to 96 hours without having to think about the risk that the patient might be infected (Gilles et al., 2008). Furthermore, Gilles et al. (2004) revealed that there are quite a lot of research studies made in the past that can provide sufficient evidences that changing the intravenous administration set every 72 hours or more will not increase the patients’ risk of developing infusate-related bloodstream or catheter-related infection. These research findings partly explain why the University Hospital of Leicester and NHS revealed that the IV lines “should be changed every 7 days or sooner if contaminated” (Morgan, Range, & Staton, 2007, p. 14). In case surgical nurses notice a leakage in the insertion site of IV lines, they should immediately change the dressing to prevent the growth of bacteria (Machado, Pedreira, & Chaud, 2008). Proposed Change, Alternative Strategies and Reasoning behind the Final Choice of Action Most of the IV line infection or phlebitis is caused by the inability of the surgical nurses to maintain the sterility of the dressing used to cover the patients’ IV insertion site (Morgan, Range, & Staton, 2007, p. 20) and their failure to observe and practicing aseptic technique before and after they touch the dressing of the patients’ IV line (Morgan, Range, & Staton, 2007, p. 21). Through health teachings, the proposed change will focus on reminding Mr. Phillip to observe proper hand washing before touching the IV insertion site and immediately report to the nurses in case the dressing is soiled. Other than health teachings, alternative strategy includes the need to design and implement a strict hospital guidelines with regards to the practice of proper hand washing or aseptic technique and maintain the sterility of the dressing. Since this study will focus on continuing care, the final choice of action will focus on providing health teachings to the patients. (Actions taken )To ensure that the proposed change is properly implemented, the student nurse discussed with her mentor about the need to teach Mr. Phillip to observe proper hand washing each time there is a need for him to touch the IV insertion site. By explaining the rationale behind the proposed change, the student nurse was able to convince the mentor to support the necessary health teaching intervention. Contribution of the Proposed Change and Rationale Underpinning the Change in Patient Care Student nurses do not have the license to insert IV lines. In fact, all registered nurses are obliged to undergo further training on peripheral cannulae insertion before they can legally perform the IV line insertion process (Morgan, Range, & Staton, 2007, p. 4). Therefore, not all registered nurses have the license to insert IV lines. Surgical nurses will always be the front-liners within the surgical ward. With this in mind, surgical nurses should keep in mind that is is part of their continuing care to closely monitor and regulate the patients’ IV line, educate the patients about the proper way of maintaining the IV line free from infection, troubleshoot problems on IV line, and caring for patients on a regular basis (Morgan, Range, & Staton, 2007, p. 21). Furthermore, it is equally important on the part of the surgical nurses to immediately report problems related to IV line insertion failure, potential risk of nerve injury, IV line infection, mechanical phlebitis, failure to regulate the patients’ IV line, and possible risk of arterial puncture (Morgan, Range, & Staton, 2007, p. 20). Most of the surgical nurses are busy with the delivery of other patient care such as monitoring the patients’ vital signs, identify the patients correctly before the administration of pre- and post-surgical medication as prescribed the physicians, ensure that the patients’ IV line is properly regulated, and make sure that the patients are free from any signs of post-surgical pain, signs of fever and allergies. Therefore, by implementing the proposed change, the patients would learn more about the health consequences of IV line infection and encourage them to report signs of soiled dressign. This strategy will allow the surgical nurses to immediately change the dressing of IV line insertion site each time it is soiled. Eventually, the proposed change would help reduce the risks wherein the patients in surgical ward would suffer from the health and socio-economic consequences of IV line infection (Machado, Pedreira, & Chaud, 2008; Morgan, Range, & Staton, 2007, p. 21). Potential Outcome and Ways on How Change in Care Can be Evaluated The outcome of the proposed change reduces the patient’s risk of IV line infection. To effectively and accurately evaluate the patient’s understanding of the health teaching, the student nurse purposely asked the patient why there is a need to wash their hands before touching the IV line. To closely monitor the patient, the student nurse made use of keen observation to determine whether or not the patient was touching the IV line even without washing his hands. Ethical and Legal Consideration when Implementing the Proposed Change It is the duty of surgical nurses to deliver high standard of care and practice when attending to each patient (Nursing & Midwifery Council, 2008, p. 6). In general, surgical nurses are accountable for the quality of healthcare service they deliver to their patients (Ronis, 2008). Therefore, allowing the patients to suffer from IV line infection can be considered as a form of negligence. When conducting health teachings with regarsd to the importance of proper hand washing or aseptic technique before touching the IV insertion site and maintaining the sterility of the dressing, it is ethical on the part of the student nurse to win the trust of the patients yet maintain a clear professional boundaries at all times (Nursing & Midwifery Council, 2008, p. 4). Aside from treating each patient with respect and dignity, the student nurse should respect their confidentiality and seek for consent before performing any form of care and body contact (i.e. changing the dressing) (Nursing & Midwifery Council, 2008, p. 3). Conclusion Aside from immediately reporting problems on IV line insertion failure, potential risk of nerve injury, IV line infection, mechanical phlebitis, failure to regulate the patients’ IV line, and possible risk of arterial puncture (Morgan, Range, & Staton, 2007, p. 20), surgical nurses should keep in mind that is is part of their continuing care responsibility to closely monitor and regulate the patients’ IV line, educate the patients about the proper way of maintaining the IV line free from infection, troubleshoot problems on IV line, and caring for patients on a regular basis (Morgan, Range, & Staton, 2007, p. 21). The need to change the peripheral IV catheter line is not always dependent on time but mostly on signs of infection due to the alteration of the skin integrity, blockage, infiltration or dislodgement of the needle causing phlebitis, and the presence of tissue extravasation (Machado, Pedreira, & Chaud, 2008; Webster et al., 2008). Since the patients themselves can be a source of IV line infection, I told to my mentor that the proposed change focused on educating the patients about the importance of proper hand washing before or when there is a need for him to touch the IV insertion site and instruct him to report to the nurses any incidence of soiled dressing. After explaining the rationale behind the proposed change, my mentor agreed and supported my suggestions. References Gilles, D., O'Riordan, L., Wallen, M., Rankin, K., Morrison, A., & Nagy, S. (2004). Timing of Intravenous Administration Set Changes: A Systematic Review. Infectious Control Hospital Epidemiology, 25: 240-250. Gilles, D., Wallen, M. M., Morrison, A. L., Rankin, K., Nagy, S. A., & O'Riordan, E. (2008). Optimal timing for intravenous administration set replacement. The Cochrane Collaboration, 4, 1 - 75. Kozier, B., Erb, G., Berman, A., & Snyder, S. (2004). Fundamentals of Nursing: Concepts, Process, and Practice. Pearson Prentice Hall. Lavery, I., & Ingram, P. (2006). Prevention of infection in peripheral intravenous devices. Nursing Standard, 20(49): 49-56. Machado, A., Pedreira, M., & Chaud, M. (2008). Adverse Events Related to the Use of Peripheral Intravenous Catheters in Children According to Dressing Regimens. Rev Latino-am Enfermagem, 16(3): 362-367. Maki, D. G. (2008). Improving the safety of peripheral intravenous catheters. BMJ, 337(7662): 122-123. Morgan, M., Range, S., & Staton, G. (2007, July). NHS. Retrieved October 11, 2012, from Policy and Guidelines for the Insertion, Care and: http://www.knowledge.uhl-tr.nhs.uk/Shared%20Documents/Policies%20and%20procedures/Business%20conduct%20and%20service%20provision%20policies%20and%20procedures/Insertion%20care%20and%20Removal%20of%20Intravenous%20Peripherally%20Inserted%20Midline%20Cathet Morris, W., & Heong Tay, M. (2008). Strategies for preventing peripheral intravenous cannula infection. British Journal of Nursing, 17(19): S14-S21. Nursing & Midwifery Council. (2008, May 1). Retrieved October 11, 2012, from The code: Standards of conduct, performance and ethics for nurses and midwives: http://www.nmc-uk.org/Documents/Standards/The-code-A4-20100406.pdf O’Grady, N. P., Alexander, M., Dellinger, P., Gerberding, J. L., Heard, S. O., Maki, D. G., et al. (2002). Guidelines for the Prevention of Intravascular Catheter–Related Infections. Infection Control and Hospital epideiology, 23(12): 759-769. Ronis, V. (2008, October). NHS. Retrieved October 11, 2012, from Venepuncture Guidelines for Practice: Guidelines for Practice and Training Programme: https://www.lincolnshirecommunityhealthservices.nhs.uk/Staff/sites/default/files/documents/Downloads/CPS012%20Venepuncture%20-%20Guidelines%20for%20Practice%5B1%5D.pdf Smith, B., & Royer, T. I. (2007). New standards for improving peripheral I.V. catheter securement. Doing It Better. Nursing, 37(3): 72-74. Webster, J., Clarke, S., Paterson, D., Hutton, A., van Dyk, S., Gale, C., et al. (2008). Routine care of peripheral intravenous catheters versus clinically indicated replacement: randomised controlled trial. BMJ, 337(7662): 157-160. Read More