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Sinergias educativas

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Nursing educational intervention in the

prevention of complications in health-

related situations

Intervención educativa de enfermería en la prevención

de complicaciones en situaciones relacionadas al área

de salud

Diana Lucila Remache-Márquez

Isabel Cristina Mesa-Cano

Andrés Alexis Ramírez-Coronel

Pedro Carlos Martínez-Suárez

Abstract

A peripheral venous access is the insertion of a catheter to obtain access to

the venous circulation for drug administration or fluid therapy, which is

* Maestrante en Gestión del Cuidado del Posgrados de la

Universidad Católica de Cuenca, Ecuador.,

diana.remache.10@est.ucacue.edu.ec ,

https://orcid.org/0000-0003-0452-9289

* Docente de la Maestría en Gestión del Cuidado del

Posgrados y de la Carrera de Enfermería de la Universidad

Católica de Cuenca, Ecuador. imesac@ucacue.edu.ec ,

https://orcid.org/0000-0003-3263-6145

* Docente de la Maestría en Gestión del Cuidado del

Posgrados y de la Carrera de Enfermería de la Universidad

Católica de Cuenca. Laboratorio de Psicometría, Psicología

Comparada y Etología del Centro de Investigación,

Innovación y Transferencia de Tecnología (CIITT).

andres.ramirez@ucacue.edu.ec, https://orcid.org/0000-

0002-6996-0443

* Docente de la Facultad de Psicología Clínica de la

Universidad Católica de Cuenca. Laboratorio de

Psicometría, Psicología Comparada y Etología del Centro

de Investigación, Innovación y Transferencia de

Tecnología (CIITT). pmartinezs@ucacue.edu.ec,

https://orcid.org/0000-0002-1441-3821

Article

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not exempt from complications, which are preventable. For this reason, an

educational intervention on prevention of complications from peripheral

venous access was developed at Hospital Básico de Paute, through a

quantitative, descriptive, cross-sectional and quasi-experimental study,

with a sample of 38 participants, A survey with 12 questions was

administered to determine the level of knowledge of biosafety measures in

the management of peripheral venous access. The statistical analysis,

descriptive by means of absolute and relative frequencies and measures of

central tendency in both pretest and posttest, normality test by Shapiro

Wilk, t-test for related samples to evaluate the impact of the educational

intervention, was carried out using the statistical program Infostat. Of the

total number of participants, 86% were women. Statistically significant

differences were found (p 0.001) between the pretest and posttest,

obtaining a positive impact, which contributes to strengthening knowledge

on biosafety measures in peripheral venous access, to prevent

complications, improving the quality of care.

Keywords: peripheral venous access, nursing care, prevention of

complications.

Resumen

Un acceso venoso periférico es la inserción de catéter para obtener un

acceso a la circulación venosa para administración de fármacos o

fluidoterapia, por lo cual no está exento de presentar complicaciones las

mismas que son prevenibles es por ello que se desarrolló una intervención

educativa sobre prevención de complicaciones por acceso venoso

periférico, en Hospital Básico de Paute, mediante un estudio cuantitativo,

descriptivo, transversal y cuasi- experimental, con una muestra de 38

participantes, a los cuales se les aplicó una encuesta con 12 preguntas para

determinar el nivel de conocimiento sobre medidas de bioseguridad en el

manejo de acceso venoso periférico, el análisis estadístico, descriptivo

mediante frecuencias absolutas, relativas y medidas de tendencia central

tanto en el pretest como postest, prueba de normalidad mediante Shapiro

Wilk, prueba t para muestras relacionadas para evaluar el impacto de la

intervención educativa, se desarrolló mediante el programa estadístico

infostat. Del total de los participantes el 86% fueron mujeres, se encontró

diferencias estadísticamente significativas (p 0,001) entre el pre y post test,

obteniendo un impacto positivo, que contribuye al fortalecimiento del

conocimiento, sobre medidas de bioseguridad en acceso venoso periférico,

para prevenir complicaciones, mejorando la calidad en la atención.

Palabras clave: Acceso venoso periférico, cuidados enfermería,

prevención de complicaciones.

Introduction

Patient care must be clean and safe to avoid nosocomial infections

in invasive procedures that include the insertion of peripheral lines.

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The use of peripheral venous access in clinical practice is variable,

it constitutes a primordial axis in patient recovery, (Bravo et al.,

2019). Being a procedure in which the skin is invaded by penetrating

a needle until reaching the blood circulation, it is not exempt from

complications, ranging from mild to severe that require receiving

therapeutic and come to increase expenses and hospital stay, this

procedure is managed by nursing staff (Berganza et al., 2017);

(Bravo et al., 2019) In Paraná they demonstrate as a risk factor for

complications: prolonged hospitalization time, use of antimicrobials

and corticosteroids, infusion of solutions, they also recommend: the

procedure should be performed by trained personnel, avoiding

multiple punctures, constant monitoring of puncture sites and in case

of complications make a detailed record, Leal, (2014) In Portugal,

complications predominate; phlebitis and infiltration. In Chile

phlebitis is considered the main complication, while in Ecuador

predominates; hematomas, infiltrations, phlebitis, related to; use of

metacarpal veins, inconclusive aseptic technique, the length of stay

3 days (Contreras & Ríos, 2020), (Vergara, 2017, p. 22).

A peripheral venous access, being an invasive method to have access

to the blood circulation, must be performed with all the biosecurity

measures, considering the evaluation of the clinical condition of each

patient (10). To prevent associated complications should be taken

into account; conditions of the product; caliber, material, size and

length; of the patient: disease, characteristics of the veins,

medications to be administered, permanence, catheter insertion

technique and its maintenance, therefore it should be: choose

adequate caliber, its rotation every 72 hours, fixation with adequate

material, avoid multiple punctures, asepsis of the insertion site,

Berganza et al, (2017) Such a procedure is the responsibility of the

nursing staff from the beginning, its maintenance and removal, it

should be taken into account that their actions are aimed at avoiding

associated complications (Correa, 2019, p. 32).

Based on the above, the following research questions were

formulated: What are the nursing interventions that should be

applied in hospitalized patients requiring peripheral venous access

to avoid complications and maintain the quality of nursing care?

What is the level of knowledge and practice on biosafety measures

in the management of peripheral venous access? In health facilities

it is common the use of intravenous treatment for this, it is required

a peripheral venous access the same that will be destined for the

administration of different therapeutics, directly to the bloodstream,

for fluid therapy, sampling and exclusively for blood transfusions

(Correa, 2019). Nursing care in the hospital environment includes

actions related to the insertion, maintenance and removal of

peripheral venous accesses, since most hospitalized patients have

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one during their hospitalization, in addition to actions such as:

constant monitoring, early detection of possible adverse effects and

taking necessary measures, for all this it is essential that the

professional keeps his knowledge updated and has skills and abilities

(Braga et al., 2018, p. 23).

For Cataldi the selection of the catheter is made according to its

purpose, with different sizes to be used according to the patient's

characteristics and for special situations such as administration of

blood components and patients who are going to undergo surgery,

the size of the catheter should be smaller than the caliber of the

chosen vein. (2021, p. 34)

Causes for complications; Inadequate asepsis since the bacterial

flora on the skin is not eliminated, handling without safety measures,

lack of monitoring of the insertion site, excessive handling of the

equipment, absence of a label indicating the date of permanence,

poor fixation and stabilization of the catheter which hinders the

assessment of the insertion site, The measures to be taken include

the change or definitive withdrawal, in addition to making the

professional aware of the importance of proper management, with

emphasis on biosafety measures (Capdevila, 2013). The most

common complications: extravasation, hematomas, infiltration,

phlebitis, being the characterization of symptoms: edema, erythema,

localized pain/heat and hardening of the vein, presence of palpable

venous cord, sometimes febrile and presence of pus (Urbanetto et al.,

2016). The relationship between nursing interventions and scientific

evidence is variable due to factors related to the patient, their

environment, institution and the knowledge of the professional,

which have generated risk factors within health care, so it is

necessary to implement standardized interventions that allow the

updating of knowledge to bring them to daily practice, improving the

quality of care, Oliveira et al., (2019).

The main objective was to develop an educational intervention in

nursing aimed at the prevention of complications due to peripheral

venous access, in the Basic Hospital of Paute in the province of

Azuay, based on this, the following specific objectives were

proposed: 1- To characterize the study population according to

variables of research interest, 2 - To identify the level of knowledge

about biosafety measures that contribute to the prevention of

complications due to the use of peripheral venous access that nursing

professionals of the study context possess. 3- To apply a nursing

educational intervention on the prevention of complications due to

peripheral venous access, in the research setting. 4- To evaluate the

impact of the educational intervention on the degree of knowledge

acquired.

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Materials and methods

This is a quantitative descriptive cross-sectional study with a quasi-

experimental design (pretest, educational intervention and posttest).

For the following study there was a population of 40 nurses,

auxiliary nurses and rotating nursing interns of the Hospital Básico

de Paute, in the province of Azuay, Ecuador. A non-probabilistic

sampling was carried out. The sample consisted of 38, according to

the Sierra Bravo formula of 1988, the error (5%) we made in

estimating the sample size, based on a confidence level of 99%.

As indicated by Gamboa et al. (2019), the study included nurses with

appointments and/or contracted nurses, auxiliary nurses and rotating

nursing interns who work at the Hospital Básico de Paute and who

wished to participate voluntarily in the research. And, those who

presented a disability and were suffering from an illness were

excluded. Is the cannulation of a peripheral venous line defined as,

Is the cannulation of a peripheral venous line used for, Does the

inadequate cannulation of peripheral lines imply the appearance of

the following complications? Does peripheral line cannulation

involve a set of health risks to the nurse, such as, Is the risk of local

infection due to peripheral venous line cannulation due to, To

maintain biosafety before placing the peripheral venous line should

follow the following order, Is skin disinfection before peripheral

venous line cannulation performed in the following manner, What is

the correct sequence during peripheral venous line cannulation, For

clinical hand washing should the following be taken into account?

To discard the catheter needle after cannulation of the peripheral

venous line, the following should be taken into account, List in the

parentheses the sequence to be followed in ascending order as it

corresponds to each premise, Relate as appropriate by writing in the

parentheses the letter that corresponds to the device where the

contaminated material would be placed. Questionnaire validated by

the judgment of 7 experts in 2010 by Mayorca, the scales used for

its validation are the following: Crobach's scale: in the 12 items it

exceeds 0.65, which proves its validity.

Kuder-Richardson test: 0.7 for knowledge, which is defined as

highly reliable. The survey consisted of 12 questions that evaluated

knowledge of activities performed before, during and after the

procedure, with emphasis on maintaining adequate biosafety

standards when cannulating a venous line, which contributes to

preventing complications. The following parameters were taken into

account in these activities: general knowledge of venous line

cannulation, its use, possible risks and complications, hand hygiene

(indicated moment, clinical hand washing, use of gloves), skin

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disinfection, catheter selection and insertion, and finally, the correct

disposal of waste generated during the procedure.

The research was carried out by accessing the sample. First, the

respective permissions were requested from the director and nursing

management leader of the Hospital de Salud de Paute. Subsequently,

the participants were socialized with the purpose of informing them

of the objectives of the research, after which the prestest was applied

to collect the sociodemographic variables and provide the

questionnaire on the knowledge of biosafety measures in peripheral

venous line cannulation. The data of each subject, in rows, were

determined by means of an identifier code; in no case were names,

surnames, ID card numbers or e-mail addresses recorded; therefore,

the subjects were not identified.

Results

Of the total of 38 participants: 31 (82%) were women, of which 25

(66%) corresponded to the hospitalization service, 18 (47%) were

nursing graduates followed by 11 (29%) nursing assistants, in

relation to age 12 (32%) over 36 years followed by 10 between ages

20 to 25, in years of experience 14 (37%) predominated between 0

to 2 years followed by 10 (26%) between 6 to 10 years.

Of the 100% of participants, in the pre-test only 63% (n=14) knew

about the health risks involved in venous cannulation, after the

training 97% (n=37) were able to identify them, 76% (n=29) in the

pre-test identified the risks for venous access and in the post-test

95% (n=36) did so adequately, 63% (n=24) identified the adequate

biosafety measures before cannulation of the venous line and in the

post test 95% (n=36) identified them, in the pre-test 68% (n=26)

knew about skin disinfection and the post test showed that 95%

(n=35) , 29% (n=27) knew the correct sequence of venous

cannulation in the pre-test, while in the post-test it was 92% (n=35),

in the pre-test 76% (n=29) knew about hand washing and in the post-

test it was 95% (n=35), in the pre-test 95% (n=35) identified the

classification of sharps and in the post-test it was 97% (n=37), In the

pre-test only 79% (n=30) knew about the steps to follow once the

procedure was finished, after the training 97% (n=37) knew about it,

in the pre-test 84% (n=36) classified the waste after the procedure

was finished and in the post-test it was evidenced that 100% (n=38).

The educational intervention was carried out in 40 hours, with the

use of available material and resources, where basic knowledge on

peripheral venous access cannulation was addressed, including

biosafety measures before, during and after the procedure, as well as

the main complications, and the corresponding actions to prevent

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and treat them in case of occurrence, emphasizing the importance of

continuous monitoring and proper management of peripheral venous

access that contributes to the prevention of associated complications.

The intervention was developed according to the established norms

and based on studies carried out to improve knowledge and

guarantee the quality of care.

An analysis of differences was performed using the T-test for related

samples, in which statistically significant differences were found (p

0.001) between the pre- and post-test on knowledge of biosafety

measures in peripheral venous line cannulation, that is, in the post-

intervention test a mean of 1.63 was obtained, which is within the

optimal level, since in the pre-test it was 8.97, equivalent to an

acceptable level.

Discussion

In the present study it was shown that 82% were women, within the

age range over 36 years old, followed by the range 20 to 25 years

old, 47% were graduates in nursing, with 66% working in the

hospitalization service, with a predominance of 0 to 2 years of

experience (37%), followed by the range 6 to 10 years (26%). In the

study with title; peripheral venous catheter: phlebitis and patient

safety, the nursing staff who participated was mostly female (72%),

with a mean age of 33.7 years (Braga et al., 2018). In Brazil a study

on nursing care in safe peripheral venous line cannulation in

hospitalized elderly, the sample was constituted by nine nursing

professionals of female gender of which were; 2 nurses and 7 nursing

technicians, ranging in age from 25 to 49years, with work experience

from 6 months to 16 years in the service (Rodrigues et al., 2021, p.

4).

According to the study; knowledge and nursing criteria to avoid

phlebitis in neonates with peripheral venous catheter, where the

population was 17 of which, 64.8% were nursing graduates, general

nurses and specialists 17.6% each group, with a predominance of age

between 36 years and older (23.5%) followed by 23.5% between 20

and 24 years, knowledge and attitudes on management and

complications for peripheral venous access were evaluated. In the

study on knowledge about health risks, knowledge improved from

63% in the pre-test to 97% in the post-test, 76% in the pre-test

identified the risks for venous access and in the post-test 95% did so

adequately, 63% identified the adequate biosafety measures before

cannulation of the venous line and 95% in the post-test, 68% in the

pre-test knew about skin disinfection and 95% in the post-test, 29%

knew the correct sequence of venous cannulation in the pre-test,

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while in the post-test, 92% identified the adequate biosafety

measures before cannulation of the venous line and 95% in the post-

test, 29% knew the correct sequence of venous cannulation in the

pre-test, In the pretest 76% knew about hand washing and in the post

test 95%, in the pretest 95% identified the classification of sharps

and in the post test 97%, in the pretest only 79% knew about the

steps to follow once the procedure was finished, after the training it

improved to 97%, in the pretest 84% classified the waste after the

procedure was finished and in the post test 100% did it.

In Brazil, a study on nursing care in safe peripheral venous access

cannulation in hospitalized elderly, defined that safe peripheral

venous access cannulation depends on certain characteristics related

to the type of patient; however, it determined that the care practices

of the professionals are not systematized or standardized, which may

contribute to the occurrence of adverse events, therefore, the need

for continuing education was seen. On the part of the nursing staff,

it was found that the knowledge regarding peripheral venous access

complications is good and in some cases is deficient, they do not

comply with biosafety standards and peripheral venous access

management standards, in addition to the fact that there is no

relationship between practice and knowledge, which contributes to

the occurrence of complications. The educational intervention

carried out in the present study, with the use of available material

and resources, addressed basic knowledge about peripheral venous

access cannulation, biosafety measures before, during and after the

procedure, as well as the main complications and the corresponding

actions to prevent and treat them in case of occurrence, emphasizing

the importance of continuous monitoring and proper management of

peripheral venous access, which contributes to the prevention of

associated complications. The intervention was developed according

to the established norms and based on studies carried out to improve

knowledge and guarantee the quality of care.

In a medical clinic service of a hospital in the central region of

Portugal, when conducting the study the researcher made the

decision to train the nursing staff in order to obtain good results

(Braga et al., 2018). To perform an educational nursing intervention,

one must proceed according to the established standards, in addition

to taking into account skills to be developed based on the educational

training received, which allow minimizing the risks of

complications, taking as reference that they are preventable, if the

nursing action is done under protocols established from the scientific

literature that guarantees the quality of care. This study showed that

the educational intervention had a positive impact on the population

under study, since the pretest mean was 8.97 and the post-test mean

was 1.63, which according to the classification corresponds to an

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increase from an acceptable to an optimal level, finding statistically

significant differences (p 0.001).

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