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"Phase 1; Exploration of paramedic protocol for field IV insertion" and "Field IVs: To Replace or Not"

Caitlin Wright, En-Dien Liao, and Dr. Deborah Behan

This is a two-phase study. We are willing to have either two different phases for you to publish, or combine our two studies into one manuscript for publication. HURCA Abstract Caitlin Wright, Senior II Nursing Faculty Advisor: Dr. Deborah Behan, PhD, RN-BC Phase 1; Exploration of paramedic protocol for field IV insertion Current protocol at a south central hospital in the U.S. requires nurses to change field IVs within 24-48 hours. Changing IVs in-hospital result in patient duress and nurse time loss. This article reports data from the IV Insertion Protocol Survey and the Paramedic Educator Survey. These surveys attempt to identify paramedic protocol and practice related to IV insertion and aseptic technique. Further, the surveys explore paramedic education regarding IV insertion. Surveys were hand-delivered, participants were invited to participate in the anonymous survey, and data were then analyzed using RemarkOffice. The results suggest paramedics are educated on the use of aseptic technique and that paramedics clean the IV site unless circumstances such as limited space or patient acuity prevent proper cleansing. Eighty-eight percent of participants report following a protocol, 64% almost never/never use hand sanitizer, and 83% of educators said that paramedics are not instructed to use hand sanitizer. In summary, paramedics use aseptic technique, which suggests that field IVs should not need to be replaced within 24-48 hours after a patient’s hospital admission. PURPOSE STATEMENT The purpose of this study is to determine whether or not the paramedic providers to this South Central region of the United States follow a protocol for IV insertions that is equivalent to hospital protocol. PHASE 1; EXPLORATION OF PARAMEDIC PROTOCOL FOR FIELD IV INSERTION OUTLINE Introduction • Background o Some studies indicate that IV insertions are periodically performed without maintenance of aseptic technique. • Problem and Purpose o Current protocol at a South Central hospital in the United States requires nurses to change all field IVs within 24-48 hours after a patient’s admission. o If paramedics are complying with a protocol requiring site cleansing before IV insertion, changing the IV in-hospital may not be necessary. o The purpose of this study is to determine whether or not the paramedic providers to this South Central region of the United States follow a protocol for IV insertions that is equivalent to hospital protocol. Materials and Methods • IV Insertion Protocol Survey and the Paramedic Educator Survey were created for the study. • The survey is a 10 item survey using a likert scale to determine paramedic practice and adherence to IV insertion protocol. • A pre-written script was read before each survey. • The survey was given to each paramedic, paramedic educator, and paramedic supervisor who chose to participate. Results • Eighty-eight percent said they follow a protocol for IV insertion. • Eighty-nine percent of participants reported to always use aseptic technique and the remaining 11% reported almost always. • Nine percent of participants always use hand sanitizer before inserting IVs in the field, and 64% almost never/never use hand sanitizer. • Certain circumstances in the field may not allow for aseptic technique to be used. • The Paramedic Educator Survey results showed that 100% of the educators teach cleaning of the skin before IV insertion. Discussion • The EMS providers that we surveyed do not have a protocol that is equivalent to hospital IV insertion protocols; they follow algorhythms. • The results from the Paramedic Educator Survey suggest that paramedics are taught to use aseptic technique when inserting a peripheral IV • The group felt that it was impractical to use hand sanitizer before applying gloves. • Educators did not express the desire to begin teaching about the use of hand sanitizer. • There is no form or official process of communicating whether or not the IV was placed with proper aseptic technique • Future study recommendations: hand-off report between paramedic and receiving personnel, follow IVs in-hospital to see if there is a need for replacement Conclusion • EMS providers in this South Central region of the United States have been well educated on aseptic technique and IV insertion. • Change of protocol could better manage nurse time, as well as provide substantial health benefits for the patient. ABSTRACT FIELD IVS: TO REPLACE OR NOT En-Dien Liao, B.S. in Nursing The University of Texas at Arlington, 2014 Faculty Mentor: Deborah Behan, Ph.D., RN-BC Patients admitted to the emergency room via Emergency Medical Services with a field-established peripheral intravenous catheter (IV) were observed for 96 hours while in the hospital. Currently, many nurses restart the IV upon admission because they feel an IV started by a paramedic while in the field needs to be changed within 48 hours of hospital admission. The purpose of the study was to determine if field IVs started by paramedics could be utilized after patient admission to the hospital. Each day, observations of the IV site were recorded for signs of redness, swelling, and pain or tenderness, which would indicate the IV needed to be restarted. Results suggest that IVs started in the field by a paramedic in the ambulance may last up to 96 hours before they need to be changed. PURPOSE STATEMENT The purpose of this study was to determine if the field EMS IVs can last up to 96 hours without being changed by the nurse in the acute care setting. This study is aimed at identifying the aftereffects of IVs inserted in the field and determining whether or not pre-hospital IVs need to be replaced in the acute hospital setting within 24-48 hours of patient arrival. OUTLINE Introduction Purpose • The purpose of this study was to determine if the Emergency Medical Service (EMS) peripheral intravenous catheters (IVs) can last up to 96 hours. Background/Literature Review • Lawrence and Lauro (1988)- field-started IVs are 2.88 times more likely than hospital-started IVs to develop complications within 24 hours of insertion. • Lee et al. (2009)- In the hospital setting, IV catheter replacement time can be extended from 48 up to 96 hours. • Wright (2011)- evaluation of aseptic technique used by EMS personnel. • 88% of EMS follows a protocol for IV insertion • 100% always or almost always use aseptic technique when inserting field IVs • All paramedic educators were found to teach cleaning of the skin with alcohol prior to IV insertion Method • On random days, the researcher went to the emergency room (ER) and identified patients who arrived by EMS with an EMS established IV. • After admission orders, the patient was followed to room. • Verbal consent obtained, and patients were followed for the next four days • Data were collected each day on the following criteria: Site, redness, swelling, and pain/tenderness. Result • Total participants: 62 (134 measurements across 4 days) • One participant withdrew, and another participant passed away IV Location: Within the 134 measurements, 37 of the measurements were for an IV located in the right arm (33.9%). Seventy-two of the measurements were for an IV located in the left arm (66.1%). IV Redness: Out of 134 measurements, 12 measurements had redness (9%) and 110 measurements did not have redness (82.1%). IV Pain: Out of the 134 measurements, seven measurements were reported as pain or tenderness (5.2%) and 114 reported no pain or tenderness (85.1%). IV Swelling: Out of the 134 measurements, seven had signs of swelling (5.2%) and 110 measurements did not (85.8%). Discontinued Reasons ranked from highest to lowest: 36 due to discharge (64.3%), 6 to leaking (10.7%), 5 to policy removal (8.9%), 5 to pulled-out (8.9%), 2 to infiltration (3.6%), 1 to bruising (1.8%), and 1 to poor location (1.8%). Conclusion • EMS IVs may remain longer than 24 hours and up to 96 hours before they need to be changed. • Potential benefits : • Better quality of care for patients • More time saved for nurses from restarting IVs • Decreased cost to hospitals from reduced length of stays in hospitals. • Majority of patients were left handed • Inconsistency between system policy and actual bedside practice. Further education from nurse educators may be needed on the hospital’s IV policies. • Future Research: correlation between IV needle size and IV leakiness. • Wright (2011) found 82% of paramedics to use 18 gauge needles • Leaking was found to be the 2nd highest cause for IV discontinued Cont'd

Clinical Considerations for Patients with Active Clostridium difficile Infection

Donna Boyer,RN,WCC James McShane,BA,RN and

This article addresses the probable significant environmental Clostridium difficile (c. difficile) spore contamination that occurs when patients with active C. difficile infection are utilizing low air loss mattress therapy. We site published works that have proven environmental contamination exists in the absence of low air loss therapy. We assert that by virtue of the mechanism of action of low air loss surfaces, significantly increased environmental soiling is inevitable. Therefore, the risk of spreading infection is significantly increased. We are calling for additional research to determine the extent of increased contamination that occurs when low air low therapy is used on patients with active C difficile infection. Cont'd


Principal Author: Cik Norfidah Binti Mohamad Contributing Author(s) 1. Zaleha Binti Mohd Hashim 2. Umi Kalsom Binti Ibrahim 3. Nordiana Binti Borhan Designation PA Head, Department of Nursing CA1. Registered Nurse CA2. Registered Nurse CA3. Registered Nurse Principal Author Tel. No: +6019 2413108 Principal Author-email address:

Abstract Background: Obesity and overweight are more frequent in workers working in shift and psychological distress increased among working women in Malaysia. A supportive manager and a flexible working time are linked with a decrease of the conflicts between family and work. Objectives: The purpose of the research was to investigate the patterns of eating habit and its relationship factors, with focus on psychological factor among nurses. Methods: A study of 100 nurses was conducted in medical-surgical wards of a public hospital. Data was collected using a cross sectional study using a convenience sampling (non probability). A self-administered questionnaire on eating habits was used, and analyzed using SPSS (version 21). Results: A majority of (89%) participants was from a female group while a number of male participants are only (11%). Majority (86%) responded they ate because of feeling happy followed by eating because of feeling lonely (80%) and most of them did not perceived that they have a healthy eating habits (53%). Conclusions: The findings indicated that employers need to identify physical workload that is acceptable to avoid risks of unhealthy eating habits and monitor the availability of healthy food in the worksite. Keywords: Eating habits,Psychological Factors, working in shifts. Cont'd

History of Ebola and Nursing

Chinazo Echezona-Johnson, Ed.D, LL.B, RNC-MNN Assistant Director of Nursing/Women and Children Nursing Education Metropolitan Hospital Center

Many healthcare providers and the public are paying very special attention to the outbreak of the Ebola Virus in West Africa and the subsequent infection of the two critical care nurses at Texas. Many healthcare professionals expressed their confusion about the virus and the seeming stigmatization of nurses. Currently with the outbreak in Texas, nurses and other healthcare providers were encountered the same dilemmas as Central Africa nurses years ago. Cont'd

The Cost of Caring

Julie Givens RN, BSN Cynthia Bain MSN, RN, CNE

Nurses care for individuals when they are most vulnerable and often serve as emotional outlets. It is this deep caring that can lead to nurses becoming burnt out or developing vicarious traumatization, secondary traumatic stress, or compassion fatigue. Awareness of these phenomena and methods of prevention needs to be increased throughout the profession. This includes teaching nursing students as they begin having interactions with patients in the clinical setting. Cont'd

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