A STUDY TO EVALUATE EFFECTIVENESS OF COLD

APPLICATION AND MAGNESIUM SULPHATE

APPLICATION ON SUPERFICIAL THROMBOPHLEBITIS

AMONG PATIENTS RECEIVING INTRAVENOUS

THERAPY IN SELECTED HOSPITALS, AMRITSAR.

A Synopsis

Submitted for the partial fulfillment of the requirement for the degree of

MASTER OF SCIENCE IN NURSING

(Medical Surgical Nursing)

Of

Baba Farid University of Health Sciences,

Faridkot, Punjab

2012

Navjot Kaur

Mai Bhago College of Nursing, Tarn-Taran

1

A STUDY TO EVALUATE EFFECTIVENESS OF COLD

APPLICATION AND MAGNESIUM SULPHATE

APPLICATION ON SUPERFICIAL THROMBOPHLEBITIS

AMONG PATIENTS RECEIVING INTRAVENOUS

THERAPY IN SELECTED HOSPITALS, AMRITSAR.

A Synopsis

Submitted for the partial fulfillment of the requirement for the degree of

MASTER OF SCIENCE IN NURSING

(Medical Surgical Nursing)

Of

Baba Farid University of Health Sciences,

Faridkot, Punjab

2012

Navjot Kaur

Name and Signature

Of Supervisor

Mr. Sekar P.

Name and Signature

of Co-Supervisor

Ms. Jicy Shaji

Mai Bhago College of Nursing, Tarn-Taran

2

Title A study to evaluate effectiveness of cold application and

magnesium sulphate application on superficial thrombophlebitis

among patients receiving intravenous therapy in selected

hospitals Amritsar

For the degree of MSc (Nursing) Medical Surgical Nursing

Name of the

candidate

Navjot Kaur

Supervisor Mr. Sekar P.

Lecturer ( deptt. Of Medical Surgical Nursing)

Mai Bhago College of Nursing, Tarn-Taran

Institution Mai Bhago College of Nursing, Tarn-Taran

University Baba Farid University of Health Sciences, Faridkot

ABSTRACT OF PLAN OF THESIS

Superficial thrombophlebitis is defined as inflammation of superficial vein.The use of

intravenous devices is an integral part of patient care in hospitals. These devices are used

for the administration of fluid, nutrients, medications, blood products and to monitor the

hemodynamic status of a patient. Infusion phlebitis, defined as the inflammation of a

cannulated vein, is a common cause of pain and discomfort in these patients. Studies over

the past 2 decades have shown that 20 to 70% of patients receiving peripheral IV therapy

develop phlebitis. Some recent trends in hospital care include the application of

magnesium sulphate (Epsom salt) for reducing the oedema. Magnesium sulphate reduces

striated muscle contractions and blocks peripheral neuromuscular transmission by

reducing acetylcholine release at the myoneural junction. Cold application is a simple and

inexpensive therapy which is an effective nonpharmacologic intervention for

thrombophlebitis. Applying cold may help numb tissues and relieve muscle spasms. Ice

chips is used in reducing the inflammation, Ice reduces swelling by decreasing blood

flow of blood to an area and increase the platelet aggregation. The study is quasi

experimental in nature. The study will be conducted on 60 samples, 30 in magnesium

sulphate group and 30 in cold applications group. A standardized Visual infusion

3

phlebitis scale will be used to collect data. The data will be analyzed by using descriptive

and inferential statistics.

4

Index of content

Chapte

r no.

Title Page no.

1. Background of the study

Introduction 1-4

Need of the study 4,5

Research problem 5

Aim of the study 5

Objectives 6

Operational definitions 6

Hypotheses / assumptions 7

Delimitations 7

2. Review of literature 8-12

3. Methodology

Research design 13

Research setting 13

Target population 13

Sample and sampling technique 13

Inclusion and Exclusion criteria 13

Selection and Development of tool 14

Description of tool 14

Validity of tool 14

Reliability of tool 14

Pilot study 14

Data collection procedure 14

Ethical considerations 15

Plan of data analysis 15

References 16,17

5

Chapter-I

Background of the study

Introduction:

An ounce of prevention is worth a pound of cure

Health is a dynamic process and it is always changing. All have times of good

health, times of sickness, and maybe even times of serious illness. As lifestyles change,

so does the level of health. Health is the level of functional and (or) metabolic efficiency

of a living being. It is the general condition of a person in the mind, body and spirit,

usually meaning to be free from illness, injury or pain.1

An impairment of the normal state of a human being that interrupts or modifies its

vital functions is known as disease. Disease is a main reason for the people to seek

medical help and admit in hospitals. According to American hospital association,

hospitals are licensed institutions with at least six beds whose primary function is to

provide diagnostic and therapeutic client services for medical conditions.2

The use of intravenous devices is an integral part of patient care in hospitals.

These devices are used for the administration of fluid, nutrients, medications, blood

products and to monitor the hemodynamic status of a patient. In modern medical practice,

up to 80% of hospitalized patients receive intravenous therapy at some point during their

admission.3-4

A number of factors increase the risk of infection from intravascular devices. For

example, infection rates are higher among patients in large hospitals who may be

especially ill, those with burns or surgical wounds or those who are malnourished or

immune compromised. In addition, the rates are higher for certain devices, the type of

fluid being infused and the length of time the catheter is left in place.5

Serious complications related to peripheral IVs are uncommon, but problems do

occur, especially with prolonged use. That is why there are guidelines in different

6

hospitals about the recommended duration that a peripheral IV should be in place. As

with any side effect or complication of health care procedures, early detection, and good

communication between the patient and healthcare provider are important.6

Infusion phlebitis, defined as the inflammation of a cannulated vein, is a common cause

of pain and discomfort in these patients. Studies over the past 2 decades have shown that

20 to 70% of patients receiving peripheral IV therapy develop phlebitis According to

statistics; about 80% of the patients with intravenous therapy develop varying degrees of

infusion phlebitis in China alone.7

The incidence of superficial venous thrombosis is highly dependent on the

population studied as well as the means by which it is documented. It is generally

believed that incidence rates from epidemiological studies are underestimates since

autopsy studies indicate that up to 50% of venous thromboembolism are not recognized

ante mortem. Community based studies of hospitalized patients have suggested an annual

incidence of 56 per 100,000 while population based studies of healthy volunteers have

produced estimates of 122 per 100,000. Studies confirmed thrombophlebitis in Sweden

has suggested a somewhat higher incidence of 160 cases of new or recurrent disease per

100,000 population per year. Extrapolated to the population of the United States, this

represents 116,000 to over 250,000 new cases of clinically recognized infusion phlebitis

per year.8

Phlebology is the medical discipline that involves the diagnosis and treatment

of disorders of venous origin. The American Medical Association has added Phlebology

to their list of self-designated practice specialties. A medical specialist in Phlebology is

termed a phlebologist.

Phlebitis means inflammation of a vein. Thrombophlebitis is the term used when

a blood clot in the vein causes the inflammation. Thrombophlebitis usually occurs in leg

veins, but it may occur in arms. The thrombus in the vein causes pain and irritation and

may block the blood flow in the veins. Blood clots (thrombi) can form which may break

off and travel to the lungs. This is a potentially life threatening condition called

Pulmonary embolism.9

7

Some recent trends in hospital care include the application of magnesium

sulphate (Epsom salt) for reducing the oedema. Magnesium is the second most plentiful

cation of the intracellular fluids. It is essential for the activity of many enzyme systems

and plays an important role with regard to neurochemical transmission and muscular

excitability. Magnesium sulphate reduces striated muscle contractions and blocks

peripheral neuromuscular transmission by reducing acetylcholine release at the

myoneural junction. Additionally, Magnesium inhibits Ca2+ influx through

dihydropyridine-sensitive, voltage-dependent channels. This accounts for much of its

relaxant action on vascular smooth muscle.10

Cold application is a simple and inexpensive therapy which has been accepted

for decades as an effective nonpharmacologic intervention for thrombophlebitis.

Applying cold may help numb tissues and relieve muscle spasms. Ice chips is used in

reducing the inflammation, Ice reduces swelling by decreasing blood flow of blood to an

area and increase the platelet aggregation. While some blood flow is required to bring the

healing cells to the injured area, the body always overdoes it and sends too much blood,

that's why we can reduce blood flow without too much concern Ice also numbs the area,

thereby reducing pain. The nursing interventions should be meaningful and affordable by

the client in terms of this aspect this study is relevant to the profession.11

Need for study:

It is estimated that 150 million peripheral intravenous devices are placed each

year in North America alone. One of the most common complications of peripheral

intravenous catheter is phlebitis that may occur in up to 75-80 % of hospitalized patients.

It remains a significant problem in clinical practice and causes patient discomfort,

catheter replacement, prolonged hospital stay and healthcare costs. Maintenance of the

patency of these catheters and prevention of phlebitis is an important problem. It is

estimated that 200,000 cases of catheter related infections are occurring worldwide each

year.

Superficial Thrombophlebitis which occurs in about 75% of all patients receiving

intravenous therapy, deep vein Thrombophlebitis occurs at least 5% of surgical patients.12

8

In hospitalized individuals, the incidence of venous thrombosis varies

considerably, from 20% to 80%, and the incidence of Deep vein thrombosis is estimated

to be about 80 cases per 100,000 populations annually. Superficial Thrombophlebitis is

very common in hospitalized patients, but frequency is not known precisely because

many cases go unreported and untreated. Deep vein thrombosis frequency also is not

known precisely because of misdiagnoses.13

If Thrombophlebitis is in a vein just under the skin (superficial vein),

complications are rare. However, if the clot occurs in a deep vein the client may develop

a serious medical condition known as deep vein thrombosis. If that happens, the risk of

serious complications is greater. Complications may include: pulmonary embolism and

heart attack or shock.

A study conducted to evaluate superficial thrombophlebitis and the incidence of

cancer in primary care patients. the results conclude that only single exposure to

superficial thrombophlebitis does not cause cancer, but frequent exposure may cause

malignancies after 2-3 years of exposure.14

Student researcher during clinical practices had experienced that there is higher

incidence of superficial thrombophlebitis among patients who are receiving continuous

intravenous therapy. Some degree of erythema is a frequent occurrence around drip

infusion sites, so much so that it may easily be disregarded. The complaints of

patients who are troubled by the pain and irritation often pass unheard. Sometimes

the vein thromboses, the drip stops, and the patient are suffering from a full-blown

thrombophlebitis. This complication, although not so frequent nor apparently so

severe as in former times, is a very familiar problem; but the pathophysiology

remains poorly understood and hence the management is often unsatisfactory.

Thus, in extensive review of literature, investigator came across so many studies

regarding infusion phlebitis. So investigator felt need to conduct study to find out which

is the most effective method in relation to rapidity of subside the signs and symptoms,

and practicability in patients with superficial thrombophlebitis. The cost effective care

9

also one of the main concepts of quality of nursing care. The cost effective management

is necessarily carried out to reduce oedema and anxiety related to care.

Research problem

A study to evaluate effectiveness of cold application and magnesium sulphate application

on superficial thrombophlebitis among patients receiving intravenous therapy in selected

hospitals Amritsar.

Aim of the study:

To evaluate the effectiveness of two interventional strategies on treatment of superficial

thrombophlebitis.

Objectives:

Assess the pre test degree of superficial thrombophlebitis among clients

receiving IV therapy

Assess the post test superficial thrombophlebitis scores among clients

receiving IV therapy.

Assess the effectiveness of cold application on superficial thrombophlebitis.

Assess the effectiveness of magnesium sulphate on superficial

thrombophlebitis.

Compare the effectiveness of cold application and magnesium sulphate on

thrombophlebitis.

Find the association between post test superficial thrombophlebitis scores in

cold applications group with selected demographic variables.

Find the association between post test superficial thrombophlebitis scores in

magnesium sulphate group with selected demographic variables.

Operational definitions:

10

1. Effectiveness: The degree to which level of superficial thrombophlebitis is reduced

after the cold applications and magnesium sulphate. It is measured by visual infusion

phlebitis scale.

2. Cold Application: It is application of ice chips externally over the site 3 times a day

for 3 days to reduce sign and symptoms of superficial thrombophlebitis

3. Magnesium sulphate: It refers to the application of magnesium sulphate over the site

3 times a day for 3 days to reduce superficial thrombophlebitis. Magnesium sulphate is

crystal like substance which helps to reduce the redness, edema and swelling.

4. Superficial Thrombophlebitis: Inflammation of superficial vein followed by

formation of clot at the site of intravenous line.

5. Intravenous Therapy: Administration of fluids and drugs into veins through the use

of hypodermic needle, peripheral cannula, and intravenous catheter, etc

Hypothesis:

H 1: There will be significant association between selected clinical variables and pre-test

superficial thrombophlebitis score.

H 2 -There will be a significant effect of cold application on superficial

thrombophlebitis.

H 3 -There will be a significant effect of magnesium sulphate application on superficial

thrombophlebitis.

H 4 -There will be a significant difference among cold application and magnesium-

sulphate application in reducing the signs and symptoms of superficial thrombophlebitis.

Delimitations:

Study is limited to the patients who are receiving continuous IV therapy.

Study is limited to hospitals of only one district of Punjab.

Study is concise to small sample size.

11

Chapter-II

Review of Literature

A literature review is summary of previous research on a topic which can be either a part

of a large report of a research project, a thesis or bibliographic essay that is published

separately in scholarly journal. The purpose of literature review is to convey the reader

what knowledge and ideas have been established on topic and what are the strength and

weaknesses. It allows the reader to bring up to date reading the state of research in the

field and familiarizes the reader with any contrasting perspectives and view point on the

topic. There are many reasons for beginning a literature review before starting a research

paper.

a) Studies Related to superficial thrombophlebitis among clients with I V Cannulation.

b) Studies Related to magnesium sulphate and other topical drug therapies.

c) Studies Related to hot and cold applications.

a) Studies Related To superficial thrombophlebitis among clients with I V

Cannulation.

A prospective, randomized, controlled unblinded study was conducted to assess the

effectiveness of elective re-siting of intravenous cannula decrease peripheral

thrombophlebitis. Forty-two patients admitted for major abdominal surgery were

included in the study. The patients were allocated to either the study or the control group

using block randomization–restricted randomization method. Cannula in the study group

were changed and re-sited electively every 48 hours. All the patients were examined

every 24 hours for signs and symptoms of peripheral thrombophlebitis at the current and

previous sites of infusion. The incidence of peripheral thrombophlebitis was 100%

(21/21) in the control group and only 9.5% (2/21) in the study group (p<0.0001). The

severity of peripheral thrombophlebitis was also less in the study group compared with

12

that in the control group. Day-wise correlation of the incidence of peripheral

thrombophlebitis showed that 82.6% of the episodes of peripheral thrombophlebitis

occurred on day 3.15

A study was conducted to compare the rates of phlebitis of peripheral intravenous

lines left in place for 72 hours versus rates of those left in place 96 hours. Design was a

prospective, nonrandomized study. Setting was a university teaching hospital with 375

beds. Results were a total of 2503 peripheral lines were evaluable. The overall phlebitis

rate was 6.8%. It was estimated that in 1 month approximately 300 intravenous lines

potentially could be prolonged beyond 72 hours; 215 lines were changed at 72 hours

despite no signs of inflammation, 61 lines were kept till 96 hours, and 19 lines were kept

beyond 96 hours. Conclusion of the study was Phlebitis rate for our peripheral

intravenous catheters at 96 hours was not significantly different from that at 72 hours.16

A Randomized Controlled Trial on factors Affecting Complications and Patency

of peripheral IVs.This sample was composed of 88 patients, from neonates to 12-year-

olds, on whom a total of 377 catheters were started. Intravenous cannulations were

randomized for heparin flushes (1:100 dilutions) and splints. Prospective data was

collected regarding duration of patency and complications. Both univariate and

multivariate analysis were done. There was a statistically significant increase in the

duration of patency with the use of heparin flushes and splints. Shorter patency duration

and increased complications were associated with younger age, wrist and scalp insertions,

and 24-gauge catheters.17

A study was conducted on two groups of patients received one of two

intravenous catheters, a 20-gauge Criticon (C group;n=96) or a 20-gauge Vitaflon Plus

(V group;n=100).The incidence of early complications (erythema, swelling, tissue

hardness, pain) was comparable in both groups. The survival distribution curves for all

complications and swelling >2 cm were significantly longer in the V group. The

incidence of complications following cannulation was high in both groups. The period

from catheter insertion to the clinical onset of phlebitis was prolonged in both groups if

antiphlebitogenous fluids were used. The incidence of late complications (phlebitis,

displacement of the cannulae, etc.) and damage to the catheters was more frequent in the

C group. 18

13

A study was done on Relevance and complications of intravenous infusion.

Objective of the study was Insertion of peripheral venous catheters (PVCs) is current

practice within the hospital environment and particularly in the emergency department

(ED). During the study 2515 patients over 16 years of age attended the unit. Overall, 390

PVCs were followed until the time of their removal. Mean duration of IV infusion was 28

h. Among these 390 patients, 62 (15.9%) developed complications, of which 54 (13.6%)

had thrombophlebitis and 9 (2.3%) developed local infection. Conclusion of the study

was Insertion of PVC is common practice especially in EDs.19

b) Studies Related to magnesium sulphate and other topical drug therapies.

A quasi-experimental study was conducted to assess the effectiveness of the therapeutic

effect of tanshinone, magnesium sulphate and hirudoid in the treatment of infusion

phlebitis on 150 in patients with infusion phlebitis. Patients were randomly divided into

tanshinone group (n=50), hirudoid group (n=50) and magnesium sulphate group (n=50).

The therapeutic effect was assessed after 5 days treatment. The results shows the

excellence rate of 64% in tanshinone group, 36% in hirudoid group and 18% in

magnesium sulphate group, the differences was statically significant at level of p= 0.05.

The efficacy rate was 94% in tanshinone group, 80% in hirudoid group and 60% in

magnesium sulphate group, the differences was statically significant at level of p=0.001.20

A quasi experimental study was conducted to assess the effectiveness of cold

application, heparinoid application and magnesium-sulphate application on superficial

thrombophlebitis among patients in selected hospitals of Indore. Three-group pre test and

post test design was adopted for the study. 45 patients were selected using purposive

sampling and they were randomly assigned into three groups. A superficial

thrombophlebitis scale and pain intensity distress scale was used for data collection.

Following the pre-test, intervention with cold application was given to 1st experimental

group (C), for a period of twenty minute, 2nd experimental group (H) was intervened with

heparinoid application using thrombophobe ointment by gentle massage and similarly in

3rd experimental group (M), magnesium-sulphate dressing was done by dipping the gauze

in the magnesium sulphate glycerine solution and applied on superficial thrombophlebitis

three times a day for three days. The finding of the study indicated that the computed’t’

14

value of cold application group ('t'14 =14.33), heparinoid application group ('t14' =11.90)

and magnesium sulphate application group ('t'14 =20.82) were statistically significant,

which suggested that all three interventions were effective in reducing the signs and

symptoms of superficial thrombophlebitis. The computed 'F' ratio of all the three groups

('F'2.42 =10.10) showed that three types of application differ significantly. However, the

mean difference of magnesium sulphate group (18.34) was higher than the cold

application (13.33) and heparinoid application (12.8) group. This study concluded that

magnesium sulphate application is most effective intervention in reducing the superficial

thrombophlebitis.21

An interventional study was conducted in Mangalore on effectiveness of ice packs

versus thrombophobe gel for reducing intra venous infiltration in patients admitted in

paediatric wards. The study was conducted on 40 samples (20 for thrombophobe gel

group and 20 for ice cube group) selected using purposive sampling technique. The

infiltration was assessed by using modified infiltration scale. The results showed that

before the treatment, majority (65%) of patients had grade two infiltrations after the

treatment with thrombophobe and 100% of patient’s infiltration had reduced to grade one

infiltration. In group two majorities (80%) had grade two infiltrations after the treatment

with ice cube 100% had grade one infiltration. The study concluded that both

thrombophobe gel and ice pack are effective in reducing intravenous infiltration among

paediatric patients.22

A study was conducted on Anti-coagulant ointment in the prevention of post-

infusion thrombophlebitis. 169 cases were included (84 experimental, 85 control) to

study the effect of topical anticoagulant ointment. The finding was the Topical

anticoagulant ointment was effective in decreasing the incidence of thrombophlebitis if

the duration of infusion was up to 12 hours or less, the use of anticoagulant ointment

reduced the average number of days of recovery especially in moderate to severe grades

of thrombophlebitis. 23

A study was conducted on Topical heparin for the treatment of acute superficial

phlebitis secondary to indwelling intravenous catheter A double-blind, randomized,

placebo-controlled trial. Objective of the study was to assess the clinical efficacy of a

topical gel containing 1000 IU.g−1 of heparin, applied three times daily for a maximal

15

period of 7 days to patients with acute superficial phlebitis secondary to indwelling

intravenous catheter. Result of the study was, after treatment for 7 days superficial

phlebitis healed in 27 of the 61 patients (44.3%) who received topical heparin, and in 17

of the 65 patients (26.1%) receiving placebo, giving a relative risk of 1.69 (1.03–2.78).

Conclusion of the study was the topical heparin is safe and effective for the treatment of

superficial phlebitis secondary to indwelling intravenous catheter.24

A study was conducted on Topically Applied Heparins for the Treatment of

peripheral Vascular Disorders. A total of 1055 patients participated in a total of 20

studies that compared topical heparin formulations with placebo, no treatment,

subcutaneous heparin or with each other in the treatment of superficial thrombophlebitis.

In head-to-head studies comparing different topical heparin formulations, all preparations

appeared effective. Conclusion of the study was topical heparin preparations may be

useful for relieving the signs and symptoms of vascular disorders while improving

microcirculation.25

c) Studies Related To hot and cold applications.

A study was conducted on Effect of warm and cold applications on the resolution

of IV infiltrations. Differences in pain intensity, surface area measurements of

indurations and erythema, and interstitial fluid volume when warm versus cold

applications were randomly made to an intentional intravenous infiltrate of 5 mL of a

designated solution were examined. Three solutions were used: 0.5 saline (154 mOsm),

normal saline (308 mOsm), and 3% saline (1027 mOsm). The sample was 18 healthy

adults between 20 and 45 years. Pain intensity did not differ by treatment but a significant

difference was found by solution, with 3% saline producing the greatest difference.

Erythema was absent with all solutions. Study reveals that there is no significant

difference between the cold and warm application in resolution of IV infiltrations.26

A study was conducted on local warming and insertion of peripheral venous

cannulas it is a single blinded prospective randomised controlled trial and single blinded

randomised crossover trial. Objective of the study was to determine whether local

warming of the lower arm and hand facilitates peripheral venous cannulation. Setting was

Neurosurgical unit and haematology ward of university hospital participants were 100

neurosurgical patients and 40 patients with leukaemia who required chemotherapy.

16

Intervention was given was Neurosurgical patients' hands and forearms were covered for

15 minutes with a carbon fibre heating mitt. Results were In neurosurgical patients, it

took 36 seconds (95% confidence interval 31 to 40 seconds) to insert a cannula in the

active warming group and 62 (50 to 74) seconds in the passive insulation group

(P=0.002). The crossover study in patients with leukaemia showed that insertion time was

reduced by 20 seconds (8 to 32, P=0.013) with active warming and that failure rates at

first attempt were 6% with warming and 30% with passive insulation (P<0.001).

Conclusion of the study was Local warming facilitates the insertion of peripheral venous

cannulas, reducing both time and number of attempts required. This may decrease the

time staff spend inserting cannulas, reduce supply costs, and improve patient

satisfaction.27

17

Methodology flow chart

18

Research design

Quasi-experimental two groups pre test post test design

Research setting

Medical and surgical wards of selected hospitals of Amritsar, Punjab

Target population

Clients with infusion phlebitis

Sample size

The sample size for the study will be consisting of 100

Sampling technique

The purposive sampling technique

Research tool

Standardized infusion phlebitis scale

Data collection procedure

Samples will be selected purposively and randomly. Pre test and post test will be conducted by using visual infusion phlebitis scale. Selected interventions magnesium sulphate and cold applications will be provided to the group.

Data analysis

Descriptive and inferential statistics, unpaired ‘t’ test and chi square test will be used for analysis.

Chapter-III

Methodology

Research design

A quasi experimental two group pre test post test design will be adopted for the study to

evaluate the effectiveness of magnesium sulphate and cold applications on superficial

thrombophlebitis.

Research setting

This study will be conducted in Medical and surgical wards of selected hospitals of

Amritsar, Punjab.

Target population

The population of the study will be the clients who developed superficial

thrombophlebitis and having intravenous line and admitted in Medical wards of hospitals

of Amritsar, Punjab.

Sample and sampling technique:

The sample size for the study will be consisting of 60 samples those who fulfil the

inclusion criteria, 30 in magnesium sulphate group and 30 in cold application group. The

purposive sampling technique will be adopted for sampling and samples will be divided

into two groups randomly.

Inclusion and exclusion criteria:

Inclusion criteria

Clients with peripheral intravenous cannula induced phlebitis who are willing to

participate in the study.

Clients who are available during the period of data collection.

Clients who are hospitalized in medical and surgical wards.

19

Exclusion criteria

Clients with phlebitis who are having skin disorders.

Clients having open wounds.

Clients having associated vascular disorders like DVT, varicose veins etc.

Clients having hypersensitivity to magnesium sulphate

Selection and development of tool:

A standardized visual Infusion Phlebitis Scale will be selected.

Description of tool:

TOOL-1

Demographic questionnaire will be used to assess the demographic data of the

clients such as age, gender, occupation, diagnosis, purposes of intravenous

infusion, site of intravenous cannula, number of prick during the intravenous

cannulation procedure, size of peripheral intravenous cannula, types of medication

infused, period of hospital stay, and duration of peripheral intravenous cannula.

TOOL-II

Visual infusion phlebitis scale will be used to assess the severity of peripheral

intravenous cannula induced phlebitis.

Validity of tool:

Content validity will be determined by experts’ opinion.

Pilot study:

It will be conducted to find the reliability and feasibility of tool by taking 10

samples.

20

Data collection procedure:

Formal permission will be obtained from the concerned authority. Samples will be

selected purposively and randomly assigned into magnesium sulphate and cold

application group. Pre test will be conducted by using standard visual infusion

phlebitis scale. Selected interventions magnesium sulphate and cold application

will be provided to the respective groups. Post test will be conducted for the by

using the same tool after seven days of interventions.

Ethical considerations:

Approval of research/ethical clearance will be taken from research committee

of Mai Bhago College of Nursing, Tarn-Taran.

The formal permission will be taken from concerned authorities of selected

hospitals.

The written informed consent from each sample will be obtained.

Plan of data analysis

The plan of data analysis is as follow:-

The data obtained will be analysed in terms of the objective of the study using

descriptive and inferential statistics. The plan of data analysis is as follows.

Frequency and percentage distribution will be used to analyse the socio

demographic variables and severity of peripheral intravenous cannula induced

phlebitis.

Mean, mean percentage and standard deviation will be used to assess pre test and

post test severity of peripheral intravenous cannula induced phlebitis.

unpaired ‘t’ test will be used to compare pre test and post test severity of

peripheral intravenous cannula induced phlebitis of magnesium sulphate group

and cold applications group

21

Chi-square test will be used to determine association between pre test severities

of peripheral intravenous cannula induced phlebitis and selected socio

demographic variables.

22

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