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Rajivgandhi University of Health Sciences Bangalore, Karnataka
Rajivgandhi University of Health Sciences Bangalore, Karnataka
BANGALORE, KARNATAKA
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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
DATE OF ADMISSION TO
4. 2nd July 2010
THE COURSE
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6. BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION:
Circulatory system is major system in human body; veins are blood vessels
that carry blood towards the heart. Millions of veins are present in human body, the
length of veins are 60,000 – 100,000cm. Most of the veins carry deoxygenated blood
from the tissues back to the heart; exceptions are the pulmonary and umbilical veins,
both of which carry oxygenated blood to the heart. Vein colour is determined in large
part by the colour of venous blood, which is usually dark red as a result of its low
oxygen content. Veins are classified in a number of ways, including Superficial versus
Deep, Pulmonary versus Systemic, and Large versus Small. 1
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Superficial Thrombophlebitis is usually an easily diagnosed condition; it may
be an iatrogenic, resulting from intravenous catheter or infusion of solutions. Deep
vein thrombosis (DVT) is Thrombophlebitis of deep veins. It is a common disorder,
more so in women than in men. Deep vein thrombosis develops in approximately one
third of clients older 40 years who have had major surgery, orthopaedic surgery, or
myocardial infarction. In addition clients with cancer or family history of clotting
disorders are at risk.
Phlebitis, if mild, may or may not cause symptoms. Pain, tenderness, redness
(Erythema), and bulging of the vein are common symptoms of phlebitis. The redness
and tenderness may follow the course of the vein under the skin. Low grade fever may
accompany superficial and deep phlebitis. High fever or drainage of pus from the site
of Thrombophlebitis may suggest an infection of the Thrombophlebitis (referred to as
septic Thrombophlebitis). Palpable cords along the course of the vein may be a sign of
a superficial clot or superficial Thrombophlebitis. A deep venous thrombosis may
present as redness and swelling of the involved limb with pain and tenderness. In the
leg, this can cause difficulty in walking.
The application of Magnesium sulphate (Epsom salt) alone may cause skin
irritation so any of the skin softeners also should apply with this; preferably Glycerine
used. Glycerine is a thick liquid that has a variety of uses. It is capable of softening
skin and it will help to nourish the skin tissues.4
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The combination of magnesium sulphate and glycerine application on a limb
oedema with help of roller bandage and followed by limb elevation may help in
reduction of swelling and nourishment of skin as evidenced by studies. The nursing
interventions should be meaningful and affordable by the client in terms of this aspect
this study is relevant to the profession.
In the year 2004, the annual hospital report of Kerala, stated that the incidence
of Thrombophlebitis was (78%) in ICU as compared to (30%) in general wards. The
study highlighted the cause as lack of physicians, nurses and poor standard of care
provided by health care personnel.7
A study was carried out on the clinical importance, diagnosis, incidence, and
pathogenesis of peripheral vein infusion Thrombophlebitis, including catheter-related
and patient-related risk factors. The study reviewed the evidence linking thrombosis,
particularly prothrombotic states such as the inherited thrombophilic disorders, with
peripheral vein infusion Thrombophlebitis. Peripheral vein infusion Thrombophlebitis
occurs in 25% to 35% of hospitalized patients with peripheral intravenous catheters
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and has both patient-related implications (e.g., sepsis) and economic consequences
(e.g., extra nursing time). Although duration of catheterization, catheter-related
infection, and catheter material are important risk factors for peripheral vein infusion
Thrombophlebitis, patient-related risk factors are not well elucidated.8
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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.
In a randomized double blind study on patients with oedema treated with one
of the following, magnesium sulphate (Epsom salt) and hot application. The result
revealed that there is more effectiveness of magnesium sulphate, in reducing oedema
than hot application.9
Thrombophlebitis may lead to dry, scaly and disntegrity of the skin. In order to
prevent complications of skin nurses should aware about the managements like
medications, moisturizing creams and application of glycerine
From the above information researcher has realized that there is high
prevalence of Thrombophlebitis among the patients with intravenous therapy. There
is a management for the limb oedema with the combination of the magnesium
sulphate and glycerine. The method is also very feasible and less expensive. These
factors made researcher to design a study to assess the effectiveness of application of
combination of magnesium sulphate and glycerine dressing on management of limb
oedema.
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6.4 OBJECTIVES
1. To assess the level of limb oedema among patients with Thrombophlebitis
before the intervention.
2. To assess the level of limb oedema among patients with Thrombophlebitis after
the intervention.
3. To compare the pre test and post test level of limb oedema among patients with
Thrombophlebitis.
4. To associate the pre-test level of limb oedema among patients with
Thrombophlebitis with their selected demographic variables.
1. Effectiveness:
The degree to which level of limb edema is reduced after the application of
dressing.
3. Limb oedema:
Swelling present in either upper or lower extremities.
4. Thrombophlebitis:
Inflammation of vein followed by formation of clot after application of
intravenous infusion.
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6.6 ASSUMPTIONS
H1 – There will be a significant difference in the mean pre test and post test level
of limb oedema.
H2 – There will be significant association between the pre test levels of limb
oedema among the patients with Thrombophlebitis with their selected
demographic variables.
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A prospective study was carried out on the frequency of Thrombophlebitis and
bacterial contamination of cannulas associated with four commonly used intravenous
cannulas of differing length and chemical composition. For all cannulas the frequency
of Thrombophlebitis increased significantly with time. It was suggested that infusion
Thrombophlebitis could be eliminated as a clinical problem by the use of intermittent
short duration intravenous infusions.11
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chloride.. In conclusion, a glycerine containing cream appears to be a suitable
alternative to urea/sodium chloride in the treatment of atopic dry skin.15
A questionnaire study was set up to assess the perceptions of risk factors for
infusion phlebitis among Swedish nurses, as their concepts of these factors may
influence the incidence. A majority of the nurses believed that insertion of a peripheral
venous catheter in the forearm and catheter rotation within 48 hours was protective.
These measures were not supported in recent studies and guidelines. Surveillance of
the educational level of staff, who inserts peripheral venous catheters, was an
important tool for reducing the incidence of infusion phlebitis.16
A study was carried out to determine the incidence of deep vein thrombosis
(DVT) in patients diagnosed with superficial Thrombophlebitis (STP) after presenting
to an outpatient DVT service. A total of 79 patients were diagnosed with STP after the
exclusion of DVT with the diagnostic protocol. The incidence of a subsequent
diagnosis of DVT on 6-month follow-up was three out of 79 patients (4%, 95% and
0.8% to 11%). 17
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of patients, venous scans should be performed only in patients with features
suggestive of DVT or pulmonary embolism.19
iii) Settings
The study will be conducted in K.C.G. Hospital, Bangalore.
iv) Population
The population of the study will be all the patient with Thrombophlebitis in
K.C.G. hospital, Bangalore.
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v) Sample
The sample consists of the patients who fulfil the inclusion criteria and the sample
size is 60.
Inclusion criteria:
- The patients with Thrombophlebitis.
- Patients with pitting oedema.
- Both male and female patients above 18 years of age.
Exclusion criteria:
- The patient who are not willing to participate the study.
- The patients who are having limb fracture.
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The study will be conducted in the following phases,
PHASE 1: Pre test level of limb oedema will be assessed using pitting oedema
scale.
PHASE 2: 20gram of magnesium sulphate diluted in 100 ml of glycerine and this
combination applied on limb oedema with help of roller bandage and the limb will
be elevated. This procedure will be repeated two times in a day. The first dressing
will be applied for four hours followed by second application for the next four
hours.
PHASE 3: After second application of intervention the post test level of limb
oedema will be assessed by using the pitting oedema scale.
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7.4 Has ethical clearance been obtained from your institution?
Yes, permission will be obtained from the concerned authorities of the institution
and formal consent will be taken from the samples. Confidentiality and privacy of
data will be maintained
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8. LIST OF REFERENCES
4. Julith C. Evan. How Epsom Salts helps to reduce swelling. Alternative health.
Available from http://www.care2.com/greenliving/use-epsom-salts13wonderful
way.html.
10. Gupta a, Mehta y, Juneja R, Trehan N. The effect of cannulae material on the
incidence of peripheral venous Thrombophlebitis. Avail from:
http://www.ncbi.nlm.nih.gov/pubmed/17924895.
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11. Jack collin, F. L. Constable, Christine Collin and I. D. A. Johnston.
Thrombophlebitis and infection with various cannulas. Royal victoria infirmary.
Newcastle upon tyne. United kingdom. Available on
http://www.ncbi.nlm.nih.gov/pubmed/17924895
12. P. J. Van Den Broek, M. M. De herder-Swinkels, B. G. Moffie, H. C. Van den
Berg, J. Hermans. Thrombophlebitis. Anz journal of surgry 2003oct;73(10):794-
6. Available from: http://pmj.bmj.com/content/69/807/37 abstract
13. Lodén m, Andersson ac, Anderson 13. Dennis G. Maki, Marilyn Ringer. Risk
factors for infusion related phlebitis with small venous peripheral catheters. Avail
on: www.annals.com
14. J.R. Berrazueta, J.J. Poveda. The anti- inflammatory and analgesic action of
topical glycerine in the treatment of infusion related Thrombophlebitis. Anz
journal of surgery 2003 oct;73(10):794-6.
15. Anderson C, Bergbrant im, Frödin T. The cochrane central register of controlled
trials. The cochrane collaboration. Available on
http://onlinelibrary.wily.com/o/clcentral/article/042/ cn-00408640/frame. html
16. P. Paulseno. Perception of risk factors for infusion phlebitis among swedish
nurses. Journal american acad nurse practice. 2008 april 20;4:172-80.
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19. Manik PE, Andrews L, Malini B. The incidence of deep venous thrombosis in
ICU patients. Vascular journal 1997 march 3. Available on:
www.ncbi.nlm.gov/pubmed145
20. Polit F, Beck T. Nursing research –generating and assessing evidence for nursing
practice.8th edition: Wolters kluwer;2008.
21. Barbara H. Statiscal methods for health care research – inferential statistics. 3 rd
edition: lippincot; 1997.
11.6 Signature :
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12.1 Remarks of the principal :
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