| 1. |
- Ahlqvist, Margary, et al.
(author)
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A new reliable tool (PVC assess) for assessment of peripheral venous catheters
- 2010
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In: Journal of Evaluation In Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 16:6, s. 1108-1115
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Journal article (peer-reviewed)abstract
- Rationale and aims To evaluate the extensive use of peripheral venous catheters (PVCs), including catheter-related complications, a reliable tool for PVC assessment is needed. The aim of this study was to develop such a tool to evaluate PVCs in relation to management, documentation and signs and symptoms of thrombophlebitis (TH), as well as to determine its inter-rater and test-retest reliability. Method The tool development included confirmation of content and face validity. Two groups of registered nurses used the new tool (PVC assess) to assess PVC management and signs of TH independently. Group A (n = 3) assessed 26 items in 67 PVCs bedside (inter-rater reliability). Group B (n = 3) assessed photographs (67 PVCs, 21 items) of the same PVCs as those in Group A with a 4-week interval (test-retest reliability). Proportion of agreement P(A) and Cohen's kappa were calculated to evaluate inter-rater and test-retest reliability. Results Among nurses assessing PVCs at bedside, the P(A) was good to excellent (0.80-1) in 96% of the items in PVC assess. In 80% of the items kappa was substantial to almost perfect (0.61-1). TH sign erythema fell into the fair range (kappa = 0.40). In test-retest reliability analysis the P(A) was within the good and excellent range (0.80-1.0) and kappa varied from moderate to almost perfect (0.41-1.0) in 95% of the items. One item 'outer dressing is clean' was in fair range (0.21-0.40). Conclusions The PVC assess instrument shows satisfactory inter-rater and test-retest reliability. Reliability tests on reviewing documentation remain to be performed.
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| 2. |
- Ahlqvist, Margary, et al.
(author)
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Handling of peripheral intravenous cannulae : effects of evidence-based clinical guidelines.
- 2006
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In: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 15:11, s. 1354-61
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Journal article (peer-reviewed)abstract
- AIM: This study aimed at evaluating the outcome of implemented evidence-based clinical guidelines by means of surveying the frequency of thrombophlebitis, nurses' care, handling and documentation of peripheral intravenous cannulae. BACKGROUND: Peripheral intravenous cannulae are frequently used for vascular access and, thereby, the patients will be exposed to local and systemic infectious complications. Evidence-based knowledge of how to prevent these complications and how to care for patients with peripheral intravenous cannula is therefore of great importance. Deficient care, handling and documentation of peripheral intravenous cannulae have previously been reported. DESIGN: A cross-sectional survey was conducted by a group of nurses at three wards at a university hospital before and after the implementation of the evidence-based guidelines. METHOD: A structured observation protocol was used to review the frequency of thrombophlebitis, the nurses' care, handling and the documentation of peripheral intravenous cannulae in the patient's record. RESULTS: A total of 107 and 99 cannulae respectively were observed before and after the implementation of the guidelines. The frequency of peripheral intravenous cannulae without signs of thrombophlebitis increased by 21% (P < 0.01) and the use of cannula size 0.8 mm increased by 22% (P < 0.001). Nurses' documentation of peripheral intravenous cannula improved significantly (P < 0.001). CONCLUSION: We conclude that implementation of the guidelines resulted in significant improvements by means of decreased frequency of signs of thrombophlebitis, increased application of smaller cannula size (0.8 mm), as well as of the nurses' documentation in the patient's record. RELEVANCE TO CLINICAL PRACTICE: Further efforts to ameliorate care and handling of peripheral intravenous cannulae are needed. This can be done by means of increasing nurses' knowledge and recurrent quality reviews. Well-informed patients can also be more involved in the care than is common today.
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| 3. |
- Ahlqvist, Margary
(author)
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Peripheral venous catheters : quality of care assessment
- 2010
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Licentiate thesis (other academic/artistic)abstract
- About half of the patients admitted to hospitals receive intravenous therapy through peripheral venous catheters (PVCs). Unfortunately, the use of PVCs is associated with the risk of complications that may lead to increased morbidity and prolonged hospitalisation. Because of the frequent use of PVCs and the risk of PVC-related complications, there are good reasons to assess quality of care. The overall aim of this study was to attain increased knowledge about PVC documentation in the patient s medical record and to develop methods for assessment of inserted PVCs. Patients were recruited on medical and surgical wards at two emergency hospitals (Study I) and at one university hospital (Study I, II). A convenient sample of 933 adult inpatients with PVCs inserted into a vein on their upper extremity was included in study I. A study-specific data collection form was used for bedside registration of PVC insertion site, hand side, lumen size, patient s age and gender. The post-insertion documentation of the same PVCs was checked in patient medical record and recorded. The data were descriptively analysed via frequency distribution and factors associated with PVC documentation were examined using univariate and multivariate logistic regression analysis. Results showed that 10 descriptions could be used to explain PVC insertion site. Any kind of PVC documentation was found in 72% of the patients medical records. Notes that included information on insertion site, hand side and lumen size were identified in 46%. Documentation, including the latter three variables, was significantly associated with medical wards at general hospitals and smaller lumen size. A PVC assessment tool (PVC ASSESS) was developed through confirmation of content validity, evaluation of face validity, inter-rater and test-retest reliability (Study II). The tool consists of three sections: PVC management, signs and symptoms of PVC-related thrombophlebitis and PVC documentation. To test the reliability two groups of registered nurses (RNs) (Study II) and nursing students (NSs) (Thesis) used the tool to perform PVC assessments on 67 PVCs on actual patients at bedside (inter-rater reliability). Two other groups of RNs and NSs assessed 67 PVC photographs taken concurrently with the bedside assessments (test-retest reliability). The tool s reliability was evaluated by calculation of proportion of agreement and Cohen s unweighted kappa coefficient (κ) among the RNs and NSs. The inter-rater reliability (κ) ranged from moderate to almost perfect in 93% and 81% of the tested items among RNs and NSs, respectively. Test-retest reliability (κ) ranged between moderate and almost perfect in 95-100% of the items tested among RNs and in 90-95% among NSs. In conclusion, the findings imply the need for education of RNs in PVC documentation and development of terms for documentation of PVC insertion site. The reliability of the PVC ASSESS instrument is considered satisfactory and of relevance for use in research and clinical audits.
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| 4. |
- Ahlqvist, Margary, et al.
(author)
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Satisfactory reliability among nursing students using the instrument PVC ASSESS to evaluate management of peripheral venous catheters
- 2014
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In: Journal of Vascular Access. - : SAGE Publications. - 1129-7298 .- 1724-6032. ; 15:2, s. 128-134
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Journal article (peer-reviewed)abstract
- Purpose: Nursing students should be given opportunities to participate in clinical audits during their education. However, audit tools are seldom tested for reliability among nursing students. The aim of this study was to present reliability among nursing students using the instrument PVC assess to assess management of peripheral venous catheters (PVCs) and PVC-related signs of thrombophlebitis. Methods: PVC assess was used to assess 67 inserted PVCs in 60 patients at ten wards at a university hospital. One group of nursing students (n= 4) assessed PVCs at the bedside (inter-rater reliability) and photographs of these PVCs were taken. Another group of students (n= 3) assessed the PVCs in the photographs after 4 weeks (test-retest reliability). To determine reliability, proportion of agreement [P(A)] and Cohen's kappa coefficient (k) were calculated. Results: For bedside assessment of PVCs, P(A) ranged from good to excellent (0.80-1.0) in 55% of the 26 PVC assess items that were tested. P(A) was poor (< 0.70) for two items: "adherence of inner dressing to the skin" and " PVC location." In 81% of the items, k was between moderate and almost perfect: moderate (n= 5), substantial (n= 3), almost perfect (n= 5). For edema at insertion site and two items on PVC dressing, k was fair (0.21-0.40). Regarding test-retest reliability, P(A) varied between good and excellent (0.81-1) in 85%-95% of the items, and the k ranged between moderate and almost perfect (0.41-1) in 90%-95%. Conclusions: PVC assess demonstrated satisfactory reliability among nursing students. However, students need training in how to use the instrument before assessing PVCs.
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