THE EFFECTIVENESS OF ORAL SUCROSE ON PAIN DURING INVASIVE PROCEDURES IN PREMATURE INFANTS: SCOPING REVIEW

Introduction: Nowadays premature births continue to be common, it caused the infant necessitating treatment. Invasive procedures, such as the placement of an peripheral intravenous catheters or the drawing of blood, should be carried out while the baby is being cared for. Some intervention needed, sucrose is one approach to make invasive procedure less painful. This study aims to determine the effectiveness of oral sucrose in reducing the pain of invasive procedures in premature infants. Method: This study is a scoping review, and 11 articles were selected from Proquest, ScienceDirect, Willy Online, PubMed, and EBSCO (CINAHL) databases. Results: In eight of the articles, giving oral sucrose two minutes before the invasive procedure was effective in reducing pain, while sucrose was not effective in reducing pain in infants in the other three of the articles, during or after procedures. Conclusion: According to these studies, giving oral sucrose to premature infant before invasive procedure is significant reducing the pain during invasive procedure.

The algorithm of decision-making in administration of anticoagulant therapy due to COVID‑19. Review

There is a hypothesis that on its late complicated stages, coronavirus disease of 2019 (COVID‑19) represents an endothelial disease. According to Peter’s Libbi data (2020), the endothelial monolayer measures up to 7000 m2 in surface area. The endothelial functions include anticoagulant, antiplatelet, anti‑inflammatory, vasomotion, and structure. The aim of the review was to figure out COVID‑19 logistics from the standpoint of its pathogenesis, in particular its thrombotic complications, to summarize data on the choice of an anticoagulant, its dose and duration of use. COVID‑19 is a new disease with the lack of evidence‑based data, however, its per‑syndrome analysis results in conclusion that the most part of acute and post‑COVID complications refer to thromboembolic ones. According to the recommendations of the European Society of Cardiology on diagnostic and treatment of thromboembolism, the need for thromboembolism prevention is defined in case of respiratory failure, installed intravenous catheters, infection (specifically pneumonia), bed rest, elderly age, etc. The adherence to evidence‑based recommendations will allow one to administer rational anticoagulation therapy without harm to a patient. It concerns both patients, who are on anticoagulant therapy at hospital admission, and those who requires its new administration. The following questions are mostly frequent arising in doctors: How one should manage a patient with active bleeding, or platelet levels < 25 · 109/ L, or with congenital abnormality of coagulation? What types of blood chemistry should be considered when administering anticoagulant? What therapy should be administered at discharge? Compliance with clear anticoagulation algorithms will prevent thromboembolic complications, further damage to organs and systems, and significant bleeding.

Routine Replacement versus Clinically Indicated Replacement of Peripheral Venous Catheters through Assessment of Incidences and Grades of Phlebitis in Patients with IV Cannula at a Tertiary Care Hospital, Mumbai

Background: The current study assesses the incidences and grades of phlebitis among patients with IV cannula to determine the association of grades of phlebitis. The purpose of the study was to study the feasibility of Routine replacement versus Clinically indicated replacement of peripheral venous catheters. The study observes the incidences of removing peripheral intravenous catheters when clinically indicated compared with removing and re‐siting the catheter routinely. Methods: An observational study was conducted in the tertiary care private hospital of Mumbai, India. The study was conducted over 5 weeks from May -June 2020. Purposive sampling was considered during the collection of data. The sample size of the study was 117 patients admitted having peripheral venous catheters. The standard visual infusion phlebitis (VIP) score was used as a tool for data collection. Descriptive analysis was done. Results: Out of 117 patients (VIP score 0 -56, Score 1- 49, Score -12 no cases with score 3, 4, and 5). Routine replacement of IV cannula after every 5 days is judiciously followed, 45 healthy lines were replaced at score 0; which is the major concern (Rs. 633/- the total cost of replacing 1 PVC line). Conclusion: Following the routine practice of IV cannula replacement based on VIP score to avoid phlebitis is equally good but simultaneously clinically indicated replacement of IV cannula is advisable to make it cost-effective and reduced number of a prick to the patients; this will help to improve patient satisfaction.

Idle peripheral intravenous cannulation: an observational cohort study of pre-hospital and emergency department practices

Background Unused ('idle') peripheral intravenous catheters (PIVC) are those not used within 24 hours of insertion. There is little data on cannulation practices and idle PIVC rates in emergency settings, especially the pre-hospital environment. Methods This was an observational cohort study set in south-east Queensland, Australia using data from a large tertiary level emergency department (ED) and the local statutory ambulance service. Demographic, clinical and PIVC data were collected over two periods; 9 February–18 March 2017 and 5 January–4 February 2018. Adult patients were included if they were allocated an Australasian triage scale (ATS) category between 2 and 5, and had a PIVC inserted in the pre-hospital setting or ED. PIVC use was defined as idle if no fluids, medications or contrast were administered intravenously within 24 hours of insertion. Comparisons between pre-hospital and ED practice and idle PIVC status were undertaken using descriptive statistics and logistic regression. Results A total of 1249 patients with a PIVC (372 pre-hospital; 877 ED) were included. Overall, 366 PIVCs (29.3%; 95% CI 26.9%–31.9%) remained idle at 24 hours. In the pre-hospital group, 147 (39.5%) PIVCs inserted were not used pre-hospital, and 74 (19.9%) remained idle. In comparison, 292 (33.3%) PIVCs placed in the ED remained idle. ED staff more frequently inserted PIVCs in the antecubital fossa than paramedics (65.5% vs. 49.7%), where forearm PIVC insertion was more common pre-hospital than in ED (13.7% vs. 7.4%). Nursing staff inserted idle PIVCs at a rate of (35.1%) compared to doctors (29.6%) and paramedics (19.9%). Having a PIVC inserted in the ED was the only factor significantly (p ≤ .001) predicting an idle outcome (Odds Ratio: 2.4; 95% CI 1.7–3.3). Conclusion One-third of PIVCs inserted within the emergency setting remained idle, suggesting unnecessary risk and costs. Pre-hospital and ED PIVC insertion practices differed, with idle PIVCs 2.4 times more prevalent if inserted in the ED than pre-hospital and with greater use of antecubital insertion. Reasons for these differences are not well understood and requires more targeted research.

Deterioration in hygiene behavior among fifth-year medical students during the placement of intravenous catheters: a prospective cohort comparison of practical skills

Background The American Association of Medical Colleges has defined peripheral intravenous cannulation as one of the eight practical skills that a medical student should possess upon graduation. Since following a standard hygiene protocol can reduce the rate of complications such as bloodstream infections, the medical student’s compliance to hygienic standards is highly relevant. Methods This unicentric longitudinal cohort study included 177 medical students undergoing OSCE 1 in the winter semesters 2016/2017 and 2017/2018 as well as OSCE 2 during the winter semesters 2018/2019 and 2019/2020 at the University of Cologne. Their performance in peripheral intravenous cannulation was rated by trained student supervisors using a scaled 13-item questionnaire and compared between OSCE 1 and OSCE 2. Results Overall, a decline in the correct placement of peripheral intravenous catheters was observed among advanced medical students during OSCE 2 (mean total score: 6.27 ± 1.84) in comparison to their results in OSCE 1 (mean total score: 7.67 ± 1.7). During OSCE 2, the students were more negligent in regard to hygienic behavior, such as disinfection of the puncture site as well as hand disinfection before and after venipuncture. Their patients were also less likely to be informed about the procedure as compared to OSCE 1. Conclusions An unsatisfying performance in regard to peripheral intravenous cannulation was observed in medical students with hygiene compliance deteriorating between the third and fifth year of their study. Thus, we promote an extension of practical hygiene and stress management training in medical school to reduce complications associated with intravenous catheters, such as bloodstream infections.

Mothers’ knowledge regarding peripheral intravenous catheter caring and complications among pediatric patients: A cross-sectional study

Objective: Pediatric patients are considered at risk for Peripheral intravenous catheters (PIVCs) complications more than adults. This study aimed to assess the level of mothers’ knowledge of PIVC maintenance, caring, and complications among pediatric patients. It was also aimed to investigate the association between maintenance and complication knowledge of PIVC. Furthermore, demographic factors were investigated to assess associations on mothers’ knowledge of PIVC.Methods: The study adopted a cross-sectional design. This study was performed on a convenience sample of 193 mothers from a tertiary hospital in Jordan in 2020.Results: Mothers’ knowledge regarding complications was higher than their knowledge of maintenance and caring of PIVC. Mothers’ knowledge toward caring for PIVC was positively correlated with their knowledge about PIVC complications. Mothers’ age and the number of hospital admissions were found to be significantly associated with the level of maintenance and caring knowledge of PIVC but not with complication knowledge of PIVC. The higher the educational level of a mother the less prone she is to complications of PIVC in pediatric patients.Conclusions: It is recommended that health professionals working in pediatric engage mothers in educational sessions to improve maintenance, care, and to prevent complications of PIVC among pediatric patients.