Evaluation of the Quality and Effect of 360° Safe Indwelling Infusion of Peripheral Venous Indwelling Needle in Pediatric Clinic.

To evaluate the application effect of the 360° safe indwelling infusion program of peripheral venous indwelling needle in the infusion room of pediatric outpatient clinic. A total of 1,000 children who received indwelling needle infusion were randomly divided into experimental group (n = 500; 360° safe indwelling needle) and control group (n = 500; a routine indwelling needle). The incidence of indwelling needle-related complications and adverse events in the experimental group was significantly lower than that in the control group, and the number of indwelling days, indwelling needle usage rate, and parent satisfaction were significantly higher than those in the control group. The 360° safe indwelling infusion program can significantly reduce the incidence of complications and adverse events, and improve the quality of the indwelling needle infusion. The 360° safe indwelling infusion can effectively improve the comprehensive quality and safety of nursing care in the outpatient infusion room.

1. Introduction

Peripheral Intravenous Cannulation is also called a trocar, and it is composed of a stainless steel core, a soft outer tube and a plastic needle seat. During puncture, the needle core and the tube are fed into the blood vessel together, and the needle core is finally withdrawn, A peripheral intravenous infusion tool that leaves the hose in the blood vessel, mainly used for short-term intravenous infusion therapy [1].

Peripheral venous indwelling needles have become the first choice for clinical intravenous infusion, blood transfusion, rescue, intravenous nutrition and emergency rescue methods [2], however, the current status of indwelling needle infusion in children with outpatient intravenous treatment is not ideal, and peripheral venous indwelling needles are not available. It is widely used in pediatric outpatient clinics [3, 4], mainly because the indwelling needle infusion is used in the outpatient infusion room without the safety assessment of the indwelling needle, the 24-hour indwelling needle care management for children treated in the outpatient department cannot be carried out, and the lack of peripheral intravenous indwelling needle 360° safe indwelling infusion The complications of indwelling needles in outpatients of the program are higher than those in hospitalized wards, which brings great distress to the children and medical staff [5]. Therefore, in the outpatient infusion, the standardized outpatient indwelling needle evaluation system, infusion procedures and nursing management methods are of great significance to maintaining the safety of indwelling needles in children. This study established the 360° safe indwelling infusion program for indwelling needles in outpatient clinics to reduce the incidence of complications and adverse events of indwelling needles in outpatient infusion patients, reduce suffering and pain, improve the quality of care in the infusion room.To provide a reference for the quality and safety of care in the pediatric outpatient infusion room.

2. Materials and Methods

2.1. General Information

We selected 1,000 children with indwelling needle infusion in the outpatient infusion room of our hospital from January 1, 2019 to December 31, 2019. They were randomly divided into the experimental group and the control group according to the infusion sequence number according to the convenience sampling method, with 500 children in each group. There were 243 boys and 257 girls in the experimental group, aged 1–9 years old, with an average age of (4.1 ± 1.1) years old, and 249 boys and 251 girls in the control group, aged 2–9 years old, with an average age of (4.3 ± 1.2) years old. There was no statistical difference between the two groups in terms of gender, age, disease diagnosis, and nursing staff (P > 0.05).This study was approved by the ethics committee of Shaanxi Provincial People's Hospital. Signed written informed consents were obtained from all participants before the study.

2.2. Inclusion and Exclusion Criteria

2.2.1. Inclusion Criteria

Children who use indwelling needle infusion in the outpatient infusion room of our hospital and the infusion course is greater than or equal to 3 days

Diagnosed as common diseases such as respiratory tract and digestive tract

Infusions are commonly used antibiotics, antiviral drugs, dehydration fluids, etc.

Live in this city during treatment

The child has telephone contact information and can maintain smoothness, and is proficient in using WeChat functions

The indwelling needle is used to indwell the child with infusion with the consent of the parent

2.2.2. Exclusion Criteria

The course of infusion between infusions is less than 3 days

Children who are not outpatients with infusion in our hospital

Children with cardiovascular disease, blood disease, tumor, etc.

Import chemotherapy drugs and other irritating drugs, foaming agents, strong acids, strong alkaline drugs, blood products, etc.

Leave or not live in this city during the treatment

The telephone contact is not smooth, and the WeChat function is not used

The indwelling needle is used for indwelling children with infusion after the parents disagree

2.3. Methods. Control Group: Conventional Indwelling Needle Infusion + Nurse Oral Education

Experimental group: conventional indwelling needle infusion +360° all-round safe infusion program, mainly including: outpatient indwelling needle infusion assessment + clever fixation and protection + points of attention in publicity and education + home care manual + home care WeChat platform. The specific process is as follows:

2.3.1. Evaluation Method and Requirements

Evaluation of the indwelling needle before infusion: (1) remove the bandage and leave it to the parents for safekeeping, and evaluate item by item according to the evaluation form: whether the indwelling needle extension tube has returned blood, and whether the indwelling needle handle, clip, and heparin cap are directly Contact with the skin, whether there are indentations, redness, skin damage, dampness, rash, etc. on the skin, whether there is bleeding in the needle under the film, whether the film is curled, whether it needs to be replaced, etc. Fill in the evaluation results and inform the parents of the evaluation results. The nurse signs them and keeps them in the department. At the same time, the nurse stamps the indwelling needle evaluation stamp on the patient's outpatient medical record, and the parents sign after filling in the evaluation results. Inform parents that after the indwelling needle is sealed, the nurse will wrap a bandage to protect the indwelling needle as required. Deal with the abnormal conditions found during the assessment, such as skin infection, skin injury, displacement, blood oozing, etc. in a timely manner. (2) Operation and maintenance standards: implement the intravenous treatment technical operating standards promulgated by the National Health and Family Planning Commission. Flush the tube with 5 ml saline, withdraw the blood return first, and then slowly push in. (3) After the evaluation is normal, the indwelling needle can be connected to the indwelling needle for infusion.

2.3.2. Methods of Fixation and Protection

(1) After successful puncture of the indwelling needle, an infusion patch or cotton ball must be used to pad under the needle handle, and then a transparent paste shall be used for tension-free application. The purpose is to prevent the needle handle of the indwelling needle from directly contacting the skin and excessive pressure Large, long-term pressure can cause skin damage. The child is active to prevent the indwelling needle from coming out. Put a cotton ball behind the needle handle, and fix it in a U-shape under the needle handle with breathable tape. Wrap the tape around the needle handle for one week. Do not stretch it too tightly. (2) In order to avoid accidents such as accidental ejection of the indwelling needle, pediatric removal, collision, etc., the indwelling needle is cleverly fixed method: apply a cotton breathable medical bandage, cut the 2 cm length in the direction with scissors in the middle of the bandage, and pass the extension tube of the indwelling needle. Fix it on the needle handle and place the clip on the bandage. If it is a scalp indwelling needle, wrap it directly. If it is an indwelling needle on the hand, cut a small hole in the thumb and pass it through the thumb. All indwelling needle bandages protect the indwelling needle. The upper part is a double layer. The extension tube, heparin cap, and positive pressure connector are between the two layers of bandages, and do not directly touch the skin. The bandages should not be wound too tightly. The length of the bandage should be 1 : 1.2∼1.3.

2.3.3. Diversified Health Education and 24-Hour Home Care Programs

One-to-one oral education, group classroom, TV education, written education, online platform (WeChat platform) and other methods are adopted. Each parent of a child with an indwelling needle will issue a home care manual for an indwelling needle to inform the parents of key points for attention. At the same time, parents are invited to join the indwelling needle home care WeChat platform to regularly push the precautions for indwelling needle home care, answer parents' questions at any time, and determine whether the indwelling needle is safe and whether it needs to be handled in the hospital.

2.4. Evaluation Method

2.4.1. Complications and Adverse Events of Indwelling Needle Infusion in Outpatient Department

The indicators used include: the incidence of indwelling needle complications (clogging, phlebitis, catheter return blood); the incidence of adverse events (accidental extubation, bleeding, pressure injury, loss of heparin caps, etc.); indwelling days; indwelling needle use rate.

2.4.2. Satisfaction

A satisfaction survey was conducted on the parents of children with indwelling needle infusion. The questionnaire was divided into satisfied, relatively satisfied and dissatisfied. At the end of the infusion treatment, the parents will be surveyed on satisfaction with the indwelling needle. The calculation method of satisfaction is (the number of satisfied people + the number of more satisfied people)/total number of people surveyed.

2.5. Statistical Analysis

Using Statistical Product and Service Solutions (SPSS) 21.0 statistical software (IBM, Armonk, NY, USA) to analyze relevant data. Measurement data is expressed by (x̅ ± s), comparison between groups is expressed by t-test; count data is expressed by frequency and percentage (%), and comparison between groups is expressed by χ2 test. P < 0.05 indicates that the difference is statistically significant.

3. Results

3.1. Comparison of Indwelling Needle-Related Complications and Adverse Events in the Two Groups of Children Using Peripheral Venous Indwelling Needle Infusion (Table 1)

Table 1 shows that the use of pediatric outpatient indwelling needles for 360° safe indwelling infusion, the incidence of indwelling needle pressure injury decreased from 7.4% to 0.4%, the incidence of blood in the catheter decreased from 52% to 23%, and the incidence of tube blockage was 9.8% Decreased to 4.2%, the incidence of phlebitis decreased from 3.6 to 0.6%, and the rate of unplanned extubation of the indwelling needle decreased from 13.4% to 6%. The P values were all less than 0.01, which was statistically significant.

Table 1

Comparison of complications and adverse events related to indwelling needle in the two groups of children (n (%)).

	Pressure injury	Exudation from the needle	Blood return in the catheter	Blocking of the tube	Accidental tube-off	Phlebitis	Unplanned extubation
Experimental (500)	2 (0.4)	16 (3.2)	115 (23.0)	21(4.2)	4 (0.8)	3 (0.6)	30 (6.0)
Control (500)	19 (7.4)	51 (10.2)	260 (52.0)	49 (9.8)	23 (4.6)	18 (3.6)	67 (13.4)
χ2	14.6	19.60	89.71	12.04	13.74	10.94	15.63
P	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01

3.2. Comparison of the Quality of Infusion and Parental Satisfaction between the Two Groups of Children after Using Peripheral Venous Indwelling Needles (Table 2)

Table 2 shows that the 360° safe indwelling infusion of indwelling needles in pediatric outpatient clinics has increased from 73.8% to 95.2% in indwelling needles for more than three days, the use rate of indwelling needles has risen from 5% to 64%, and the incidence of fluid leakage has dropped from 5.8%. To 2.2%, parental satisfaction rose from 86% to 98%, and the P values were all less than 0.01, which were all statistically significant.

Table 2

Comparison of sensitive indexes of nursing quality between infusion before and after implementation (%).

	Indwelling ≥3 d (%)	Indwelling needle usage rate (%)	Liquid exudation rate (%)	Parent satisfaction (%)
Experimental	94	64	2.2	98
Control	86.6	5	5.8	86
P	<0.01	<0.01	<0.01	<0.01

4. Discussion

The implementation of 360° safe indwelling infusion of indwelling needles in children's outpatient clinics has effectively reduced the incidence of adverse events of indwelling needles in children with outpatient infusion treatment.

As a common treatment for intravenous infusion, intravenous indwelling needles are less irritating to children's blood vessels and relieve the pain of repeated puncture in children. They are favored by medical staff and parents of children in clinical applications [6]. Children who are treated with infusion in the outpatient infusion room belong to daytime treatment. They often go home to rest after the infusion treatment on the same day, and take the peripheral venous indwelling needle home. Because the child is more active and curiosity is strong, the indwelling needle is infused While bringing convenience, there are certain hidden safety hazards, such as catheter blockage, blood return in the catheter, accidental needle removal/disconnection, puncture site infection, etc. Parents lack the relevant professional knowledge of indwelling needles and it is difficult to obtain timely and effective care from the nursing staff. Treatment increases the potential safety hazards [3, 7–9]. Therefore, it is not widely used in pediatric outpatient infusion rooms. The use rate of steel needles is very high. During the process of steel needle infusion, the needle tip is likely to shift and puncture the blood vessel to cause infusion. Extravasation and high repetitive puncture rate increase the pain of children and increase the workload and work pressure of nurses. Through a complete evaluation tool and system, the skin conditions around the indwelling needle, whether there is blood or fluid from the eye of the needle, whether there is any discount, whether there is blood back, etc., can be found in time, and can be treated in time. The ingenious fixation and protection method of the indwelling needle effectively reduces the risk of indwelling for the skin of the child, avoiding accidents such as prolapse caused by the traction of the child. At the same time, the hospital care is extended to the home care through the WeChat platform, achieving 24 hours Nursing can timely solve the problem that parents of children cannot care for indwelling needles at home, avoid the occurrence of adverse events caused by improper care of parents at home, and reduce the safety risk of indwelling needles in pediatric outpatient clinics [10]. Table 1 shows that the comparison of indwelling needle-related complications and adverse events in the experimental group and the control group has significant statistical significance.

Pediatric outpatient indwelling needle 360° safe indwelling infusion, effectively improving the quality of care in the infusion room.

For a long time, the national health department regards the management of nursing quality and indicators as the top priority, and the management of nursing quality is no longer a personal problem for managers. It is more scientific and objective to use nursing sensitive indicators to evaluate nursing quality. And it can promote the participation of all staff in the department and comprehensively improve the quality of care [11]. The indwelling days of the indwelling needle, the incidence of adverse events, the incidence of fluid leakage, and the satisfaction of parents are unique sensitivity indicators established in the infusion room of our hospital. Application of steel needle infusion, frequent liquid leakage and repeated venipuncture will not only increase the suffering of children, reduce the quality of care, but also cause doctor-patient disputes [12]. The 2019 U.S. Intravenous Infusion Guide clearly states that steel needles are only used for single blood sampling and infusion within 4 hours. The indwelling needle evaluation system, clever fixation and bandage protection can effectively reduce the unplanned extubation rate of indwelling needles and extend the number of indwelling days. Really exert the advantages of indwelling needles. Table 2 shows that the number of indwelling days for more than 3 days and the usage rate of indwelling needles in the experimental group were significantly higher than those in the control group (P < 0.01). The use of a comprehensive and safe indwelling infusion program better reflects the advantages of the indwelling needle. The child does not need to undergo infusion puncture again for at least 3 days, which not only protects the blood vessel but also reduces the pain of the child. Parents are willing to use the indwelling needle for indwelling infusion. The needle usage rate will rise, avoiding many negative effects caused by overload of nursing work, and reducing medical costs and the loss of medical resources. Through a combination of online and offline diversified health education methods such as WeChat platform, parent classroom, etc., regular delivery of indwelling needle-related knowledge, and timely answers to routine questions raised by parents of children with children, can not only improve the knowledge of parents of children with indwelling needle-related knowledge, It can also provide parents with more sense of security, avoid complications and adverse events of indwelling needles, and increase the number of days of indwelling needles in children [13, 14]. Table 2 shows that the satisfaction of parents in the experimental group was significantly higher than that in the control group (P < 0.01), which was statistically significant, indicating that the 360° safe indwelling infusion of the indwelling needle in the outpatient clinic can significantly improve the sensitive indicators of infusion care and improve the infusion room. Quality of care.

The use of outpatient indwelling needles for safe indwelling infusion 360° all-round safe indwelling infusion solutions need to pay attention to issues.

Enhancing the initiative of nurses to participate in safety management is crucial, and each step must be strictly implemented in accordance with the system, and there must be no chances. If the bandage must be opened and removed before the infusion for evaluation, inform the parents of the evaluation result and ask the parents to sign. The bandage must not be used for infusion; the indwelling needle must be covered with an infusion patch, especially the scalp vein indwelling needle, and the indwelling needle component must not be used Direct contact with the skin; the indwelling needle connecting tube should be placed between the two layers of bandages to avoid accidents such as falling off and accidental removal. At the same time, this measure allows parents to participate in the nursing work throughout the whole process, which not only ensures the safety of nursing, but also achieves the goal of the nurse and the parents to cooperate to make the nursing work more refined, and harmonize the nurse-patient relationship.

Outpatient clinic is the primary link for children to see a doctor, and the quality of care is closely related to the overall quality of the hospital. The results of this study show that the implementation of the pediatric outpatient indwelling needle 3600 all-round safe indwelling infusion mode reduces the incidence of complications and adverse events of indwelling infusion in pediatric outpatient clinics, significantly increases the number of days of indwelling peripheral venous indwelling needles in children, and ensures the use of indwelling needles in outpatient clinics The safety of indwelling infusion can reduce the work pressure of nurses in the infusion room and improve the quality of care in the infusion room in an all-round way. It can meet the satisfaction of parents and nurses. It can be widely used in outpatient indwelling needle infusion children.