Investigating the effect of heating device on the diameter of antecubital veins in adults aged 20-40

Dissertation

To receive a master's degree in intensive care nursing

Introduction: Insertion of a venous catheter is the most common invasive procedure performed for hospitalized patients. In many cases, this simple procedure can save the patient's life. On the other hand, this action becomes a difficult and time-consuming technique in some groups and patients. Various auxiliary measures are used to solve problems with this technique.  One of these measures is the use of local heat to increase the diameter of surface veins. In this regard, taking into account the lack of means that can be controlled by means of heat, the position of the process can be controlled and used to create vein dilatation; a heating means was designed and manufactured with the necessary permits, with the aim of "determining the effect of the use of heating means on the diameter of the antecubital vein of 20-40-year-old adults".

Materials and methods: This research is a clinical trial that was conducted in the radiology department of Porsina Hospital in Rasht. The research units included 18 students of Shahid Behshi College of Nursing and Midwifery in Rasht and 37 nurses of Porsina Hospital in Rasht. The heating device in this research was designed after the safety principles and was approved by the medical equipment department of the university and the Industrial Patent Office. Each of the participants was initially measured and recorded by a radiologist, the diameter of the cubital vein using ultrasound. Then, the hand of each participant was heated for 10 minutes by an innovative device at a temperature of about 42 degrees, and after the completion of the heat presentation, an ultrasound of the same area was performed by a radiologist and the vein diameter was re-measured and recorded. The data recorded in Ward SPSS 18 software was analyzed using descriptive and analytical statistics.

Results: The average diameter of the vein in the first time of measurement (before applying heat) was 378 mm and in the second time (after applying heat) it was 421 mm. The results showed that the application of local heat causes a significant change (43 mm) in the diameter of the cubital vein. The change of vein diameter has no significant relationship with the sex, age, weight, height and body mass index of the research subjects.

Discussion and conclusion: According to the statistical analysis, it can be concluded that after the application of heat, the diameter of the veins increased significantly and the heat created by the heating device caused the dilation of the veins of the anthenocubital region (P>0.05).

key word: local heat, peripheral vein vasculature, accessurid

Research field:

In modern medical practices, more than 80 percent of people admitted to the hospital receive intravenous treatment during hospitalization, and in many of them, this action will continue even after discharge. Today, many medicinal and non-medicinal substances such as intravenous drugs, injectable fluids, nutritional substances, blood and blood products can be used intravenously and in peripheral or central forms for patients (3, 1, 2).

Placement of a venous catheter is the most common invasive procedure performed in hospitalized patients and in many cases it is a life-saving factor for the patient. becomes (5, 1, 3, 4).

In a country like the United States, nearly 200 million peripheral vascular catheters are used annually, and this invasive treatment imposes an annual cost of 140 billion dollars to the health care systems of this country (2).

There are many points for inserting venous catheters. has Lower arm veins or leg veins can be good places for vein extraction after forearm veins. If it is difficult to insert a venous catheter at these points, the veins of the mid-cubital region are usually the next step for venous catheter insertion (2).

Any unsuccessful attempt to insert a venous catheter can increase the patient's discomfort and delay necessary treatments and laboratory tests for the patient (6). Additional attempts for this invasive procedure increase the risk to personnel (such as needle stick).Additional efforts for this invasive method increase the risk to the personnel (such as the insertion of an infected needle into the body) and will be accompanied by the risk of complications (such as hepatitis and acquired immunodeficiency virus) (11, 6).

if possible), injecting blood products, giving medicine (either continuously or intermittently), using in many invasive procedures and methods, and using for patients who are unstable in terms of vital signs (10, 1, 4, 7). The cases of not using peripheral venous catheter placement include inflammation and infection in the target area, not using forearm veins in patients with renal inaccessibility (may be necessary for fistula placement) ) and when stimulant drugs are used inside the small vessels (12, 8) .

Quick access to the cardiovascular system of patients, in the treatment of patients especially "emergency drug therapy" is necessary (8) and in addition to this, it allows the restoration of the lost intravascular volume and, if necessary, the use of drugs and blood (11, 8, 13) .

Difficulty in placing a peripheral intravenous line is a very common and frustrating experience for nurses, especially those who take care of children and patients in special departments (12,8,7).

Inserting a catheter in cases of intravenous drug abuse, long-term use of intravenous drugs in patients who periodically undergo chemotherapy is catastrophically difficult. This action is also difficult in children and children, patients with a lack of body fluids (dehydration), people with poor peripheral blood flow, mental factors, patients with a lot of scar tissue, obese patients and black people (13, 1, 6, 7, 11). In addition, it will be more difficult and complicated in patients who are afraid of injections or those who have experienced an unsuccessful placement of a venous catheter, because fear activates the sympathetic nervous system and this causes vasoconstriction. When the first attempt fails, almost all patients experience a degree of sympathetic activity that increasingly complicates the insertion of the catheter. It also frustrates the staff, so it is important to insert a catheter quickly and on the first attempt (6, 7).

The most important system for controlling the capacity of the body's veins is the sympathetic nervous system. Many factors cause vasoconstriction in the body. such as lowering skin temperature, lowering blood pressure, using nicotine and caffeine (14, 6, 11).

Medicines such as noradrenaline, as well as pain due to repeated attempts to insert a catheter or fear of performing these procedures, can make it difficult to access the vessels (14, 6, 11).

In most cases, to insert a catheter from Alcohol is used. This standard technique has several obvious disadvantages: alcohol or any substance containing ethyl or isopropyl, although it helps to see a vein, and is also used in cleaning the skin of the area, but it is a vasoconstrictor that causes the size of the veins to decrease (3). This rate is 28% in adults, 44% in children and 43% of children will need third or more attempts. 23% to 28% prevalence of fluid entering the extravascular space and inflammation of the area is also seen, and 12% of patients in the hospital environment on the third day are among the patients in whom it is difficult to insert a venous catheter (4).

In addition, it has been reported that more than 50% of attempts to reach a vein in very old patients, in those who have lost a high percentage of fat tissue It has been unsuccessful and more efforts are needed (5).

Techniques that are currently used both in routine situations and in emergency cases to improve vascular access include: local heat, use of local nitroglycerin, transillumination, coat down of peripheral vessels, guidance through ultrasound, use of central vessels and intraosseous infusion (3, 8).