Hastanın derisi yoluyla damar lümeni içerisine kanül yerleştirilmesi işlemi olan periferik venöz kateterizasyon (PVK), hastanede yatarak tedavi olan hastalarda en sık uygulanan invaziv hemşirelik girişimlerinden birisidir. PVK doğru şekilde uygulandığında yararlı ve hastanın hayatını kurtarabilen bir uygulama iken, yanlış şekilde uygulandığında veya kateter bakımının yetersiz olduğu durumlarda flebit, infiltrasyon, ekstravazasyon, kanama, hematom, emboli, enfeksiyon gibi ciddi lokal ve sistematik komplikasyonlara neden olmaktadır. Bu komplikasyonlar arasında yer alan flebit, venin tunika intima tabakasının inflamasyonu olup, intravenöz tedavi uygulamalarında sık görülen ve önlenebilir bir komplikasyondur. Gelişen komplikasyonlar nedeniyle PVK'lerin zamanından önce çıkarılma oranı %70'lere ulaşabilmektedir. Yapılan çalışmalarda; ileri yaş, PVK uygulamalarında aseptik koşullara dikkat edilmemesi, hastaya uygulanan ilaç sayısı ve ilaç uygulama sıklığının fazla olması, asit-alkali sıvı ve asit-alkali ilaçların uygulanması, ilaç uygulamalarında hızlı infüzyon, sürekli infüzyon ve bolus yöntemiyle ilaç uygulamasının flebit gelişme riskini artırdığı; bununla beraber vialon kateterlerin ve 20-22 numaralı kateter kullanımının, PVK'nin sefalik, bazilik ve antekübital bölge venlerine uygulamasının flebit gelişme riskini azalttığı ve rutin kateter değişiminin flebit gelişme riskini etkilemediği belirlenmiştir. Ayrıca kateterin cilde sabitlenmesi, kateter uygulayan kişinin bilgi ve beceri düzeyi, set değişim süreleri gibi faktörlerin flebit gelişimini etkilediği tespit edilmiştir. Bu derlemede, periferik venöz katetere bağlı flebit gelişiminin önlenmesine yönelik kanıta dayalı hemşirelik uygulamaları açıklanmıştır.
Anahtar Kelimeler: Periferik venöz kateter; flebit; hemşirelik; kanıta dayalı hemşirelik uygulamaları
Peripheral venous catheterization (PVC), which is the process of inserting a cannula into the vessel lumen through the patient's skin, is one of the most frequently applied invasive nursing interventions in hospitalized patients. While PVC is a useful application that can save the life of the patient when applied correctly, it causes serious local and systemic complications (phlebitis, infiltration, extravasation, bleeding, hematoma etc.) when applied incorrectly or when catheter care is insufficient. Among these complications, phlebitis is inflammation of the tunica intima layers of the vein and is a common and preventable localization in intravenous examination procedures. Due to the developing difficulties, the premature removal rate of PVCs can reach 70%. Studies have shown that factors such as advanced age, not paying attention to aseptic conditions in PVC applications, number of drugs administered to the patient and frequency of drug administration, administration of acid-alkaline liquids/drugs, some methods used in drug administration (rapid infusion, continuous infusion and bolus method)' etc. increase the risk of developing phlebitis. However, in related studies, it has been determined that use of vialon catheters and number 20-22 catheter and application of PVC to cephalic, basilic and antecubital region veins reduce the risk of developing phlebitis and that routine catheter replacement does not affect the risk of developing phlebitis. Also, it has been confirmed that factors such as fixation of catheter to skin, knowledge and skill level of person applying catheter, and set change over times affect development of phlebitis. In this review, it is explained that evidence-based nursing practices for the prevention of peripheral venous catheter-related phlebitis.
Keywords: Peripheral venous catheter; phlebitis; nursing; evidence-based nursing practice
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