Effectiveness of heparin gel versus magnesium

i
EFFECTIVENESS OF HEPARIN GEL VERSUS MAGNESIUM
SULPHATE WITH GLYCERINE APPLICATION ON
THROMBOPHLEBITIS AMONG INTRAVENOUS CANNULIZED
PATIENTS ADMITTED IN OG POST OPERATIVE WARD,
AT GRH, MADURAI.
M.Sc (NURSING) DEGREE EXAMINATION
BRANCH – III OBSTETRICS AND GYNAECOLOGICAL NURSING
COLLEGE OF NURSING
MADURAI MEDICAL COLLEGE, MADURAI – 20
A dissertation submitted to
THE TAMILNADU DR.M.G.R MEDICAL UNIVERSITY
CHENNAI- 600 032
In partial fulfillment of the requirement for the degree of
MASTER OF SCIENCE IN NURSING
OCTOBER 2020

ii
EFFECTIVENESS OF HEPARIN GEL VERSUS MAGNESIUM
SULPHATE WITH GLYCERINE APPLICATION ON
THROMBOPHLEBITIS AMONG INTRAVENOUS CANNULIZED
PATIENTS ADMITTED IN OG POST OPERATIVE WARD,
AT GRH, MADURAI.
Approved by dissertation committee on 06.03.2020
Nursing Research Guide _________________________________
Dr. S. RAJAMANI, M.Sc (N)., M.B.A (HM)., M.Sc (Psy)., Ph.D.,
Principal,
College of Nursing,
Madurai Medical College,
Madurai – 20.
Clinical Specialty Guide_________________________________
Mrs. SOBANA JOY JOHN, M.Sc (N)., M.Sc(PSY).,
Reader,
Department of Obstetrics and Gynaecological Nursing,
College of Nursing,
Madurai – 20.
Medical Expert________________________________________
Dr. N.SUMATHY, MD., DGO.,
Professor and HOD,
Department of Obstetrics and Gynaecology,
Madurai – 20.
A dissertation submitted to
THE TAMILNADU DR.M.G.R MEDICAL UNIVERSITY
CHENNAI-600032
In partial fulfillment of the requirement for the degree of
MASTER OF SCIENCE IN NURSING
OCTOBER – 2020

iii
CERTIFICATE
This is to certify that this dissertation titled, “EFFECTIVENESS
OF HEPARIN GEL VERSUS MAGNESIUM SULPHATE WITH
GLYCERINE APPLICATION ON THROMBOPHLEBITIS AMONG
INTRAVENOUS CANNULIZED PATIENTS ADMITTED IN OG POST
OPERATIVE WARD, AT GRH, MADURAI.” is a bonafide work done by
Mrs. S. SELVA RAJESWARI, M.Sc (N) student, College of Nursing, Madurai
Medical College, Madurai-20, and submitted to THE TAMILNADU DR. M.G.R.
MEDICAL UNIVERSITY, CHENNAI in partial fulfillment of the university rules
and regulations towards the award of the degree of MASTER OF SCIENCE
IN NURSING, BRANCH III - OBSTETRICS AND GYNAECOLOGICAL
NURSING, under our guidance and supervision during the academic period from
2018 – 2020.
Dr. S. RAJAMANI, M.Sc (N)., Ph.D., Dr. J. SANGUMANI, MD.,
Principal, Dean,
College of Nursing, Madurai Medical College,
Madurai Medical College, Madurai - 20.
Madurai – 20.

iv
CERTIFICATE
This is to certify that this dissertation titled, “EFFECTIVENESS
OF HEPARIN GEL VERSUS MAGNESIUM SULPHATE WITH
GLYCERINE APPLICATION ON THROMBOPHLEBITIS AMONG
INTRAVENOUS CANNULIZED PATIENTS ADMITTED IN OG POST
OPERATIVE WARD, AT GRH, MADURAI.” is a bonafide work done by
Mrs. S. SELVA RAJESWARI, M.Sc (N) student, College of Nursing, Madurai
Medical College, Madurai – 20, in partial fulfillment of the university rules and
regulations towards the award of the degree of MASTER OF SCIENCE IN
NURSING, BRANCH III-OBSTETRICS AND GYNAECOLOGICAL
NURSING, under our guidance and supervision during the academic period from
2018 – 2020.
Name & Signature of the Clinical Speciality Guide _______________________
Mrs. SOBANA JOY JOHN, M.Sc (N)., M.Sc(PSY).,
Reader,
Department of Obstetrics and Gynaecological Nursing,
College of Nursing,
Madurai – 20.
Name & Signature of the Research Guide _______________________________
Dr. S. RAJAMANI, M.Sc (N)., M.B.A (HM)., M.Sc (Psy)., Ph.D.,
Principal,
College of Nursing,
Madurai – 20.
Name & Signature of the Dean ________________________________________
Dr. J. SANGUMANI, MD.,
Dean,
Madurai – 20.

v
ACKNOWLEDGEMENT
“Feeling gratitude and not expressing it is like wrapping a present and
not giving it”
William Arthur Ward.
First and foremost, I would like to thank God Almightyto whom I owe my
very existence for providing me this opportunity and giving me the strength,
knowledge, attitude and ability to proceed successfully. I am grateful for his provision
of joys, challenges and grace for growth that have been bestowed upon me during this
research work, and indeed, throughout my life.
I owe my sincere gratitude to Dr. J. SANGUMANI, MD., Dean, Madurai
Medical College, Madurai for granting permission to conduct the study in this
esteemed institution.
It is a genuine pleasure with immense gratitude and deep sense of thanks that I
acknowledge the support and help of my mentor and my guide Dr. S.Rajamani,
M.Sc (N)., M.B.A (HM)., M.Sc (Psy)., Ph.D., Principal, College of Nursing,
Madurai Medical College, Madurai. Her excellent guidance, priceless advises,
insightful discussion, constant encouragement, profuse assistance, skillful suggestions
and continuous support throughout the study are bases for the success of this research.
In fact, the encouragement, support and freedom rendered by my guide and timely
support, meticulous scrutiny advice by my guide provided to me a lot of opportunity
to build my confidence in accomplishing the research work successfully.
I wish to extend my sincere and heartfelt thanks to Prof. Dr. N. Sumathy,
MD., DGO., HOD., Department of Obstetrics and Gynaecology, Government Rajaji
Hospital and Madurai Medical College, Madurai for her valuable generous support,

vi
encouragement and enlightening ideas have been great contributors in the completion
of the study.
I have great pleasure to express my faithful gratitude to my clinical speciality
guide Mrs. S. Sobana Joy John, M.Sc (N)., M.Sc (PSY)., Reader, Department of
Obstetrics and Gynaecological Nursing, College of Nursing, Madurai Medical
College, Madurai for her valuable suggestions, motivation, unwavering
encouragement, timely help, enduring support, elegant direction and boosting up my
confidence and enthusiasm to go ahead and complete this study successfully.
With deep sense of gratitude, I thank Prof. Dr. V.N. Nagarajan, MD.,
MNAMS., DM (Neuro)., DSC (Neuroscience)., DSC (Hons)., Professor Emeritus in
Neuroscience, The Tamilnadu Govt. Dr. M. G. R Medical University, Chairman IEC
for approved this study.
I acknowledge my faithful thanks to Mrs. S. Ayuisha Sithik, M.Sc (N).,
M.BA (HR)., Nursing Tutor Grade II, Mrs. N. Rajalakshmi, M.Sc(N) and
Mrs. S. Umarani, M.Sc (N), Nursing tutor grade II, for their guidance to complete
this project Department of Obstetrics and Gynaecological Nursing, College of
Nursing, Madurai Medical College, Madurai, for her precious guidance and
continuous support throughout the study.
I wish to express my sincere thanks to, Mr. R. Kathirvel, M.Sc., B.Ed.,
M.Phil., SET., Statistician, Microbiology Department, Madurai Medical College,
Madurai for his expert suggestions and guidance in statistical analysis.
I express my warm thanks to Mr. S. Vinayagamoorthy, M.A., M.L.I.Sc.,
Librarian, College of Nursing, Madurai Medical College, Madurai, for his cooperation
in collecting the related literature for this study.

vii
I extend my thanks to Mrs. V. Esther, M.A., B.Ed., (English) for editing this
manuscript in English.
I extend my thanks to Mr.A.Chandran, M.A., B.Ed., (Tamil)
for editing this manuscript in Tamil and for translating the tool in local language
Tamil).
My acknowledgement would be incomplete without thanking the biggest
source of my strength, my family. The blessings of my father
Mr. S. Shunmuga Sundaram, my mother Mrs. S. Pitchammal my husband
Mr. K. Ravikumar, my daughter R. Kruthiga Shree and my lovable family
members have all made a tremendous contribution in helping me reach this stage in
my life. I thank them for supporting me in difficult moments where I felt stumped and
for goading me on to follow my dream of getting this degree. This would have not
been possible without their unwavering and unselfish love and support given to me at
all times.
I extend my thanks to Laser Point Staff for doing editing, printing and
binding of my entire dissertation book on time.
I would like to pay high regards to my relatives, friends and classmates for
their support, timely help, cooperation and creating a pleasant atmosphere in hard
moments.
Last but not least my earnest gratitude to all my study subjects for their
support and kind cooperation to complete this study successfully.
Above all I owe my success to God Almighty for giving me the capability to
complete the study. Without his blessings, this achievement would not have been
possible.

viii
ABSTRACT
Title: Effectiveness of Heparin gel versus Magnesium sulphate with glycerine
application on thrombophlebitis among Intravenous cannulized patients admitted in
OG postoperative ward, at GRH, Madurai. Objectives: 1. To assess the level of
thrombophlebitis among Intravenous cannulized patients 2. To evaluate the
effectiveness of heparin gel among intravenous cannulized patients in intervention
group I and magnesium sulphate with glycerin in intervention group II.
3. To associate the level of thrombophlebitis among intravenous cannulized patients
with their selected socio demographic and clinical variables. Hypotheses: There is
statistically significant difference between pretest and posttest level of
thrombophlebitis among the Intravenous cannulized patients in intervention group I
and II. There is statistically significant difference between posttest level of
thrombophlebitis among in intervention group I and II. There is statistically
significant association between the level of thrombophlebitis with their selected socio
demographic and clinical variables. Methodology: True experimental design was
used. 60 subjects were selected by simple random sampling technique. Intervention
was given twice a day for 3 days. Results: The finding revealed that,
reduction of thrombophlebitis in interventional group I (χ2
=0.650), (p=0.001).
Conclusion: Heparin gel was more effective than magnesium sulphate with glycerine
application in the reduction of thrombophlebitis.
Key words: Heparin gel, Magnesium sulphate with glycerine, thrompophlebitis,
intravenous cannulized patients.

ix
TABLE OF CONTENTS
CHAPTER
NO
TITLE
PAGE
NO
I INTRODUCTION 1
1.1 Need for the study 6
1.2 Statement of the problem 8
1.3 Objectives of the study 8
1.4 Hypotheses 9
1.5 Operational definitions 9
1.6 Assumption 10
1.7 Delimitation 10
1.8 Projected outcome 11
II REVIEW OF LITERATURE 12
Section – A
2.1 Literature review related to intra venous cannula
induced thrombophlebitis.
13
2.2 Literature review related to effectiveness of heparin
gel on thrombophlebits.
17
2.3 Literature review related to effectiveness of
Magnesium sulphate with glycerine on thrombophlebitis
20
Section – B Conceptual framework 24
III RESEARCH METHODOLOGY 29
3.1 Research approach 29
3.2 Research design 29
3.3 Research variables 30
3.4 Setting of the study 31
3.5 Population 31
3.6 Sample 31

x
CHAPTER
NO
TITLE
PAGE
NO
3.7 Sample size 32
3.8 Sampling technique 32
3.9 Criteria for selection of samples 32
3.10 Research tool and technique 32
3.11 Pilot study 36
3.12 Ethical consideration 37
3.13 Procedure for data collection 37
3.14 Plan for data analysis 38
3.15 Protection of human rights 39
3.16 Schematic representation of methodology 40
IV DATA ANALYSIS AND INTERPRETATION 41
V DISCUSSION 118
VI SUMMARY, CONCLUSION, IMPLICATIONS
AND RECOMMENDATIONS
130
6.1 Summary 130
6.2 Conclusion 135
6.3 Implications 137
6.4 Recommendations 137
REFERENCES 139
APPENDICES i-xxviii

xi
LIST OF TABLES
TABLE
NO
TITLE
PAGE
NO
1
Frequency and percentage distribution of intravenous
cannulized patients with thrombophlebitis according to their
selected socio demographic variables
43
2
Frequency and percentage distribution of intravenous
cannulized patients with thrombophlebitis according to their
selected clinical variables in Intervention group I and
Intervention group II
56
3
Frequency and percentage distribution of pretest level of
thrombophlebitis among intravenous cannulized patient in
intervention group I and intervention group II
76
4
Comparison between pretest level of thrombophlebitis among
intravenous cannulized patients in intervention group I and
intervention group II
78
5
Comparison between pretest and post test level of
thrombophlebitis among intravenous cannulized patients in
intervention group I
79
6
Comparison between mean pretest and post test level of
thrombophlenitis among intravenous cannulized patients in
Intervention group I
81
7
Comparison of pretest and post test level of thrombophlebitis
among intravenous cannulized patients in Intervention
group II
82
8
Comparison between mean pretest and post test levels of
hrombophlebitis among intravenous cannulized patients
among intravenous cannulized patients in Intervention group II
84
9
Frequency and percentage distribution of post test level of
thrombophlebitis in intervention group I and intervention
group II
85

xii
TABLE
NO
TITLE
PAGE
NO
10
Comparison between mean post test level of thrombophlebitis
among intravenous cannulized patiens in intervention group I
and intervention group II
87
11
Effectiveness of heparin gel and magnesium sulphate with
glycerine application on thrombophlebitis among intravenous
cannulized patients in Intervention group I and Intervention
group II.
88
12
Intervention group I and Intervention group II
89
13
Association between the level of thrombophlebitis among
intravenous cannulized patients with their selected socio
demographic variables in intervention group I
91
14
intravenous cannulized patients with their selected clinical
variables in intervention group I
95
15
demographic variables in intervention group II
104
16
variables in intervention group II
110

xiii
LIST OF FIGURES
FIGURE
NO
TITLE
PAGE
NO
1
Conceptual framework based on Ernestine Wiedenbach’s
helping art of clinical nursing theory (1964)
28
2 Schematic representation of methodology 40
3 Distribution of subjects according to age 47
4 Distribution of subjects according to religion 48
5 Distribution of subjects according to marital status 49
6 Distribution of subjects according to educational qualification 50
7 Distribution of subjects according to residence 51
8 Distribution of subjects according to occupation 52
9 Distribution of subjects according to family income per month 53
10 Distribution of subjects according to dietary pattern 54
11 Distribution of subjects according to body built 55
12 Distribution of subjects according to size of the cannula. 62
13 Distribution of subjects according to duration of cannulation. 63
14 Distribution of subjects according to flush the cannula. 64
15
Distribution of subjects according to type of flush in IV
therapy.
65
16 Distribution of subjects according to ambulation status. 66
17
Distribution of subjects according to site of peripheral IV
cannula insertion.
67
18
Distribution of subjects according to intravenous cannulation
done by.
68
19 Distribution of subjects according to body parts of cannulation. 69
20
Distribution of subjects according to number of prick during
IV cannulation.
70

xiv
FIGURE
NO
TITLE
PAGE
NO
21 Distribution of subjects according to type of IV therapy. 71
22
Distribution of subjects according to type of drug administered
in IV site
72
23 Distribution of subjects according to frequency of medication. 73
24 Distribution of subjects according to type of surgery. 74
25 Distribution of subjects according to coexisting disease. 75
26
Frequency and percentage distribution of Pre test level of
thrombophlebitis
77
27
among intravenous cannulized patients in Intervention group I
80
28
among intravenous cannulized patients in Intervention group II
83
29
Comparison of post test level of thrombophlebitis among
intravenous cannulized patients in Intervenion Group I and
Intervention Group II.
86
30
Intervention group I and Intervention group II
90
31
demographic variables (body built) in Intervention group I
94
32
variables (Duration of cannulation) in Intervention group I
98
33
variables (Ambulation status) in Intervention group I
99

xv
FIGURE
NO
TITLE
PAGE
NO
34
variables (site of peripheral IV cannula insertion)in
100
35
variables (number of prick during IV cannulation) in
101
36
variables (type of drug administered in affected site) in
102
37
variables (frequency of medication) in Intervention group I
103
38
intravenous cannulized patients with their selected Socio
demographic variables (Residence) in Intervention group II.
107
39
demographic variables (Familly income per month) in
Intervention group II.
108
40
demographic variables (Bodybuilt) in Intervention group II.
109
41
variables (Size of the cannula) in Intervention group II.
113

xvi
FIGURE
NO
TITLE
PAGE
NO
42
demographic variables (Ambulation Status) in Intervention
group II.
114
43
demographic variables (Site of peripheral IV cannula insertion)
in Intervention group II.
115
44
demographic variables (Body parts of cannulation) in
116
45
demographic variables (Frequency of medication) in
117

xvii
LIST OF APPENDICES
APPENDIX NO TITLE
I Ethical committee approval letter
II
Letter seeking and granting permission to conduct pilot study
and main study at GRH, Madurai
III Content validity certificates
IV Informed consent form
V Socio demographic variables and clinical variables – English
VI Research tool – English
VII Socio demographic variables and clinical variables – Tamil
VIII English editing certificate
IX Tamil editing certificate
X Plagiarism certificate
XI Photo Gallery
CD

1
CHAPTER I
INTRODUCTION
“I stab people for a living”
Phelebotomist.
A hospital is a health care institution providing patient treatment with
specialized medical and nursing staff and medical equipment. The best-known type of
hospital is the general hospital, which typically has an emergency department,
intensive care, trauma centers, rehabilitation centers, paediatric department,
psychiatric department, geriatric department, out patient department, cardiology,
Nephrology, urology, neurology like specialities etc. Intravenous cannulation has a
vital role either the treatment is conservative or surgical.
Intravenous cannulation is the corner stone of medical practice. The use of
intravenous device is an integral part of patient care and these devices are used for
administration of fluid, nutrient, medication and blood product. Now a days in
hospital setting, intravenous (IV) therapy has become a major component of patient
care. Intravascular lines are used for monitoring pressures, administering drugs and
fluids.
A cannula is a poly tetra fluoro ethylene tube that can be inserted into the
body, often for the delivery of fluid or for the gathering of samples. In simple terms, a
cannula can surround the inner or outer surfaces of a trocar needle thus extending the
effective needle length by at least half the length of the original needle. It is also
called an intravenous cannula. Its size mainly ranges from 14 to 24 gauge. Different-
sized cannula have different colours as coded. Intravenous cannulas, colours, gauge
and flow rate are as follows

2
ORANGE - 14 Gauge - Flow rate 200 ml / mt
GREY - 16 Gauge - Flow rate 140 ml / mt
GREEN - 18 Gauge - Flow rate 90 ml / mt
PINK - 20 Gauge - Flow rate 61 ml / mt
BLUE - 22 Gauge - Flow rate 36 ml / mt
YELLOW - 24 Gauge - Flow rate 20 ml / mt
The intravenous cannula generally are believed to be of three types and they
are peripheral intravenous cannula, the central intravenous cannula and the midline
intravenous cannula. Among the above three methods, peripheral intravenous cannula
is the most common form of intravenous therapy. Caregivers generally try and use the
standard intravenous lines for no longer than four days.
A venous cannula is inserted into a vein, primarily for the administration of
intravenous fluids, for obtaining blood samples and for administering medicines.
An arterial cannula is inserted into an artery, commonly the radial artery, and is used
during major operations and in critical care areas to measure beat-to-beat blood
pressure and to draw repeated blood samples. Insertion of the venous cannula is a
painful procedure that can lead to anxiety and stress. Use of a vapocoolant (cold
spray) immediately before cannulation reduces pain during the procedure, without
increasing the difficulty of cannulation.
A common problem encountered during intravenous therapy is infiltration,
extravasations and the phlebitis, i.e. the inflammation of the venous wall near the
point of entry of the cannula into the veins. Risks for thrombophlebitis include
treatment of cancer (chemotherapy) or liver disease, deep vein thrombosis ,disorders
that involve increased blood clotting (may be inherited), infection, pregnancy,
swollen, twisted, and enlarged veins (varicose veins).

3
Infiltration-the inadvertent leakage of a nonvesicant solution into surrounding
tissue-and extravasation the inadvertent leakage of a vesicant solution into
surrounding tissue are both known risks of intravenous therapy. While the injury is
usually minor and resolves spontaneously, some cases result in serious complications,
including full-thickness skin loss and muscle and tendon necrosis requiring
reconstructive surgery or even amputation, leading to longer hospital stays, increased
morbidity, and increased costs.
However, management of infiltration and extravasation lacks evidence-based
standardization, and many institutions do not have adequate policies and procedures.
It is often due to patient movement and disruption of vein at the site of insertion of the
cannula. The patients who are on cytotoxic drugs, hyper osmolar agents and vaso
active drugs are more prone to phlebitis. Intravenous infusion has become an
indispensible component in the medical therapy. It is used to convert electrolyte
imbalances; to deliver medications; blood transfusions or as fluid replacement. In
spite of its therapeutic effects the most encountered problems are phlebitis,
infiltration, extravasations etc. The Infusion Nurses Society, National Standards of
Practice (Australia) stated that a nurse who administers iv medication or fluid must
know its adverse effects and appropriate interventions to be taken before starting the
infusion. Hence nurses need to be aware of and consider certain interventions to
reduce phlebitis when managing intravenous therapy in patients.
Although eliminating the occurrence of complication is nearly impossible, the
risk for infiltration and extravasation can be markedly reduced by understanding the
process of occurrence, selection of the right veins and equipment like syringe pump
and infusion pump therapy that has been ordered, and monitoring the site of infusion.
The incidence of peripheral vein extravasation has been reported to range from 0.1%

4
to 6.5%. The effect of intravenous infiltrations is patient discomfort and need for
re-insertion of an intravenous, which requires time and increases the cost of
hospitalization for the patients large infiltrations may cause serious outcomes like
marked tissue damage. The extent of injury from infiltration is often related to how
much of the fluid or medication has leaked into the tissues, and the time when
intervention was started. Early detection of infiltrations or extravasations is essential
for prevention of nerve damage and/or tissue sloughing, which may require surgery.
Failure to detect infiltrations early may lead the patient to permanent disfigurement
and loss of function.
Phlebitis is defined as inflammation of a vein related to a chemical or
mechanical or bacterial irritation, or both. It is characterized by a redden, warm area
around the insertion site of along the path of the vein, pain or tenderness at the site or
along the vein, and swelling. The incidence of phlebitis increases with the length of
time the intravenous line is in place, the composition of the fluid or medication
infused, the size and site of the cannula inserted, ineffective filtration, improper
anchoring of the line, and the introduction of microorganisms at the time of insertion.
Chemical phlebitis can be caused by an irrigating medication or solution (increased
pH or high osmolarity of a solution), rapid infusion rates, and medication in
compatibilities. Mechanical phlebitis results from long periods of cannulation,
catheter in flexed areas, catheter gauges larger than the vein lumen, and poorly
secured catheters. Bacterial phlebitis results from poor hand hygiene, lack of aseptic
technique, failure to check all equipments before use and failure to recognize early
signs and symptoms of phlebitis.
Thrombophlebitis refers to the presence of a clot plus inflammation in the
vein. It is evidenced by localized pain, redness, warmth and swelling around the

5
insertion site or along the path of the vein, immobility of the extremity, because of
discomfort and swelling, sluggish flow rate, fever, malaise, and leukocytosis.
Methods used in hospitals for phlebitis are cold application, ichthammol glycerine
application, hypertonic saline application and guggul paste application.
Magnesium sulfate is a colorless, odorless and a solid substance. It is slightly
bitter in taste. It is highly soluble in inorganic solvents like water. It is partially
soluble in organic solvents, like glycerin and alcohol. Magnesium sulfate in its
anhydrous form is hygroscopic. It has a tendency to attract moisture.
Magnesium is the second most plentiful cation of the intracellular fluids. It is
essential for the activity of many enzyme systems and plays an important role with
regard to neuro chemical transmission and muscular excitability. Magnesium sulphate
reduces striated muscle contractions and blocks peripheral neuromuscular
transmission by reducing acetylcholine release at the myoneural junction.
Additionally, magnesium inhibits ca2+
influx through dihydropyridine-sensitive,
voltage-dependent channels. This accounts for much of its relaxant action on vascular
smooth muscle.
Glycerin is an organic compound, which is a polyol compound and is odorless.
It attracts water to the skin and restores the suppleness of the skin, as it moisturizes
the skin and cleanses it as well. Pure glycerin can be used for cleaning purposes as
well. It instantly kills all the bacteria as soon as it comes in contact with the bacteria.
It draws out water from bacteria, instantly killing it. Glycerine is an excellent
moisturiser for skin, helps to maintain the pH balance of the skin and also has healing
properties.
Heparin gel is a novel form of heparin therapy for topical application. The
glass-clear gel is distinguished, in particular, by its ability to penetrate pathologically
altered tissue immediately upon application without leaving residues or degreasing the

6
skin. The properties and mode of action of natural heparin offer all the prerequisites
necessary for effective therapy of thrombophlebitis occurring close to the skin and of
other superficial inflammations. Heparin assists in strengthening and supporting the
connective tissues. Scar tissue becomes soft and regains elasticity and strength.
Heparin also has an antiphlogistic and anti-exudative effect, thus alleviating pain and
promoting tissue metabolism and the process of healing. Indications for using heparin
gel are deep vein thrombosis, varicose veins, pulmonary embolism, chronic anal
fissures and injection site thrombophlebitis.
1.1. Need for the study
Globally 60% of patients develop intravenous complications. In developed
countries approximately 1,25,000 complications reported yearly. The complication
rate in India is between 78-82% and in Tamilnadu is 85%. The management of
intravenous complication is according to the severity of complication. The common
management for infiltration and phlebitis are ice application, warm application,
heparin ointment or gel, moist heat application, antiseptic cream, anti inflammatory
cream, analgesics and antibiotics.
In modern medical practice, upto 80% of hospitalized patients receive
intravenous therapy at some point during their admission. The devices for intravenous
therapy usually include a hypodermic needle, peripheral cannula, and intravenous
catheter, etc. and this is the most common invasive procedure among patients
admitted in hospital. Because high concentration of drugs and strong stimulating
drugs enter the vein, and the large plastic catheter may stay in situ for long time.
There are different types of complications that occur frequently in patients with
peripheral intravenous therapy include infusion phlebitis (20 % to 70%), infection
(6.0%), infiltration or extravasations (10% to 30%), fluid overload, hypothermia,

7
electrolyte imbalance and embolism. Infusion phlebitis is in almost all cases. Studies
have shown that 20% to 70% of patients receiving peripheral intravenous therapy
develop phlebitis, According to statistics; about 80% of the patients with intravenous
therapy develop varying degrees of infusion phlebitis in China. At Obstetrics and
Gynaecology department, GRH, Madurai approximately 23,918 patients are admitted
as inpatients per year. Among them 80% of patients were receiving intravenous
therapy. Approximately 5,385 surgeries are performed per year.
Heparinoid (thrombophob) ointment application Glycerin magnesium sulphate
application are also found to be used widely for the management of thrombophlebitis.
It is becoming a common practice in hospitals. Some studies had also shown the
effectiveness of both the interventions. Eventhough glycerin magnesium sulphate and
heparin-benzyl nicotinate ointment are widely used in hospitals, the amount to be
applied, how to apply, frequency of application, which of the intervention is more
effective, is still confusing and debatable question to nurses and also there are little
evidence showing about that which one is more effective and cost effective on
management of thrombophlebitis. The main aim of the study is to find evidence based
answer to this dilemma that may form the basis for establishment of peripheral venous
catheter induced thrombophlebitis.
An observational study (2014) was conducted on “The incidence of
thrombophlebitis following the use of peripheral intravenous cannula” in Kolenchery,
India among a sample of 82 patients after a surgical procedure in post operative ward
during the period July to August 2014. The result revealed that the rate of
thrombophlebitis is 50% in total of 82 patients. In conclusion, thrombophlebitis in the
study population is high.

8
A cohort study (2015) was conducted on the incidence of phlebitis in a
clinical medical unit in Brasilia in Brazil, among a sample of 100 patients admitted in
a clinical unit. The study results revealed that 60% of patients were identified with
phlebitis and the presence of thrombophlebitis was associated with longer
hospitalization, greater number of assess per patient and retention of venous assess
for more than 72 hours.
During my experience as a student nurse I got a chance of providing care to
the intravenous cannulized patients in OG Post operative ward. Some of the
Post operative patients with intravenous cannula reported severe pain, redness, fever
and edema in and around the intravenous site. So I am interested to do study regarding
application of heparin jelly versus magnesium sulphate with glycerine in the reduction
of thrombophlebitis.
1.2 Statement of the problem
“A comparative study to evaluate the effectiveness of Heparin gel versus
Magnesium sulphate with glycerine application on thrombophlebitis among
Intravenous cannulized patients admitted in OG post operative ward, at GRH,
Madurai.”
1.3 Objectives
1. To assess the level of thrombophlebitis among Intravenous cannulized patients
admitted in OG post operative ward, at GRH, Madurai.
2. To evaluate the effectiveness of heparin gel in intervention group I and
magnesium sulphate with glycerin in intervention group II on
thrombophlebitis among Intravenous cannulized patients admitted in OG post
operative ward, at GRH, Madurai.

9
3. To associate the level of thrombophlebitis among Intravenous cannulized
patients admitted in OG post operative ward, at GRH, Madurai with their
selected socio demographic and clinical variables.
1.4. Hypotheses
H1: There is statistically significant difference between pretest and post test level of
and intervention group II admitted in OG post operative ward at GRH, Madurai.
H2: There is statistically significant difference between post test level of
and intervention group II admitted in OG post operative ward at GRH, Madurai.
H3: There is statistically significant association between the level of thrombophlebitis
among Intravenous cannulized patients admitted in OG post operative ward at GRH,
Madurai with their selected socio demographic and clinical variables.
1.5 Operational definition
Effectiveness
In this study, effectiveness refers to changes in the level of thrombophlebitis
either by application of heparin gel or magnesium sulphate with glycerine, and it is
measured by Jackson’s visual infusion phlebitis scale.
Heparin gel
In this study, heparin gel refers to a commercially readily available jelly and
its consist of heparin sodium 200 IU per gram and it has blocks the formation of
thrombin, inhibits the hyaluronidase activity and activates fibrinolytic blood
properties.

10
Magnesium sulphate with glycerin application
In this study, magnesium sulphate with glycerine application refers to 3 gm of
Magnesium sulphate crystal mixed with 5 ml of glycerine and its stirred up and
soaked with gauze and its applied over thrombophlebitis area.
Thrombophlebitis
In this study, thrombophlebitis refers to the presence of a clot plus
inflammation in the vein due to mechanical, chemical or bacterial irritants.
Intravenous cannulized patients
In this study intravenous cannulized patients refers to patients admitted in OG
post operative ward and having different level of gauge for medications and total
parenteral nutrition.
1.6. Assumptions
• Intravenous cannulated patients have different grading level of
thrombophlebitis.
• Magnesium sulphate with glycerine combination helps to changes in the level
of thrombophlebitis.
1.7. Delimitations
Study is limited to
• Patient with intravenous cannulation induced thrombophlebitis among
Madurai.
• Study period is limited to 4 – 6 weeks.

11
1.8. Projected outcome
• Application of heparin gel in Intervention Group I or magnesium sulphate
with glycerine in Intervention Group II reduces the thrombophlebitis and
prevent the complications due to thrombophlebitis.
• The results of the study helps the nurses to plan and use this interventions to
reduce the thrombophlebitis and prevent the complications among IV
cannulized patients.

12
CHAPTER - II
REVIEW OF LITERATURE
Books are companions, teacher, magicians, bankers of the treasures of the mind.
Books are humanity in print.
-Barbara W Tuchman.
Review of literature is a systematic identification, location, scrutiny and
summary of written materials that contains information on research problems. The
review of literature in a research report is a summary of current knowledge about a
particular problem of practice and includes what is known and not known about the
problem. The literature is reviewed to summarize knowledge for use in practice or to
provide a basis for conducting study.
-Hulmeand Grove’s (1994)
This chapter explains in detail about the review of literature. A literature
review is a body of text that aims to review the critical points of current knowledge
including substantive findings as well as theoretical and methodological contributions
to a particular topic. Literature reviews are secondary sources, and as such do not
report any new or original experimental work. Also a literature review can be
interpreted as a review of an abstract accomplishment.
Literature reviews serves a number of important functions in research process.
It helps the researcher to generate ideas or to focus on a research approach,
methodology, meaning tools and even type of statistical analysis that might be
productive in pursuing the research problem.

13
In order to accomplish the objective of present study to attempt has been made
to review and discuss the literature which shall cover the following areas. This chapter
deals with two parts.
Section A – Review of literature
Section B – Conceptual framework
Section A
In this chapter, Review of Literature in the study is organized under the
following headings.
2.1 Literature review related to intra venous cannula induced thrombophlebitis.
2.2 Literature review related to effectiveness of heparin gel on thrombophlebits.
2.3 Literature review related to effectiveness of Magnesium sulphate with
glycerine on thrombophlebitis
2.1 Literature review related to intra venous cannula induced thrombophlebitis.
Dragana Simin, et. al., (2019), conducted a observational prospective study
to determine the incidence, severity and risk factors of peripheral intravenous cannula
induced complications among 368 adult patients hospitalized in tertiary health care
clinic. Data collection was done with patient’s medical data, cannula related data and
type of medication. Descriptive analysis was done. Results found that 44% of patients
had phlebitis, 16.3% had infiltration,7.6% incidence of occlusion and 5.6% of catheter
dislodgement. Results revealed that degree of severity associated with the occurrence
of phlebitis were significantly higher.
Atay S, Sen S & Cukurlu, (2018), conducted a prospective observational
study to identify the development rate of thrombophlebitis and factors affecting
thrombophlebitis among 317 inpatients in the internal diseases clinic of a state

14
hospital, Turkey. Patient identification for, information for peripheral venous catheter,
treatment and visual infusion phlebitis scale were used as a tool. Data analysis was
done by SPSS (version 21.0) and Chi square test. Results found that 31.8% of patients
had varying level of thrombophlebitis and among this 79.2% of them had level I of
phlebitis and there is a significant relationship between the chronic disease (χ2
= 7.8,
p< 0.05), duration of cannula (χ2
= 64.3, p< 0.05) and type of fluid infused (χ2
= 9.79,
p< 0.05) with the development of thrombophlebitis.
Abijit Mandal and K Raghu, (2018), conducted a prospective observational
study to investigate the incidence of phlebitis and to evaluate contributing to the
development of phlebitis among 150 patients admitted to the medical and surgical
division of 4 Air force hospital, Kalaikunda. Data collection was done by visual
infusion phlebitis scale. Statistical analysis was expressed in percentage and odds
ratio. Results revealed that the incidence of phlebitis 31.4% and the risk factors are
female gender, age less than 60 years, insertion in the lower limb, large catheter size,
catheter inserted in emergency situations and intravenous drugs administrations.
Rajeev Dwivedi, et. al., (2018), conducted a prospective observational study
to know the common sites of thrombophlebitis and frequency of thrombophlebitis
among 300 patients, admitted in surgical ward of medical college and associated
S.G.M hospital, Madhyapradesh by random sampling method. Data were collected
with socio demographic proforma and observational checklist. Results found that
incidence of thrombophlebitis was high in saphenous vein (100%) and the incidence
of thombophlebitis is higher in earlier days with in 2 days of infusion with dextrose
containing fluid and higher in critically ill and emergency operated patients.
Janete de Souza Urbanetto, et. al., (2016), conducted a cohort study to
investigate the incidence of phlebitis and its association with risk factors when using

15
peripheral IV catheters and following the removal among 171 adult patients with 361
punctures at university hospital, city of Porto Alegre. Data was collected by socio
demographic data and IV medication being administered. Data was analyzed by
Descriptive analysis (mean, standard deviation and percentage & inferential statistics
(chi square and Fisher test). Results revealed that the average patient age was 56.96 ,
51.5% of the sample population was male, the incidence of phlebitis was 1.25% while
using PIC, and 1.38% post-infusion, the incidence of phlebitis while using PIC was
associated with the length of time the catheter remained in place, whereas post-
infusion phlebitis was associated with puncture in the forearm and significant
relationship between the incidence and risk factors.
Jisal Saji, et al., (2015), conducted an observational study to investigate the
incidence of thrombophlebitis and to evaluate the related risk factors among 82 post
operative patients with peripheral intravenous cannula at tertiary care hospital,
Kolenchery. Visual infusion phlebitis score and assessment of risk factors like age,
gender, co-morbid illness, smoking, duration of intravenous cannula and medication
were used as a tool to grade thrombophlebitis. Data was analyzed by using SPSS
version 16.0. Results found that 41 (50%) had thrombophlebitis and among this 61%
had Grade I and 39% had Grade II level of thrombophlebitis. Results revealed that
there is no significant association between the thrombophlebitis and risk factors.
Paul Nagpal, et. al., (2015), conducted a descriptive study to assess the
clinical pattern of phlebitis among 80 children admitted in paediatric intensive care
unit in civil hospital, Ambala by purposive sampling. Data collection was done with
the help of visual infusion phlebitis scale and pain assessment scale. Data was
analyzed by descriptive and inferential statistics. Results revealed that incidence of
phlebitis as 71.25%, the incidence of phlebitis started increasing from 3.7% to 21.2%

16
after24 hours and by 27.5% after 48 hours. There was a significant association of
grades of phlebitis with administration of Free water solutions, Potassium chloride, IV
fluid at rate of 50 - 100 ml/hour and 1000 – 1500 ml of IVfluid infused in 24 hours
(χ2
= 6.87, 3.58, 5.27,4.42, p<0.05) respectively. The study concluded that grades of
phlebitis increases after 24 hours of intravenous cannulation.
Joan Webster, et. al., (2014), conducted a randomized control study to assess
the incidence and riskfactor of post infusion phlebitis among 3282 patients admitted
in medical and surgical wards at three government hospitals, Queenland by stratified
sampling technique with visual infusion phlebitis scale. Data were analyzed by
descriptive ( frequency and rates) and inferential statistics ( Chi square ).Study results
revealed that 75.7% had co-morbidity and 75% of patients has post infusion phlebitis.
Anabela Saigueiro – Oliveira, (2010), conducted a prospective observational
study to identify the incidence of phlebitis and the risk factor which contribute to its
development among 317 patients with peripheral intravenous catheter at medical ward
of a central hospital in Portugal by phlebitis scale. Data was analysed by descriptive
(frequency and percentage) and inferential (chi square and t test) statistics. Results
found that incidence of phlebitis was 11.09% and risk factors of phlebitis showed that
kcl (2.112) and antibiotic (1.877) and catheter in right limb(0.31)
Cicolini G, et. al., (2009), conducted an observational study to investigate the
most suitable location of peripheral venous cannula to reduce the incidence of
thrombophlebitis among 427 patients in hospital, Italy. Data collection was done by
structured observation protocol. Data analysis was done by chi square and student t
test. Results revealed that the frequency of peripheral intravenous cannula
thrombophlebitis was higher in females (OR:1.91;CI:1.20-3.03;P < 0.006) and the
incidence was found high in patients with cannula inserted in the dorsal side of the

17
hand veins compared to those with cannula inserted in cubital fossa veins
(OR:3.33;CI:1.37-8.07; P < 0.001) and the use of cubital fossa veins rather than
forearm and hand veins should be encouraged to reduce the risk of thrombophlebitis
in patients with peripheral intravenous cannula.
2.2 Literature review related to effectiveness of heparin gel on thrombophlebits.
Saini V, et. Al., (2018), conducted a randomized control trial to evaluate the
safety and efficacy of heparin topical solution compared to heparin topical gel in
prevention of infusion associated phlebitis among 84 patients aged 18 – 65 years
undergoing intravenous cannulation by randomization with visual infusion phlebitis
scale. Results found that to develop grade I infusion associated phlebitis in quick
penetrating heparin solution group at 59.7 hours and in heparin gel group at 58.46
hours and phlebitis was comparable no adverse effects were reported in either group.
Vidhya. S, (2017), conducted a comparative study to assess the effectiveness
of aloe vera gel application versus magnesium sulphate application on reduction of
intravenous phlebitis among 60 adult patients in Annammal Hospital, Kuzhithurai by
convenient sampling technique with modified phlebitis scale. Data collection was
done by descriptive and inferential statistic Results found that in experimental group
I, the mean post-test score was 1.7 with standard deviation of 0.57 where as in
experimental group II, the mean post-test was 1.43 with standard deviation of 1.14.
The obtained t-test value was 4.39 and the P value was 0.01. Also the table value was
0.002 which was less than calculated value. This shows that magnesium sulphate was
more effective than Aloevera gel in treating phlebitis.
Minnu Thomas, et. al., (2016), conducted a quasi experimental study to
determine the prevalence of phlebitis and compare the effectiveness of topical

18
ichthammol glycerin and heparinoid application on phlebitis among 90 patients
receiving intravenous therapy at Medical, surgical and orthopedic wards, Christian
Medical College, Vellore by consecutive sampling technique with Visual infusion
phlebitis scale and pain intensity scale. Data was analyzed by descriptive and
inferential statistics and SPSS software was used. Results revealed that the prevalence
of phlebitis was 26.07% and there was statistically significant relationship between
the ichthammol glycerine (M =1.64) and heparinoid solution (M = 1.06) at 12 hours,
at 48 hours the mean score was ichthammol glycerine (M =2.6) and he parinoid
solution (M = 2.51). Results concluded that both the interventions were effective at
48 hours of observation
Dr.Omais Ali Beigh et. al., (2016), conducted a randomized observational
study to assess the efficacy of topical heparin in preventing the incidence of
thrombophlebitis after peripheral intravenous cannulation among 140 patients at
Yenopoya medical college, Mangalore. Data was collected by visual infusion
phlebitis scale. Data analyzed by descriptive and inferential statistics and results
found that the average age was 33.94% and results concluded that topical heparin is
useful in managing a patient with intravenous cannula to reduce higher incidence of
thrombophlebitis.
Gopalkrishna & Kamble, (2015), conducted an experimental study to assess
the effectiveness of Guggul paste application versus other standard care measures
(magnesium sulphate dressing, warm com-press and thrombophob application) on
intravenous infiltration among 60 hospitalized patients in Pune. A pre-test post-test
control group design was used. After applying interventions on both groups
observations were carried out using the Infusion nurses’ society infiltration scale at an
interval of 12 hours for three days. A paired t test was used to assess the effectiveness

19
of guggul application in experimental group and magnesium sulphate dressing, warm
compress and thrombophob application in control group. The corresponding p-values
were less than 0.05 at 29 degrees of freedom. Thus it was concluded that all
treatments were equally effective in intravenous infiltration.
Vikas Soloman, et. al., (2015), conducted a comparative experimental study
to find out the most effective applicant for reduction of phlebitis in comparison of
heparinoid and ichthammol glycerine among 60 patients admitted in critical care unit
at Christian medical hospital, Ludhiana by purposive sampling with using modified
visual phlebitis scale and standardized numerical pain intensity assessment scale. Data
analysis was done by descriptive and inferential statistics. Before application, after 24
hours and after 48 hours of application ‘t’ value between Heparinoid and Ichthammol
application group was 0.71, 0.63 and 1.68 respectively, which were not significant at
p < 0.05 level of significance and results concluded that both the applications were
effective in reducing IV induced phlebitis.
Dr. Sanjay Maroo, (2014), conducted a randomized parallel group design to
determine the efficacy of 1000 IU/ ML topical heparin solution with 200 IU/G topical
gel in the management of post infusion phlebitis among 200 patients in selected
hospitals, India by random sampling( computer generated randomization with visual
infusion phlebitis scale. Results found that no adverse effect found in either group.
Heparin solution was found similar safety profile to heparin gel on treatment of post
infusion superficial thrombophlebitis.
Chanda Sah & S. Sasikumar, (2014), conducted a quasi experimental
research to assess the effectiveness of Heparin, Glycerine magnesium sulphate and
moist heat application on infiltration among 45 Samples (15 in each group) by
convenient sampling technique with infiltration grading scale , extravasation grading

20
scale, pain scale and electronic thermometer to measure the temperature. The findings
on frequency and percentage distribution according to degree of infiltration and
extravasation before and after intervention showed that there was significant
difference in 3 groups 13 (86.67%) in heparin group, 9 (60%) in glycerine magnesium
sulphate group and 8 (53.33%) in moist heat application group. ANOVA
F value = 0.711. Thus there is no significant different between the groups and all the
three interventions were effective in reduction of various grading of infiltration and
extravasation and thrombophlebitis.
M. Villardel, et. al., (1999), conducted a double blind, randomized controlled
trial to assess the clinical efficacy of topical gel containing 1000 IU of heparin among
132 patients at internal medicine war, general hospital, Spain. 66 patients were
allocated in each group. Results found that 27(43..3%) were healed with heparin
group and topical heparin is safe and effective for the treatment of superficial
phlebitis secondary to indwelling intravenous catheter.
2.3 Literature review related to effectiveness of Magnesium sulphate with
glycerin on thrombophlebitis
Alwin T Varghese, et. al., (2018) conducted a quasi experimental pre test -
post test study to determine the effectiveness of magnesium sulphate with glycerine
versus cold compress on intravenous induced phlebitis among 60 patients admitted in
wards of tertiary care hospital, Kerala by purposive sampling with random allocation
of subjects for both intervention. Data collection was done by Structured
questionnaire and visual infusion phlebitis scale. Data was analyzed by descriptive
and inferential statistics. Results found that magnesium sulfate with glycerine
(MD=2.1, t29=16.16, p<0.001) and cold compress (MD=1.6, t29=17.59, p<0.001)
effective in reducing the peripheral induced phlebitis and concluded that magnesium

21
sulfate with glycerine application was more effective than cold compress for treating
intravenous induced phlebitis.
Brincy Loyolla D Souza and Shiva Kumar, (2016), conducted a quasi
experimental research study to determine the effectiveness of magnesium sulphate
crystal fomentation vs glycerine magnesium sulphate among 60 children with
phlebitis at regional advance paediatric center, Mangalore by purposive sampling
technique with demographic data, phlebitis measurement chart and observation check
list for erythema. Data analysis was done by descriptive statistics (mean and standard
deviation) and inferential statistics (t test) Results revealed that majority of the
subjects were between 9 -12 years of age 27 (45%), Male 32 (53.33%), intravenous
insertion site doral palm 32 (53.33%), hydrational fluid 43 (71.67%) and duration of
infusion was 31 to 60 hours was 41(68.33%). Results concluded that the magnesium
sulphate with glycerine application was more effective than magnesium sulphate
fomentation.
Jeya Bharathi, (2015), conducted a true experimental research study to assess
the effectiveness of glycerine magnesium sulphate application versus cold application
on thromobophlebitis among 60 patients in ward and ICU in GVN hospital, Trichy
with interview and modified visual infusion phlebitis scale by simple random
sampling. Data were analyzed by descriptive (frequency, percentage, mean and
standard deviation) and inferential statistics (t test and chisquare test). Results found
that the experimental group I mean was 6.0 was lesser than the experimental group II
mean score 6.5. The obtained t value was 2.19 significant at 0.05 level and results
evidenced that glycerine magnesium sulphate application was more effective than
cold application on reduction of thrombophlebitis.

22
Ravindra HN, et. al., (2015), conducted a quasi experimental research study
to evaluate the effectiveness of glycerine magnesium sulphate dressing on phlebitis
among 60 patients with peripheral intravenous infusion in selected hospital vadodara
by non probability convenient sampling technique with Jackson’s visual infusion
phlebitis scale. Data analyzed by ‘t’ test and ANOVA. In experimental group
M = 1.10 and SD = 0.71 respectively. In control group M= 2.53, SD = 0.78. Results
revealed that Gycerine Magenisium Sulphate is more effective.
Shalumol C George & Dr. Sunitha H Tata, (2015), conducted a quasi
experimental research study to determine the severity of phlebitis and to determine the
effect of magnesium sulphate crystal application vs glycerine magnesium sulphate
application and to compare the effect of both intervention on phlebitis among the
children between 4 to 18 years of age by simple random sampling technique with
modified phlebitis rating scale and pain rating scale. Fisher exact test and ANOVA
was used for statistical analysis. Results found that majority 5 (33.33%) children
under 4 – 6 years of age, 7 (46.6%) had dorsal venous arch infusion, 11 (60%) had
intravenous therapy .The findings of the study was magnesium sulphate crystal
(U = 60.392) and Magnesium sulphate with glycerine paste (U = 72.248) and the
findings revealed that the glycerine magnesium sulphate paste application is more
effective.
Junia d. Susanna et. al., (2014), conducted a quasi experimental study to
assess the effectiveness of aloevera and glycerine magnesium sulphate application
among 60 children in PICU and paediatric ward at Father muller medical college
hospital, Mangalore by purposive sampling. Observational check list was used as a
tool. Results found that there was a significant difference in mild phlebitis
(Z = 2.16. p < 0.05) in moderate phlebitis (Z = 2.11, p < 0.05) and severe phlebitis

23
(Z = 2.16, p < 0.05) in fresh aloevera and glycerine magnesium sulphate application
based on the severity of phlebitis and concludes that there was significant difference
between aloevera and glycerine magnesium sulphate group on severity of phlebitis.
Yambem M, Madhele M & Bagi D, (2013), conducted a pre experimental
study to assess the effectiveness of glycerine with magnesium sulphate versus
Heparin benzyl nocotinate oinment (Thrombophob oinment) on management of
thrombophlebitis among 30 patients (15 patients in each group) admitted in ICU of
selected hospital in Belgaum, Karnataka with visual infusion phlebitis scale. Data was
analyzed by descriptive and inferential statistics. The study revealed that comparison
of post test scores between group I and group II yielded p< 0.05, (t= 2.031) where
highly significant difference was observed. Magnesium sulphate application was more
effective intervention in reducing thrombophlebitis as compared to thrombophob
oinment.

24
SECTION – B
CONCEPTUAL FRAMEWORK
A conceptual frame work represents the researcher’s synthesis of literature on
how to explain a phenomenon. It maps out the actions required in the course of study
given his previous knowledge of other researchers point of view and his observations
on the subject of research.
A conceptual framework can be set of concepts and assumption that integrate
them into a meaningful configuration (Faweett, 1994). The concept is a thought, idea
or mental image framed in mind in response to learning something new. A framework
is a basic structure supporting anything. A conceptual framework deals with
abstraction (concept), which is assembled by nature of their relevance to a common
theme. (Chris Tension J. Paula and Kenny Janet W, 1990).
It is network of interrelated concepts that provides the structure of organizing
and describing the phenomenon of interest (Talbot, 1995). It deals with abstraction,
which is assembled together by virtue of their relevance to a common thing (Polit).
A conceptual frame work is a theoretical approach to the study of problems
that are scientifically based and emphasis the selection, arrangement and
classifications of its concepts. The conceptual framework is a general amalgam of all
the related concepts in the problem area.
A conceptual framework is made up of concept which are mental image of
phenomenon. These concepts are linked together to express the relationship between
them. A model is used to denote symbolic representation of the concepts.
One of the important purpose of conceptual framework is to communicate
clearly the interrelationship of various concepts. It guides an investigator to know

25
what data needs to be collected and give direction to the entire research process,
(Keringer 1993). Conceptualization is a process of forming ideas which is utilized
and forms conceptual framework for development of research design. It helps the
researchers by giving direction to go about entire research process.
This study was aimed at evaluate the effectiveness of heparin gel versus
magnesium sulphate with glycerine application on thrombophlebitis among
Madurai. The conceptual framework of this study is based on Ernestine
Wiedenbach’s helping art of clinical nursing theory (1964), consist of three factors
1. Central purpose – which the practitioner recognizes as essential to the
particular discipline
2. Prescription for the fulfillment – of central purpose
3. Realities – in the immediate situation that influence the central purpose
Wiedenbach proposes a prescriptive theory for nursing which is described as
conceiving of a desired situation and the ways to attain it. Prescriptive theory directs
action toward an explicit goal. A nurse develops a prescription based on a central
purpose and implements it according to the realities of the situation. In the present
study Wiedenbach, nursing practice consists of identifying the patients needed help
and validating the provided help.
Central purpose
It refers to what the nurses (investigator) wants to accomplish. It is the overall
goal towards which a nurse strives. In this study the main central purpose is to assess
the effectiveness of heparin gel for Intervention Group I and magnesium sulphate
with glycerine application for Intervention Group II on thrombophlebitis.

26
The conceptual framework of this nursing theory consists of following steps
I. Identifying the need for help.
II. Ministering the needed help
III. Validating
Step I - Identifying the need for help
This step involves determining the need for help. Assess the pretest level of
thrombophlebitis by Visual infusion phlebitis scale among intravenous cannulized
patients admitted in OG post operative ward, GRH, Madurai.
Step II - Ministering the needed help
This step involves provision for required help needed by the intravenous
cannulized patients with thrombophlebitis with the help of Visual infusion phlebitis
scale.
a. Prescription
Prescription refers to the plan of activity directed. It specifies the nature of the
action that will fulfill the nurse’s central purpose and the rationale for that action.
A prescription may indicate the broad general action appropriate to implementation of
the basic concepts and suggest the kind of behavior needed to carry out these actions
in accordance with the central purposes. Hence the researcher apply the heparin gel
application for Intervention group- I and magnesium sulphate with glycerine
application for Intervention group II – twice a day for three consecutive days.
b. Realities
Refers to the physical, physiological, emotional and spiritual factors that come
into play in a situation involving nursing actions. The four realities identified by
Wiedenbech’s theory were agent, recipient, goal and framework.

27
Agent - Is the Researcher
Recipient - Intravenous cannulized patients with thrombophlebitis
admitted in OG post operative ward, at GRH, Madurai.
Goal - Assess the effectiveness of of heparin gel versus magnesium
sulphate with glycerine application on thrombophlebitis among
intravenous cannulized patients.
Framework - In this study framework is a setting of the study, that is OG post
Step III - Validating
The nurse validate the ministered help. It is accomplished by means of post
test assessment of thrombophlebitis after rendering nursing intervention of applying
heparin gel in Intervention group I and magnesium sulphate with glycerine in
Intervention group II by Visual infusion phlebitis scale.

28
FIG-I MODIFIED WIDENBACH’S PRESCRIPTIVE THEORY (1964)
CENTRAL PURPOSE
Reducing the level of thrombophlebitis among intravenous cannulized patients
STEP- I
IDENTIFYING THE
NEED FOR HELP
STEP-II
MINISTERING THE NEEDED HELP
STEP – III
VALIDATING THE
ACTION
Pre test
assessment
Assess the pre test level
of thrombophlebitis by
Visual infusion
phlebitis scale among
intravenous cannulized
patients in intervention
group I and intervention
group II along with
identify the socio
demographic and
clincial variables.
Post test
assessment
Assess the post
test level of
Thrombophlebitis
among
Intervention
Group I and
Intervention
Group II by Visual
Infusion Phlebitis
Scale.
Prescription
The Researcher apply
heparin gel on
thrombophlebitis among
patients.
Intervention group I I
The Researcher apply
magnesium sulphate
with glycerine on
thrombophlebitis among
pateits
Realities
Agent: Researcher
Recipient: intravenous
cannulized patients with
thrombophlebitis
Goal: Evaluate the
effectiveness heparin
gel versus magnesium
sulphate with glycerine
on thrombophlebitis
among intravenous
cannulized patients.
Framework: OG
postoperative
ward, GRH,
Madurai.
Intervention
group I
Changes in the level
of thrombophlebtis
Intervention
group II
Changes in the level
of thrombophlebitis

29
CHAPTER – III
RESEARCH METHODOLOGY
The methodology of research indicates the general pattern of organizing the
procedure for assembling valid and reliable data for investigation. This chapter deals
with the methodology to assess effectiveness of heparin gel versus magnesium
sulphate with glycerine application on thrombophlebitis among Intravenous
cannulized patients in OG post operative ward, at GRH, Madurai. It includes the
research approach, research design, variables, setting of the study, population, sample,
sample size, sampling technique, description of the tool, data collection procedure and
plan for data analysis.
3.1 Research approach
The research approach is the most essential part of any research. The entire
study is based on it. The choice of appropriate approach depends on the purpose of the
study. It helps the researcher with suggestions of possible conclusions to drawn from
the data.
The researcher has adapted Quantitative evaluative approach.
3.2 Research design
The research design is the plan, structure and strategy of investigations of
answering the research question. It is the overall plan or blue print, the researcher
select to carry out the study.
True experimental (Pretest Post test) research design was selected for this
study.

30
Intervention group I – O1----------X----------O2
R
Intervention group II – O1----------X----------O2
R Randomization
O1 Pretest level of thrombophlebitis among Intravenous cannulized patients in
intervention group I and intervention group II
X Heparin gel for intervention group I and Magnesium sulphate with glycerine
for intervention group II, twice a day (7 AM and 5 PM) for three consecutive
days
O2 Post test level of thrombophlebitis among Intravenous cannulized patients in
intervention group I and intervention group II.
3.3 Research variables
A variable is anything that can change or anything that is liable to vary. Two
types of variables were identified in this study. They are independent and dependent
variables.
Independent variables
Heparin gel for intervention group I and Magnesium sulphate with glycerine
for intervention group II.
Dependent variables
Thrombophlebitis.
Socio demographic variables
Age, religion, marital status, educational qualification, residence, occupation,
family income per month, dietary pattern and body built.

31
3.4. Setting of the study
The setting was selected based on acquaintance of the investigator with the
institution, feasibility of conducting the study, availability of the sample, permission
and proximity of the setting to the investigation. The study was conducted in OG post
operative ward at Government Rajaji Hospital, Madurai. At present there are 3102
beds available in Multi speciality medical college attached Hospital and it provide a
comprehensive care to all. The sanctioned bed for Obstetrics & Gynaecology
Department is 450 and 123 allotted for post operative ward and bed occupancy is
100%. In an average 5385 surgeries are performed per year in Obstetrics and
gynaecology department.
3.5. Population
The population is defined as the entire aggregation of cases that meet a
designed criterion.
Target population
The study population comprises of Intravenous cannulized patients with
thrombophlebitis.
Accessible population
Intravenous Cannulized patients with thrombophlebitis admitted in OG post
3.6. Sample
In the present study, the sample comprises of Intravenous cannulized patients
with thrombophlebitis admitted in OG post operative ward, at GRH, Madurai, those
who met the inclusion criteria.

32
3.7 Sample size
The sample size consists of 60 intravenous cannulized patients with
thrombophlebitis. 30 subjects were assigned to intervention group I and 30 subjects
were assigned to intervention group II by using lottery method.
3.8 Sampling Technique
Sampling is the process of selecting a portion of the population to obtain data
regarding a problem. In this study the subjects were selected by using Probability
sampling (simple random sampling – lottery method) technique.
3.9 Criteria for selection of samples
Inclusion criteria
• Patient who is having score 4 and 5 in visual infusion phlebitis scale
• Patient who is willing to participate in study
Exclusion criteria
• Patient who is having coagulation disorders
• Patient who is having any allergic reactions.
3.10 Research tool and techniques
The tool was developed and standardized from extensive review of literature,
internet research and discussion with experts.
3.10.1 Description of the tool
The tool consists of three sections

33
SECTION –I
It included age, religion, marital status, educational qualification, residence,
occupation, family income per month, dietary pattern and body built.
SECTION II:
Clinical variables such as size of the cannula, duration of cannulaion, flush the
cannula, type of flush in IV cannula, ambulation status, site of peripheral IV cannula
insertion, intravenous cannulation done by, body parts of cannulation, number of
prick during IV cannulation, type of IV therapy, types of drugs administered in
affected site, frequency of medication, type of surgery and coexisting disease.
Section – III
Scoring and Grading Procedure:
Scoring
A standardized tool developed by Ms. Andrew Jackson to assess the severity
of phlebitis. Minimum score of the scale is zero (no phlebitis) and maximum five
(advanced thrombophlebitis).
The total score is interpreted score 4 – Starting of thrombophlebitis
5 - Advanced thrombophlebitis
The content validity of the tool was 0.94 and reliability was 0.85

34
VISUAL INFUSION PHLEBITIS SCALE
INTERPRETATION: Maximum score - 5
APPEARANCE SCORE
SIGNS OF
THROMBOPHLEBITIS
NO YES
IV site appears healthy 0
One of the following is evident:
• Slight pain near IV site or
• Slight redness near IV site
1
Two of the following is evident:
• Pain at IV site
• Erythema
• Swelling
1
1
All of the following signs are evident:
• Pain along path of cannula
• Erythema
• Induration
1
1
1
All of the following signs are evident and
extensive:
• Erythema
• Induration
• Palpable venous cord
1
1
1
1
All of the following signs are evident and
extensive:
• Erythema
• Induration
• Pyrexia
1
1
1
1
1
TOTAL 5
No - 0
Yes - 1

35
Visual Infusion Phlebitis (VIP) scale
IV site appears healthy 0 No signs of phlebitis
Observe
cannula
One of the following is evident:
• Slight pain near IV site or
• Slight redness near IV site
1 Possible first signs Observe
cannula
Two of the following are evident:
• Pain at IV site
• Erythema
• Swelling
2 Early stage of phlebitis Resite
cannula
All of the following signs are
evident:
• Erythema
• Induration
3 Mid-stage of phlebitis Resite
cannula
Consider
treatment
evident and extensive:
• Erythema
• Induration
4
Advanced stage of
phlebitis or start of
thrombophlebitis
Resite
cannula
Consider
treatment
evident and extensive:
• Erythema
• Induration
• Pyrexia
5 Advanced stage of
thrombophlebitis
Initiate
treatment

36
3.10.2 Testing of the tool
Validity
The tool was validated by five experts in the field of Obstetrics and
Gynaecology including two professors of Obstetrics and Gynaecology department
medical expert and three Obstetrics and Gynaecology Nursing experts. Experts
validate the clarity, relevance, comprehensiveness and appropriateness of the content.
Based on their suggestions reframing of the tool was made. Tool was translated into
Tamil and retranslated into English to confirm language validity.
Reliability of the tool
The reliability of measuring tool is a major criterion for assessing its quality
and accuracy. Reliability is the consistency with which it measures the target attribute.
The reliability of the tool was done by test retest method r = 0.85. The reliability test
score shows there is a stability and consistency in the tool items. Hence the tool was
considered highly reliable for proceeding with the main study.
3.11 Pilot study
Pilot study was conducted to check the feasibility of setting, samples, tool
relevance and practicability of the intervention groups. A formal permission was
obtained from the Institutional Review Board / Ethical Committee, Madurai Medical
College, Madurai - 20 and Obstetrics and Gynaecological department Government
Rajaji Hospital, Madurai. The pilot study was conducted in post operative ward for a
period of 7 days from 9.03.2020 to 15.03.2020 through Probability sampling (simple
random – lottery method) technique. 10 intravenous cannulized patients were taken
and assigned in two groups, 5 subjects for intervention group I and 5 subjects for
intervention group II. The purpose of the study was explained to the patients before

37
starting the data collection. Informed verbal and written consent was obtained from
the patients. Confidentiality was maintained throughout the study. Pretest was
conducted among intravenous cannulized patients with thrombophlebitis on first day.
Intervention group I, apply 0.5 gm of heparin gel was applied over the
thrombophlebitis area for grade IV and V in intervention group I for 15 minutes twice
a day for three consecutive days and Magnesium sulphate with glycerine application
for intervention group II, 30 gm of magnesium sulphate crystals added with 50 ml of
glycerine. 5 ml of prepared magnesium sulphate with glycerine, soaked with gauze
piece and applied over the thrombophlebitis area over 15 minutes twice a day for
three consecutive days.. Post test was conducted on 3rd
day after the intervention.
3.12 Ethical consideration
This study was conducted after the approval obtained from the Institutional
Review Board/Ethical committee, Madurai Medical College, Madurai -20. All
subjects were carefully informed about the purpose and their part in the study and
explained how the privacy was guarded. Ensured confidentiality of the result. Verbal
and written consents were obtained from all the subjects.
3.13 Procedure for data collection
After obtaining the formal permission from the Institutional Review
Board/Ethical Committee of Madurai Medical College, Madurai -20. The study was
conducted in OG post operative ward at Government Rajaji Hospital, Madurai. The
investigator introduced herself to the selected subjects. The objectives and purpose of
the study was explained to the subjects before starting the data collection and assured
confidentiality. Informed verbal consent and written consent was obtained from the
patients. On the first day, the data was collected from the subjects, those who meet the

38
inclusion criteria. The samples was selected through Probability sampling (simple
random - lottery method) technique. Heparin gel was applied to intervention group I
for 15 minutes and magnesium sulphate with glycerine application was applied to
intervention group II for 15 minutes twice a day for three consecutive days. On third
day after the intervention, the post test was conducted to find out the level of
thrombophlebitis and it was assessed by using Visual Infusion Phlebitis Scale for both
Intervention group I and Intervention group II.
Intervention 1: Heparin gel application
Explained the procedure to the intravenous cannulized patients with
thrombophlebitis in intervention group I. Applied 0.5 gm of heparin gel over the
thrombophlebitis area for grade IV and V in intervention group I over 15 minutes
twice a day for three consecutive days.
Intervention 2: Magnesium sulphate with glycerine
Explained the procedure to the intravenous cannulized patient with
thrombophlebitis in intervention group II. 30 gm of magnesium sulphate crystals
added with 50 ml of glycerine. 5 ml of prepared magnesium sulphate with glycerine,
soaked with gauze piece and applied over the thrombophlebitis area over 15 minutes
twice a day for three consecutive days.
3.14 Plan for data analysis
After the data collection the collected data will be organized, tabulated,
summarized and analyzed.
The data will be analyzed according to objectives of the study by using
descriptive and inferential statistics.

39
Descriptive statistics
1. Analysis of socio demographic data will be done by using frequency and
percentage distribution.
2. The level of thrombophlebitis among intravenous cannulized patients will be
analyzed by computing frequency, percentage, mean and standard deviation.
Inferential statistics
1. Unpaired t – test will be used to determine the effectiveness of heparin gel
versus magnesium sulphate with glycerine application among intravenous
cannulized patients admitted in OG Post operative ward, GRH, Madurai.
2. Chi – square test will be used to find out the association between the levels of
thrombophlebtis among intravenous cannulized patients with their selected
demographic and clinical variables.
3.15 Protection of human rights
1. The study was approved by the dissertation committee of college of Nursing,
Madurai Medical College, Madurai and Institutional Review Board / Ethical
Committee of Madurai Medical College, Madurai.
2. The formal approval was obtained from the Head of the department of
Obstetrics and Gynaecology, Government Rajaji Hospital, Madurai.
3. Positive benefits were explained to all the study subjects.
4. Both verbal and written consent was obtained from all the study participants
and they were also explained that they may withdraw from the study at any
time without any penalty.
5. The data was kept confidential.
6. Anonymity and confidentiality was maintained throughout the study.

40
3.16. Schematic representation of methodology
Research Approach-(Quantitative Evaluative Approach)
Research Approach-(Quantitative l
Research Approach: (Quantitative Evaluative Approach)
Research design: True experimental (Pretest - post test) research design
Study Setting: OG post operative ward at GRH, Madurai.
Target population: Intravenous cannulized patients with thrombophlebitis.
Accessible population: Intravenous Cannulized patients with thrombophlebitis admitted in
OG post operative ward, at GRH, Madurai.
Sample: Intravenous cannulized patients with thrombophlebitis admitted in OG post
operative ward, GRH, Madurai and those who met inclusion criteria.
Sample size: 60 Intravenous cannulized patients with thrombophlebitis (30 for intervention
group I and 30 for intervention group II)
Sampling technique: Probability sampling (Simple random sampling- lottery method) technique
Inclusion criteria
• Patient who is having score 4 and 5 in
visual infusion phlebitis scale
• Patient who is willing to participate in
study
Exclusion criteria
• Patient who is having coagulation
disorders
• Patient who is having any allergic
reactions.
Pre assessment – Level of thrombophlebitis among intravenous cannulized patient with
visual infusion phlebitis Scale
Dissemination of research findings and recommendation
30 intravenous cannulized patients with
thrombophlebitis – Application of heparin
gel 0.5gm, twice a day for three
consecutive days in intervention
group I.
30 intravenous cannulized patients with
trombophlebitis – Application of
magnesium sulphate (3gm) with 5ml
glycerine soaked with a gauze, twice a day
for three consecutive days in intervention
group II
Post assessment – Level of thrombophlebitis among intravenous cannulized patient with
visual infusion phlebitis Scale
DATA ANALYSIS: Descriptive and Inferential statistics

DATA ANALYSIS
AND
INTERPRETATION

41
CHAPTER - IV
DATA ANALYSIS AND INTERPRETATION
Analysis and interpretation is an important step in research process which
involves the computation of the certain measures along with searching for patterns of
relationship that exists among the data groups. Data collection is followed by the
statistical procedure enabled the investigator to deduce, summarize, organize,
evaluate, interpret and communicate the numeric information. Statistical analysis is a
method of rendering quantitative information meaningful and intelligible in an
accordance with study objectives.
This chapter deals with the analysis and interpretation of data collected from
60 samples that is 30 in Intervention group I and 30 in Intervention group II to
evaluate the achievement of the objectives of the study. This study was done to
evaluate the effectiveness of heparin gel versus magnesium sulphate with glycerine
application on thrombophlebitis among Intravenous cannulized patients admitted in
OG post operative ward, at GRH, Madurai.”
The data collected were interpreted, organized and finalized under the following
sections
Section- I
Distribution of intravenous cannulized patients with thrombophlebitis
according to their selected socio demographic and clinical variables in Intervention
group I and Intervention group II
Section- II
Description of pre test level of thrombophlebitis among intravenous
cannulized patients in Intervention group I and Intervention group II

42
Section - III
Description of post test level of thrombophlebitis among intravenous
cannulized patients in both Intervention group I and Intervention group II.
Section – IV
Effectiveness of Heparin Gel and Magnesium sulphate with glycerine
application on thrombophlebitis among intravenous cannulized patients in
Intervention group I and Intervention group II.
Section – V
Association between the level of thrombophlebitis among intravenous
cannulized patients with their selected socio demographic variables and clinical
variables in Intervention group I and Intervention group II.

43
SECTION - I
Distribution of intravenous cannulized patients with thrombophlebitis according
to their selected socio demographic and clinical variables in Intervention group I
and Intervention group II
Table: 1
Frequency and percentage distribution of intravenous cannulized patients with
thrombophlebitis according to their selected socio demographic variables
n = 60
Group
Intervention
Group I
Intervention
Group II
f % f %
1.Age in years < 20 years
20 - 30 years
31 - 40 years
41 - 50 years
51 – 60 years
> 60 years
5
19
4
2
0
0
16.65%
63.33%
13.34%
6.66%
0.00%
0.00%
7
13
10
0
0
0
23.33%
43.33%
33.33%
0.00%
0.00%
0.00%
2.Religion Hindu
Christian
Muslim
27
2
1
90.00%
6.66%
3.33%
28
1
1
93.33%
3.33%
3.33%
3. Marital status Married
Single
Divorcee
30
0
0
100.00%
0.00%
0.00%
30
0
0
100.00%
0.00%
0.00%
4.Educational
Qualification
Non Formal
Primary
Secondary
Higher secondary
Graduate
Professional
0
2
8
12
8
0
0.00%
6.66%
26.67%
40.00%
26.67%
0.00%
0
1
13
9
6
1
0.00%
3.33%
43.33%
30.00%
20.00%
3.33%

44
Group
Intervention
Group I
Intervention
Group II
f % f %
5.Residence Urban
Sub – Urban
Rural
9
12
9
30.00%
40.00%
30.00%
6
10
14
20.00%
33.33%
46.67%
6.Occupation Homemaker
Daily wages
Private employee
Government employee
Professionals
24
2
3
1
0
80.00%
6.66%
10.00%
3.33%
0.00%
19
6
4
1
0
63.33%
20.00%
13.33%
3.33%
0.00%
7.Family income
per month
< Rs. 5,000
Rs. 5,001 – Rs. 10,000
Rs 10,001 – Rs. 15,000
Rs. 15,001 – Rs. 20,000
> Rs. 20,000
3
16
7
3
1
10.00%
53.33%
23.33%
10.00%
3.33%
2
15
8
4
1
6.66%
50.00%
26.67%
13.33%
3.33%
8.Dietary
Pattern
Vegetarian
Non vegetarian
Mixed
5
0
25
16.67%
0.00%
83.33%
3
0
27
10.00%
0.00%
90.00%
9.Body built Ectomorphic
Mesomorphic
Endomophic
6
17
7
20.00%
56.67%
23.33%
8
10
12
23.33%
33.33%
40.00%
The above table 1 depicts the frequency and percentage distribution of
intravenous cannulized patients with thrombophlebitis according to their selected
socio demographic variables in Intervention group I and Intervention group II
With respect to age of patients, in Intervention group I, majority of the
subjects, 19 (63.33%) were between 20 – 30 years, 5 (16.65%) were less than 20
years, and 4 (13.34%) was between 31 - 40 years, 2 (6.66%) were between 41 – 50
years and 51 – 60 and more than 60 years, whereas in Intervention group II, majority

45
of the subjects, 13 (43.33%) were between 20 – 30 years and 10 (33.33%) were
between 31 - 40 years, 7 (23.33%) were less than 20 years and none of them were
41 – 50 years, 50 – 60 years and more than 60 years.
With regards to religion, in Intervention group I, majority of the subjects,
27 (90.00%) were belongs to Hindu, 2 (6.66%) were belongs to Christian and
1 (3.33%) was belongs to Muslim, whereas in Intervention group II, majority of the
subjects, 28 (93.33%) were belongs to Hindu, 1 (3.33%) was belongs to Christian and
1 (3.33%) was belongs to Muslim.
While considering the marital status, all the subjects, 30 (100%) were
married in both Intervention group I and Intervention Group II.
With regards the educational qualification, in Intervention group I, majority
of the subjects, 12 (40%) were studied upto higher secondary education, 8 (26.67%)
were studied upto secondary education, 8 (26.67%) were studied upto graduate,
2 (6.66%) studied upto primary education and none of them was studied upto non
formal education and professional education, whereas in Intervention group II,
majority of the subjects, 13 (43.33%) were studied upto secondary education, 9 (30%)
were studied upto higher secondary education, 6 (20%) were studied upto graduate,
1 (3.33%) was studied primary education, 1 (3.33%) was studied upto professional
education and none of them was studied upto non formal education.
While discussing the residence, in Intervention group I, majority of the
subjects, 12 (40%) were hailed from sub - urban area, 9 (30%) were hailed from rural
area and 9 (30%) were hailed from urban area, whereas in Intervention group II,
majority of the subjects, 14 (46.67%) were hailed from rural area, 10 (33.33%) hailed
from sub urban area and 6 (20%) were hailed from urban area.

46
While discussing the occupation, in Intervention group, majority of the
subjects, 24 (80%) were home maker, 3 (10%) were private employee, 2 (6.66%)
were daily wages and 1(3.33%) was Government employee and none of them was
professionals, whereas in Intervention group II, majority of subjects 19 (63.33%) were
home maker, 6 (20%) were daily wages, 4 (13.33%) were private employee,
1 (3.33%) was Government employee and none of them were professionals.
About income of the family per month, in Intervention group I, majority
of the subjects, 16 (53.33%) were earned between Rs.5001 – Rs.10,000/-, 7 (23.33%)
were earned between Rs.10,001 - Rs.15,000/-, 3 (10%) were earned below Rs. 5,000/,
3 (10%) were earned between Rs. 15,001 - 20,000 and 1(3.33%) was earned above
Rs. 20,000/-, whereas in Intervention group II, majority of the subjects, 15 (50%)
were earned between Rs.5001 – Rs.10000, 8 (26.67%) were earned between
Rs.10,001 - Rs.15,000/-, 4 (13.33%) were earned between Rs. 15,001 - 20,000/-,
2 (6.66%) were earned below Rs. 5,000, and 1(3.33%) was earned above Rs. 20,000/-.
While stating the dietary pattern, in Intervention group I, majority of the
subjects, 25 (83.33%) were had mixed diet, 5 (16.67%) were vegetarian and none of
them were had non vegetarian diet exclusively, whereas in Intervention group II,
majority of the subjects, 27 (90%) were practiced mixed diet, 3 (10%) were
vegetarian none of them were had non vegetarian diet exclusively.
While considering body built, in Intervention group I majority of the subjects
17 (56.67%) were mesomorphic, 7 (23.33%) were endomorphic and 6 (20%) were
ectomorphic, where as in Intervention group II, majority of the subjects 12 (40%)
were endomorphic, 10 (33.33%) was mesomorphic and 8 (23.33%) was ectomorphic.

47
Distribution of subjects according to age in years.
Figure 2: Clustered cylindrical diagram reveals that the distribution of
intravenous cannulized patients according to their age in years.
The above clustered cylindrical diagram showed that in Intervention group I,
majority of the subjects, 19 (63.33%) were between 20 – 30 years, 5 (16.65%) were
less than 20 years, and 4 (13.33%) was between 31 - 40 years, 2 (6.66%) were
between 41 – 50 years and 51 – 60 and more than 60 years, whereas in Intervention
group II, majority of the subjects, 13 (43.33%) were between 20 – 30 years and
10 (33.33%) were between 31 - 40 years, 7 (23.33%) were less than 20 years and
none of them were 41 – 50 years, 50 – 60 years and more than 60 years.
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
< 20 Years 21 -30
Years
31 - 40
Years
41 - 50
Years
51 - 60
Years
> 60 Years
16.65%
63.33%
13.34%
6.66%
0.00%
0.00%
23.33%
63.33%
33.33%
0.00%
0.00%
0.00%
Intervention Group I Intervention Group II

48
Distribution of subjects according to religion.
Figure 3: Clustered cone diagram reveals that the distribution of intravenous
cannulized patients according to their religion.
The above clustered cone diagram showed that in Intervention group I,
majority of the subjects, 27 (90.00%) were belongs to Hindu, 2 (6.66%) were belongs
to Christian and 1 (3.33%) was belongs to Muslim, whereas in Intervention group II,
majority of the subjects, 28 (93.33%) were belongs to Hindu, 1 (3.33%) was belongs
to Christian and 1 (3.33%) was belongs to Muslim.
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Hindu Christian Muslim
90.00%
6.66%
3.33%
93.33%
3.33%
3.33%

49
Distribution of subjects according to marital status.
Figure 4: Clustered pyramid diagram reveals that the distribution of intravenous
cannulized patients according to their marital status.
The above clustered pyramid diagram showed that all the subjects, 30 (100%)
were married in both Intervention group I and Intervention Group II.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Married Single Divorcee
100%
0%
0%
100%
0%
0%

50
Distribution of subjects according to educational qualification.
intravenous cannulized patients according to their educational qualification.
The above clustered cylindrical diagram showed that in Intervention group I,
majority of the subjects, 12 (40%) were studied upto higher secondary education,
8 (26.67%) were studied upto secondary education, 8 (26.67%) were studied upto
graduate, 2 (6.66%) studied upto primary education and none of them was studied
upto non formal education and professional education, whereas in Intervention group
II,. majority of the subjects, 13 (43.33%) were studied upto secondary education,
9 (30%) were studied upto higher secondary education, 6 (20%) were studied upto
graduate, 1 (3.33%) was studied primary education, 1 (3,33%) was studied upto
professional education and none of them was studied upto non formal education.
0%
10%
20%
30%
40%
50%
0%
6.66%
26.67%
40%
26.67%
0%
0%
3.33%
43.33%
30%
20%
3.33%

51
Distribution of subjects according to residence.
Figure 6: Clustered bar diagram reveals that the distribution of intravenous
cannulized patients according to their residence.
The above clustered bar diagram showed that in Intervention group I, majority
of the subjects, 12 (40%) were hailed from sub - urban area, 9 (30%) were hailed from
rural area and 9 (30%) were hailed from urban area, whereas in Intervention group II,
majority of the subjects, 14 (46.67%) were hailed from rural area, 10 (33.33%) hailed
from sub urban area and 6 (20%) were hailed from urban area.
30%
40%
30%
20%
33.33%
46.67%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Urban Sub - Urban Rural

52
Distribution of subjects according to occupation.
intravenous cannulized patients according to occupation.
The above clustered bar diagram showed that in Intervention group, majority
of the subjects, 24 (80%) were home maker, 3 (10%) were private employee,
2 (6.66%) were daily wages and 1 (3.33%) was Government employee and none of
them was professionals, whereas in Intervention group II, majority of subjects
19 (63.33%) were home maker, 6 (20%) were daily wages, 4 (13.33%) were private
employee, 1 (3.33) was Government employee and none of them were professionals.
0%
20%
40%
60%
80% 80%
6.66%
10.00%
3.33%
0%
63.33%
20%
13.33%
3.33%
0%

53
Distribution of subjects according to income of the family income per month.
Figure 8: Clustered bar diagram reveals that the distribution of intravenous
cannulized patients according to family income per month.
of the subjects, 16 (53.37%) were earned between Rs.5001 – Rs.10,000/-, 7 (23.33%)
were earned between Rs.10,001 - Rs.15,000/-, 3 (10%) were earned below Rs. 5,000/,
3 (10%) were earned between Rs.15,001 - 20,000 and 1(3.33%) was earned above
Rs. 20,000/-, whereas in Intervention group II, majority of the subjects, 15 (50%)
were earned between Rs.5001 – Rs.10000, 8 (26.67%) were earned between
Rs.10,001 - Rs.15,000/-, 4 (13.33%) were earned between Rs. 15,001 - 20,000/-,
2 (6.66%) were earned below Rs. 5,000, and 1 (3.33%) was earned above Rs. 20,000/.
10%
56.67%
23.33%
10%
3.33%
6.66%
50%
26.67%
13.33%
3.33%
0%
10%
20%
30%
40%
50%
60%
< Rs. 5,000 Rs. 5001 -
10,000
Rs. 10,001 -
15,000
Rs. 15,001 -
20,000
> 20,000

54
Distribution of subjects according to dietary pattern.
intravenous cannulized patients according to dietary pattern.
of the subjects, 25 (83.33%) were had mixed diet, 5 (16.67%) were vegetarian and
none of them were had non vegetarian diet exclusively, whereas in Intervention
group II, majority of the subjects, 27 (90%) were practiced mixed diet, 3 (10%) were
vegetarian none of them were had non vegetarian diet exclusively.
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
Vegetarian
Non vegetarian
Mixed
16.67%
0.00%
83.33%
10.0%
0.00%
90.0%

55
Distribution of subjects according to body built.
intravenous cannulized patients according to body built.
The above clustered bar diagram showed that in Intervention group I majority
of the subjects 17 (56.67%) were mesomorphic, 7 (23.33%) were endomorphic and
6 (20%) were ectomorphic, where as in Intervention group II, majority of the subjects
12 (80%) were ectomorphic, 10 (33.33%) was mesomorphic and 8 (23.33%) was
endomorphic.
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
Ectomorphic
Mesomorphic
Endomorphic
20.00%
56.67%
23.33%
23.33%
33.34%
40.00%

56
Table - 2
Frequency and percentage distribution of intravenous cannulized patients with
thrombophlebitis according to their selected clinical variables in Intervention
group I and Intervention group II
n = 60
Clinical Variables
Group
Intervention
Group I
Intervention
Group II
f % f %
1. Size of the
cannula
16 gauge
18 gauge
20 gauge
22 gauge
0
27
0
3
0.00%
90.00%
0.00%
10.00%
0
24
0
6
0.00%
80.00%
0.00%
20.00%
2. Duration of
cannulation
< 24 hours
24 – 48 hours
48 – 72 hours
> 72 hours
4
8
13
5
13.33%
26.67%
43.33%
16.66%
3
7
12
8
10.00%
23.33%
40.00%
26.67%
3. Flush the
cannula
Yes
No
5
25
16.66%
83.33%
4
26
13.33%
86.66%
4. Type of flush in
IV cannula
Heparin
Saline
None
2
3
25
6.66%
10.00%
83.33%
0
4
26
0.00%
13.33%
86.66%
5. Ambulation
Status
Mobilized
Partially mobilized
Immobilized
22
4
4
73.33%
13.33%
13.33%
24
4
2
80.00%
13.33%
6.66%
6. Site of peripheral
IV cannula
insertion
Basilic vein
Cephalic vein
Median vein
Cubital vein
Radial Vein
1
5
12
4
8
3.33%
16.66%
40.00%
13.33%
26.67%
2
4
8
5
11
6.66%
13.33%
26.67%
16.66%
36.66%
7.Intravenous
cannulation done
by
Registered nurse
Student nurse
Doctors
8
4
18
26.67%
13.33%
60.00%
10
6
14
33.33%
20.00%
46.67%

57
Clinical Variables
Group
Intervention
Group I
Intervention
Group II
f % f %
8. Body parts of
Cannulation
Right arm
Left arm
Right leg
Left leg
12
18
0
0
40.00%
60.00%
0.00%
0.00%
14
16
0
0
46.67%
53.33%
0.00%
0.00%
9. Number of prick
during IV
cannulation
Only one time
Two times
Three times
More than three time
10
12
8
0
33.33%
40.00%
26.67%
10.00%
15
13
2
0
50.00%
43.33%
6.66%
0.00%
10. Type of IV
therapy
Crystalloid
administration
Colloid administration
Drug administration
All of the above
6
2
0
22
20.00%
6.66%
0.00%
73.33%
3
3
0
24
10.00%
10.00%
0.00%
80.00%
11. Types of drugs
administered in
affected site
Antibiotic
Anticonvulsants
Inotropes
Other drugs
28
2
0
0
93.33%
6.66%
0.00%
0.00%
26
4
0
0
86.66%
13.33%
0.00%
0.00%
12. Frequency of
Medication
Once a day
Twice a day
Thrice a day
Every fourth hourly
0
24
6
0
0.00%
80.00%
20.00%
0.00%
0
27
3
0
0.00%
90.00%
10.00%
0.00%
13. Type of Surgery Hysterectomy
Laporatomy
Hysterotomy
(LSCS)
Others
2
0
0
28
0
6.66%
0.00%
0.00%
93.33%
0.00%
0
0
0
30
0
0.00%
0.00%
0.00%
100.0%
0.00%
14. Coexisting
disease
Hypertension
Diabetes mellitus
Skin diseases
Atherosclerosis
None of the above said
2
1
0
0
27
6.66%
3.33%
0.00%
0.00%
90.00%
0
2
0
0
28
0.00%
6.70%
0.00%
0.00%
93.33%

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