Contemp Nurse. 2020 Jul 25:1-26. doi: 10.1080/10376178.2020.1801351. Online ahead of print.
Background: In an older population, insertion of peripheral intravenous catheterizations (PIVCs) are more difficult because of specific problems, such as physiological changes (particularly in veins and subcutaneous tissue), age-related diseases, malnutrition, or insufficient hydration. For older patients, it has been determined that best practices are to use a small gauge needle, avoid using a tourniquet, insert the needle almost flat to the skin (at a 10 to 20-degree angle), stabilize the vein, and monitor the patient's signs and symptoms in order to reduce risk (e.g., pain, bruising, or infiltration). Aim: This pilot study aimed to determine the initial efficacy of non-tourniquet procedure during insertion of PIVC in older patients. Design/ Methods: This quasi-experimental study was conducted in one internal medicine clinic in Yozagat, Turkey in which 78 older patients were assigned to either a tourniquet procedure group (experimental) (n = 38) or a control group (n =40). The initial efficacy of non-tourniquet procedure was tested during insertion of PIVC, such as local pain intensity, PIVC first-attempt success, PIVC dwell time, and phlebitis grade. Results: This study showed that similar pain intensity scores immediately after inserting the PIVC (p>0.05). In addition, the first-attempt success and dwell time in non-tourniquet procedure older patients were be higher/longer and phlebitis scores were lower than the control group (p<0.05). Conclusions: To increase the success of PIVC first-attempt, a longer dwell time, and lower phlebitis scores in older patients, nurses should insert PIVCs at an almost flat degree and stabilize the vein without a tourniquet. Impact statement: This non-tourniquet procedure will lead to the long dwell time and using safely of PIVC in older patients. It is our belief that these results will be a guide for clinical nurses.