Effect of proximal massage and palm fisting exercise in reducing the risk of

thrombophlebitis among IV cannulated patients in selected hospital, Guwahati,

Assam.

Jeba Bakhtiar1 M.Sc.Nursing (Medical Surgical Nursing- Critical Care Nursing), Prof.
(Mrs). Manashi Sengupta2 Dean, i/c, Faculty of Nursing, Assam downtown University,
Guwahati, Assam, India.

Corresponding author: Prof Manashi Sengupta Dean i/c Faculty of Nursing ,Assam
down town University email: manashi_sengupta@rediffmail.com

ABSTRACT

Background- Thrombophlebitis is a condition where there is a blood clot in the vein

that results in redness, swelling. Non- pharmacological therapies that can be provided to
reduce the risk and incidence of thrombophlebitis are provision of proximal massage
and hand exercise. Objectives- 1.To assess the IV cannulated site for the risk of
thrombophlebitis among IV cannulated patients. 2. To evaluate the effect of proximal
massage and palm fisting exercise in reducing the risk of thrombophlebitis among
experimental and control group. 3. To determine the association between the risk of
thrombophlebitis with the selected demographic and clinical variables among IV
cannulated patients in experimental group. Methods-A quantitative research approach
and true experimental research design was conducted by using simple random sampling
technique with lottery method. Results-The mean VIP score (1.67) of the control group
was higher than the mean VIP score (0.8) in the experimental group. Thus, indicating
that proximal massage and palm fisting exercise was effective in reducing the risk of
thrombophlebitis. The result of chi square revealed that, there is significant association
between the risk of thrombophlebitis with selected demographic variables and clinical
variables viz., age in years, gender, body mass index, current diagnosis, size of the
cannula, and site of the cannula types and frequency of IV medications and IV
infusions, frequency of IV medications and infusion among IV cannulated patients in
experimental group. Conclusion-Proximal massage and palm fisting exercise are non-
invasive, simple techniques and these are effective in reducing the risk of
thrombophlebitis among IV cannulated patients.
Key words- Effect, Proximal massage, Palm fisting, Thrombophlebitis, IV cannulated
patient, VIP Score (Visual Infusion Phlebitis)
INTRODUCTION

IV cannula associated thrombophlebitis may lead to serious complication if the

thrombus is changed into emboli and may cause pulmonary embolism and results in
life-threatening condition. Hand exercise is the simplest way to improve blood’s ability
to circulate through the hands. The muscles of the hands and the surrounding blood
vessels will dilate to allow more of oxygenated blood to flow through while doing hand
exercises. An increase in blood circulation to muscle tissue is one of the most promoted
positive effects of massage. One reason for this that improve blood circulation is
supposed to deliver more oxygen and other nutrients to the muscle tissue. Insertion and
care of peripheral cannula is a routine task for nurses. More than 80% of patients
receive intravenous treatments via peripheral venous catheter and prescribing
intravenous drugs is an integral part of nursing care. Objectives of the study- 1. To
assess the IV cannulated site for the risk of thrombophlebitis among IV cannulated
patients. 2.To evaluate the effect of proximal massage and palm fisting exercise in
reducing the risk of thrombophlebitis among experimental and control group. 3.To
determine the association between the risk of thrombophlebitis with the selected
demographic and clinical variables among IV cannulated patients in experimental
group.

MATERIAL AND METHODS

Research approach- Quantitative research approach

Research design-True experimental post-test only control group design.
Sampling technique-Simple random sampling technique
Study setting-Medical and surgical wards of Gauhati Medical College and Hospital,
Guwahati, Assam, India
Sample size-60
Sample selection criteria-Inclusion criteria: Newly IV cannulated patients, patients
who are conscious, admitted for more than 3 days. Exclusion criteria: Patients who are
critically ill, not willing to participate in the study.
Data collection-Prior to the data collection the researcher obtained Ethical Clearance
Certificate from the Ethical Clearance Committee of Gauhati Medical College and
Hospital, Guwahati, Assam. Prior consent of the participants was taken before
administration of the tool. Data was collected by using Structured interview schedule
regarding demographic variables and clinical variables. Simple random sampling
technique with lottery method was used and divided the 60 IV cannulated patients
admitted in medical and surgical units into 30 experimental and 30 control group.
Proximal massage and palm fisting exercise was given respectively for 10 times and 15
times 3 times in a day at interval of 3 hours to experimental group for 3 days.
Observation was done to assess the effect of proximal massage and palm fisting by
using Visual Infusion Phlebitis scoring scale while the control group did not receive any
intervention.

RESULTS
Descriptive and inferential statistics was used to analyse the data. Demographic and
clinical variables was analyzed in terms of frequency (f), percentage (%). Assessment of
the IV cannulated site for the risk of thrombophlebitis among IV cannulated patients
after giving the proximal massage and palm fisting exercise was also analyzed by
frequency(f) and percentage (%). Z-test was computed to assess the significant
difference in the reduction of thrombophlebitis between the post test scores of
experimental group and control group. Chi-square (χ2) test was used to determine the
association between the risk of thrombophlebitis with the selected demographic
variables and clinical variables among IV cannulated patients in experimental group.
The level of significance was set at 0.05 levels to interpret the findings.
 Age
33.33% 33% 33.33%
35% 30%
30%
Percentage (%)
25% 20%
20% 16.67% 17% 16.67%
15%
10%
5%
0%
21-30 31-40 41-50 Above 50
Age in years

FIG1: Bar diagram representing percentage

Exp. Grpup distribution of age in years
Cont. group

With regards to age majority (33.33%) of the samples belonged to the age group of 41-

50 years of age in experimental group. Majority (33.33%) of samples belonged to age

group of 31-40 and 41-50 years of age in control group.

Gender
Exp. Group Cont.group
40%
Percentage (%)

30%
14%
20% 16%
10% 18% 12%
0%
Male Female
Gender

FIG2: Bar diagram representing percentage distribution of gender

With regards to gender majority (18%) of the samples were male in experimental group,

majority (16%) samples were male in control group.

 n=60
Sl Experimental Group Control Group
Clinical Variables
f % f %

1. BMI a) Underweight 01 3.33 02 6.67

b) Normal 25 83.33 26 86.66
c) Overweight 04 13.33 02 6.67
d) Obese - - - -
2. Current a) Respiratory 02 6.67 06 20
diagnosis b) Cardiovascular 07 23.33 04 13.33
c) Hematology - - - -
d) Metabolic 10 33.33 07 23.33
e) Musculoskeletal - - - -
f) Genitourinary 01 3.33 - -
g) Any surgery 10 33.33 07 23.33
h) Others - - 04 13.33
3. Duration of a) Acute illness 13 43.33 24 80
illness b) Chronic illness 17 56.67 06 20
a) 20G 27 90 23 76.67
b) 22G 01 3.33 07 23.33
5. Site of a) Dorsum 13 43.33 16 53.33
cannula b) Wrist 15 50 11 36.67
c) Forearm 02 6.67 03 10
d) Anticubital fossa - - - -
6. Types of a) IV fluids 25 83.33 17 56.67
medication, b) IVfluids with 02 6.67 04 13.33
infusion medication
c) Antibiotics 16 53.33 16 53.33
d) Antifibrinolytics drugs 04 13.33 - -
e) Others 27 90 29 96.67
7. Frequency of a) OD - - - -
IV b) BD 22 73.33 26 86.67
medication, c) TDS 10 33.33 07 23.33
infusion d) QDS - - - -
Table 1: Frequency and Percentage of Clinical Variables
Regarding clinical variables majority (83.33%) of the samples were having normal
BMI, majority (33.33%) of samples diagnosed with metabolic and surgical disorders,
majority (56.67%) of samples were suffering from chronic illness, majority (90%) of
samples underwent treatment with 20G of cannula, majority (50%) of samples were
having cannula at wrist site of hands, majority (90%) of samples were getting other
medications, majority (73.33%) of samples were getting medication BD in experimental
group.
Majority (86.66%) of the samples were having normal BMI, majority (23.33%) of
samples diagnosed as metabolic and surgical disorders. Majority (80%) of samples were
suffering from acute illness, majority (76.67%) of samples underwent treatment with
20G of cannula, majority (53.33%) of samples were having cannula at dorsum site of
hands, majority (96.67%) of samples were getting other medications, majority (86.67%)
of samples were getting medication by BD in control group.
 Risk of Thrombophlebitis
Risk of Thrombophlebitis

No 33.33%
Fig 3 shows the frequency and percentage distribution of risk of thrombophlebitis.
60%

Yes 66.67%
40%
0% 10% 20% 30% 40% 50% 60% 70%
Percentage (%)

Cont. group Exp. Group

FIG3: Bar diagram representing risk of thrombophlebitis in experimental and control

group
It reveals that 40% were at risk to develop thrombophlebitis and 60% were not at risk
to develop thrombophlebitis in experimental group, where as 66.67% were at risk to
develop thrombophlebitis and 33.33 were not at risk to develop thrombophlebitis in
control group.

n=60
Group Mean SD SE MD Z test Tabulated Inference
value Z test
value
Exp 0.8 1.18 0.36 0.87 2.42 2.00 S*
group
Control
group 1.67 1.62

*S- significant at P<0.05

Table 2: Effect of proximal massage and palm fisting exercise in reducing the risk of
thrombophlebitis among experimental and control group

Table 2 indicates that the mean VIP score (1.67) of the control group was higher than
the mean VIP score (0.8) in the experimental group. Thus, indicating that proximal
massage and palm fisting exercise was effective in reducing the risk of
thrombophlebitis. The calculated Z-test value for mean pain score (2.42) was higher
than tabulated Z-test value (2.00) at p <0.05. This indicates proximal massage and palm
fisting exercise was effective in reducing the risk of thrombophlebitis.
 n=30
Sl Variables Risk of thrombophlebitis df ᵡ2 Tabulate Inference
d t-value
Yes No

1. Age a) 21-30 04 02 3 24.02 7.82 S*

b) 31-40 03 06
c) 41-50 02 08
d) Above 50 03 02

2. Gender a) Male 07 11 1 11.14 3.84 S*

b) Female 05 07

*S- significant at p <0.05

Table 3.1: Association between risk of thrombophlebitis with selected demographic
variables among experimental group
Table 3.1 shows the association between the risk of thrombophlebitis with the selected
demographic variables among IV cannulated patients in experimental group at the level
of <0.05.

n=60
Sl Variables Risk of thrombophlebitis df ᵡ 2
Tabulat-ed Infer--
t- value nce
Yes No
3. BMI a) Underweight 01 - 3 40.1 7.82 S*
b) Normal 08 18
c) Overweight 03 -
d) Obese - -
4. Current a) Respiratory 02 - 7 97.52 14.07 S*
diagnosis b) Cardiovascular - 07
c) Hematology - -
d) Metabolic 06 04
e) Musculoskeletal - -
f) Genitourinary 01 -
g) Any surgery 03 07
h) Others - -

5 Duration of a) Acute Illness 04 09 1 1.14 3.84 NS*

5. illness
b) Chronic Illness 08 09

6 Size of a) 18 G 01 01 2 1.14 5.99 S*

6. cannula
b) 20G 10 17

c) 22G 01 -
7. Site of a) Dorsum 09 04 3 374.93 7.82 S*
cannula
b) Wrist 10 17

c) Forearm - 01

d) Anticubital fossa - 01
8. Types of a) IV fluids 10 14 4 147.87 9.49 S*
medication,i b) IV fluids with 02 -
nfusion medication
c) Antibiotics 09 07
 d) Antifibrinolytic drugs 01 03

e) Others 10 18
9. Frequency of a) OD - - 3 24.09 7.82 S*
IV b) BD 07 15
medication,i
nfusion c) TDS 05 05
d) QDS - -

*S- significant at p <0.05

*NS- not significant at p<0.05
Table 3.2: Association between risk of thrombophlebitis with selected clinical variables
among experimental group.

Computation of chi square revealed that, there is significant association between the risk
of thrombophlebitis with selected clinical variables viz., body mass index, current
diagnosis, size of the cannula, and site of the cannula types and frequency of IV
medications and IV infusions, frequency of IV medications and infusion among IV
cannulated patients in experimental group.

DISCUSSION

In present study, in experimental group majority (33.33%) of the samples belonged to

the age group of 41-50 years of age, majority (60%) of the samples were male. In
control group, majority (33.33%) of samples belonged to age group of 31-40 and 41-50
years of age. Majority (53.33%) of samples were female. The present findings was
supported by a study conducted by Urbanetto JS, Peixoto CG, and May TA (2016)
where 51.5% patients age was ≥58 and 51.5% of the sample population was male.
In present study 40% IV cannulated clients are at risk of thrombophlebitis in
experimental group and 66.67% in control group. The present findings was supported
by a study conducted by Saji J , Korula SV , Mathew A, Mohan L(2015), where among
80 patients 61% had developed thrombophlebitis Grade 1 and 39% had Grade 2
thrombophlebitis.
In this study, to find out the effect of proximal massage and palm fisting exercise in
reducing the risk of thrombophlebitis among IV cannulated patients, Z- test was
computed. The mean VIP score (1.67) of the control group was higher than the mean
VIP score (0.8) in the experimental group. The study was supported by, Anjum U,
Sharma V, Tamang EL, Ahwal SN (2017). They conducted a study, among group 60
samples two groups were divided into experimental and control group. Both the groups
were compared by using Fisher’s Exact Test (p=0.027) at the level of <0.05 for the
grades of thrombophlebitis and it was found significant.

CONFLICT OF INTEREST: There are no conflicts of interest.

REFERENCES
1. Anjum U, Sharma V, Tamang EL et al. Effectiveness of Palm Fisting Exercise on
Occurrence of Thrombophlebitis among the IV Cannulated Patients Receiving
Chemotherapy – A Selected Hospital of Delhi. Int J Nurs Midwif Res 2017; 4(3):
61-65. (DOI): https://doi.org/10.24321/2455.9318.201734. Available from
htts://medical.adrpublication.in/index.php/lntlJNursingandMidwiferyRes/article/
download/1114/pdf
2. Muscolino J. Learn muscles for manual therapy and movement professionals.
Available from https://learnmuscles.com/
3. Brar N. A study to evaluate effectiveness of cold application and magnesium
sulphate application on superficial thrombophlebitis among patients receiving
intravenous therapy in selected hospitals Amritsar. Available from
https://www.scribd.com/doc/132585038/
4. Urbanetto JS, Pexioto CG, May TA. Incidence of phlebitis associated with the
use of peripheral IV catheter and following catheter removal. Rev.Latino-Am.
Enfermagem. 2016;e2746. DOI:http://dx.doi.org/10.1590/1518-8345.0604.2746.
Available from https://www.ncbi.nlm.nih.gov/m/pubmed/27508916
5. Saji J, Korula SV, Methew A, Mohan L. The incidence of thrombophlebitis
following the use of peripheral intravenous cannula in post-operative patients: A
prospective observational study. IOSR Journal of Dental and Medical Sciences.
e-ISSN: 2279-0853,p-ISSN:2279-0861. Volume 6 Ver.1( June2015), PP 01-04.
DOI:10.9790/0853-14610104. Available from
https://pdfs.semanticscholar.org/af20/8213cc0b9ebc-
c24f60e54494b48055a494925.pdf
6. Makafi SA. Peripheral Intravenous Catheter (PIVC) Related Local Complications
among Patients in KFCH-Jizan. January 2017. DOI: 10.4172/2573-
0347.1000138. Available from
https://www.researchgate.net/publication/320588579