Clinical Nurse Leadership: An Original Research Study on Blood Sampling Methods in Hospitalized Pediatric Patients

14.00
Hdl Handle:
http://hdl.handle.net/10755/620298
Category:
Full-text
Type:
Poster
Title:
Clinical Nurse Leadership: An Original Research Study on Blood Sampling Methods in Hospitalized Pediatric Patients
Author(s):
Twibell, Renee Samples; Hofstetter, Paula; Siela, Debra; Brown, Dava; Jones, Holly M.
Lead Author STTI Affiliation:
Beta Rho
Author Details:
Renee Samples Twibell, RN, CNE, rtwibell@bsu.edu; Paula Hofstetter, RN; Debra Siela, RN, CCNS, APRN-BC, CCRN-K, CNE, RRT; Dava Brown, RN, CRNI, VA-BC; Holly M. Jones, RN, RNC-OB, BC
Abstract:
Session presented on Monday, September 19, 2016: Introduction:� An exemplar of direct care nurse leadership in a clinical inquiry process began when a pediatric nurse raised a question.� The question was, ?Since venipunctures are painful for children, could blood samples be drawn from pre-existing peripheral intravenous (IV) infusions?? �The case that prompted the clinical inquiry was one of a young inpatient who had a peripheral IV but experienced over 30 venipunctures for blood sampling during a short hospitalization.� The clinical inquiry was submitted to the shared governance system of one Midwestern teaching hospital, and it was assigned to the Nursing Research Council. An evidence review revealed that the majority of pediatric patients have multiple venipunctures during hospitalization and that patients and families report pain, emotional distress and dis-satisfaction with venipunctures.� A small number of research studies offered mixed results regarding the accuracy of blood drawn from infusing peripheral IVs. Professional guidelines did not support drawing blood from infusing peripheral IVs. Following the Iowa Model for Evidence-based Practice, the hospital?s Nursing Research Council recommended an original nurse-led research study to explore further this clinical inquiry. A clinical inquiry team was formed and included the pediatric direct care nurse, an infusion nurse specialist, medical laboratory scientist, nurse researcher, academic faculty partner, and pediatric nurse educator.� Doctorally prepared team members provided mentoring of the direct care nurse in research processes.� The research study proposal and protocol were designed collaboratively by the team and approved by the hospital?s Institutional Review Board, with the direct care nurse leader as a co-investigator. �The purposes of the study were to (a) compare quality outcomes from two methods of blood sampling, specifically drawing blood per venipuncture and per pre-existing peripheral infusing intravenous (IV) access, and (b) provide a model of direct care nurse leadership in an original research study. Methods:� The design of the study was correlational.� The sample consisted of patients on one pediatric unit in one Midwestern teaching hospital who were between 6 months and 17 years of age.� Parental consent and participant assent for children 7 years of age and older were required.� Per study protocol, two blood samples were drawn, one blood sample per venipuncture and one blood sample from an existing infusing IV. The two blood samples were compared for accuracy through tests of hemoglobin, glucose and potassium.� The protocol prescribed the sequence and timing for pausing and flushing the existing IV.� In addition, patients or family members scored patient satisfaction and patient distress for both methods on 1-10-point visual analog scales and stated their preference of methods. Rates of hemolysis and IV occlusion were recorded. The pediatric direct care nurse enrolled 95 patients with complete data sets.� The response rate was approximately 66%. Results: The convenience sample (n = 95) was 52% female and averaged eight years of age.� Potassium and glucose levels were not statistically significantly different between the two blood draw methods. Hemoglobin levels were significantly different (p < .001). A case-by-case review of the hemoglobin values was conducted by a team that included an experienced pathologist, statistician, and medical laboratory scientist. The statistically significant variance in hemoglobin levels was within the acceptable margin of error set by the College of American Pathologists and was not deemed clinically significant. Patient satisfaction was higher and patient distress was lower with the IV method (p < .001, p < .001, respectively).� Samples drawn per IVs were more likely to hemolyze than were the samples from venipuncture, per laboratory reports (p < .002). However, the frequency of hemolyzed samples was not beyond the usual expected rate per national standards.� Younger participants reported higher distress with the venipuncture method than older participants (p < .05). No IVs occluded. Participants (99%) overwhelmingly preferred the IV method of blood sampling. Conclusions: The results indicate that blood samples can be drawn accurately and safely from existing infusing peripheral IVs in hospitalized pediatric patients, as compared to blood samples drawn by venipuncture. �Hemoglobin, potassium and glucose levels across the two sampling methods were similar. There was no clinically significant evidence of hemolysis or IV occlusions when blood samples were drawn from IVs. Participants strongly preferred the IV method.�Implications:� Pediatric nurses can pilot procedures to draw blood samples from existing infusing peripheral IVs in hospitalized children, giving careful attention to the pausing and flushing of the IV and the monitoring of quality outcomes. Recommendations are that this study be modified and conducted as a randomized control trial, with each participant assigned randomly to a blood sampling group, rather than all participants experiencing both methods of blood sampling. This study provides a model for direct care nurse leadership in clinical inquiry within the structure and processes of a shared governance system.
Keywords:
direct care nurse leadership; pediatric blood sampling; research
Repository Posting Date:
16-Sep-2016
Date of Publication:
16-Sep-2016
Other Identifiers:
LEAD16PST159
Conference Date:
2016
Conference Name:
Leadership Connection 2016
Conference Host:
Sigma Theta Tau International
Conference Location:
Indianapolis, Indiana, USA
Description:
Leadership Connection 2016 Theme: Personal. Professional. Global. Held at the Marriott Downtown, Indianapolis.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.typePosteren
dc.titleClinical Nurse Leadership: An Original Research Study on Blood Sampling Methods in Hospitalized Pediatric Patientsen
dc.contributor.authorTwibell, Renee Samplesen
dc.contributor.authorHofstetter, Paulaen
dc.contributor.authorSiela, Debraen
dc.contributor.authorBrown, Davaen
dc.contributor.authorJones, Holly M.en
dc.contributor.departmentBeta Rhoen
dc.author.detailsRenee Samples Twibell, RN, CNE, rtwibell@bsu.edu; Paula Hofstetter, RN; Debra Siela, RN, CCNS, APRN-BC, CCRN-K, CNE, RRT; Dava Brown, RN, CRNI, VA-BC; Holly M. Jones, RN, RNC-OB, BCen
dc.identifier.urihttp://hdl.handle.net/10755/620298-
dc.description.abstractSession presented on Monday, September 19, 2016: Introduction:� An exemplar of direct care nurse leadership in a clinical inquiry process began when a pediatric nurse raised a question.� The question was, ?Since venipunctures are painful for children, could blood samples be drawn from pre-existing peripheral intravenous (IV) infusions?? �The case that prompted the clinical inquiry was one of a young inpatient who had a peripheral IV but experienced over 30 venipunctures for blood sampling during a short hospitalization.� The clinical inquiry was submitted to the shared governance system of one Midwestern teaching hospital, and it was assigned to the Nursing Research Council. An evidence review revealed that the majority of pediatric patients have multiple venipunctures during hospitalization and that patients and families report pain, emotional distress and dis-satisfaction with venipunctures.� A small number of research studies offered mixed results regarding the accuracy of blood drawn from infusing peripheral IVs. Professional guidelines did not support drawing blood from infusing peripheral IVs. Following the Iowa Model for Evidence-based Practice, the hospital?s Nursing Research Council recommended an original nurse-led research study to explore further this clinical inquiry. A clinical inquiry team was formed and included the pediatric direct care nurse, an infusion nurse specialist, medical laboratory scientist, nurse researcher, academic faculty partner, and pediatric nurse educator.� Doctorally prepared team members provided mentoring of the direct care nurse in research processes.� The research study proposal and protocol were designed collaboratively by the team and approved by the hospital?s Institutional Review Board, with the direct care nurse leader as a co-investigator. �The purposes of the study were to (a) compare quality outcomes from two methods of blood sampling, specifically drawing blood per venipuncture and per pre-existing peripheral infusing intravenous (IV) access, and (b) provide a model of direct care nurse leadership in an original research study. Methods:� The design of the study was correlational.� The sample consisted of patients on one pediatric unit in one Midwestern teaching hospital who were between 6 months and 17 years of age.� Parental consent and participant assent for children 7 years of age and older were required.� Per study protocol, two blood samples were drawn, one blood sample per venipuncture and one blood sample from an existing infusing IV. The two blood samples were compared for accuracy through tests of hemoglobin, glucose and potassium.� The protocol prescribed the sequence and timing for pausing and flushing the existing IV.� In addition, patients or family members scored patient satisfaction and patient distress for both methods on 1-10-point visual analog scales and stated their preference of methods. Rates of hemolysis and IV occlusion were recorded. The pediatric direct care nurse enrolled 95 patients with complete data sets.� The response rate was approximately 66%. Results: The convenience sample (n = 95) was 52% female and averaged eight years of age.� Potassium and glucose levels were not statistically significantly different between the two blood draw methods. Hemoglobin levels were significantly different (p < .001). A case-by-case review of the hemoglobin values was conducted by a team that included an experienced pathologist, statistician, and medical laboratory scientist. The statistically significant variance in hemoglobin levels was within the acceptable margin of error set by the College of American Pathologists and was not deemed clinically significant. Patient satisfaction was higher and patient distress was lower with the IV method (p < .001, p < .001, respectively).� Samples drawn per IVs were more likely to hemolyze than were the samples from venipuncture, per laboratory reports (p < .002). However, the frequency of hemolyzed samples was not beyond the usual expected rate per national standards.� Younger participants reported higher distress with the venipuncture method than older participants (p < .05). No IVs occluded. Participants (99%) overwhelmingly preferred the IV method of blood sampling. Conclusions: The results indicate that blood samples can be drawn accurately and safely from existing infusing peripheral IVs in hospitalized pediatric patients, as compared to blood samples drawn by venipuncture. �Hemoglobin, potassium and glucose levels across the two sampling methods were similar. There was no clinically significant evidence of hemolysis or IV occlusions when blood samples were drawn from IVs. Participants strongly preferred the IV method.�Implications:� Pediatric nurses can pilot procedures to draw blood samples from existing infusing peripheral IVs in hospitalized children, giving careful attention to the pausing and flushing of the IV and the monitoring of quality outcomes. Recommendations are that this study be modified and conducted as a randomized control trial, with each participant assigned randomly to a blood sampling group, rather than all participants experiencing both methods of blood sampling. This study provides a model for direct care nurse leadership in clinical inquiry within the structure and processes of a shared governance system.en
dc.subjectdirect care nurse leadershipen
dc.subjectpediatric blood samplingen
dc.subjectresearchen
dc.date.available2016-09-16T14:23:58Z-
dc.date.issued2016-09-16-
dc.date.accessioned2016-09-16T14:23:58Z-
dc.conference.date2016en
dc.conference.nameLeadership Connection 2016en
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationIndianapolis, Indiana, USAen
dc.descriptionLeadership Connection 2016 Theme: Personal. Professional. Global. Held at the Marriott Downtown, Indianapolis.en
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