Inserting a needle into a patient to attach an intravenous (IV) drip may look like a simple task, but getting it right is a matter of life or death.
The administration of IV fluids requires not only precision and skill, but also uncompromising levels of hygiene for the sake of patients' safety. For this very reason, a programme which aims to "train the trainer" has been organised -- specifically for medical personnel who maybe all too accustomed to the procedure.
The INNT, in cooperation with B Braun (Thailand) Ltd and GIZ Thailand, recently launched a training course on the safe administration of IV fluids for nurses at Maharaj Nakhon Si Thammarat Hospital.
According to the president of the Infusion Nurse Network of Thailand (INNT), Phatthararat Tannukit, administering IV fluids is one of the most rudimentary skills that all medical personnel should have.
"This is important considering that about 70% of patients admitted to inpatient facilities across Thai hospitals will be hooked to an IV drip at one point during the course of their treatments -- may it be saline solutions for rehydration, medicines or blood," she said.
"If done poorly, the patient will face a high risk of getting a pathogenic infection from bacteria, virus, or other microorganisms, which in turn may lead to septicaemia."
Septicaemia -- also known as sepsis -- is a life-threatening complication when large amounts of bacteria enter a patient's bloodstream and spread throughout the body, causing the patient to go into "shock" as the body reacts to the increased pathogenic load.
A nurse concentrates as she inserts a needle during the training.
While this complication is commonly associated with the incorrect insertion of needles on patients whose immune systems are compromised, medical personnel also face considerable risk of sepsis if they accidentally prick their own fingers during the procedure -- especially when combined with poor sanitary standards.
"Incorrect methods may cause infections in both patients and nurses, so it is of paramount importance that we continue to provide regular training and courses to sharpen the nurses' vein-piercing skills," she said.
According to Ms Phatthararat, the training course aimed to "re-training" nurses and showing them the proper way to administer IV fluids that meets international standards.
"This training will help increase the safety of both the patients and the nurses," she said.
The refresher course was attended by nurses from major hospitals across the country, including Bangkok's Klang and Somdet Phra Pinklao hospitals, and Chiang Mai's Nakornping Hospital, said Ms Phatthararat.
The INNT president said that the course is designed in such a way that nurses who participate in the training will be able to spread the practical knowledge they gained in the session to other medical professional at their respective hospitals -- thus creating a spillover effect.
"This will in turn, help improve standards of practices in hospitals across the country," she said.
The training was divided into four parts or "stations" -- namely "PIV and Dressing", "CVC Dressing and Scrub the Hub", "Insertion", and "Flushing and Locking".
The first part of the training dealt with selecting the appropriate peripheral intravenous device (PIV) and dressing, as well as how to prevent PIV failures, while the second station was centred around the central venous catheter (CVC) and "scrubbing the hub" -- in which access ports are sanitised with alcohol, chlorhexidine/alcohol, povidone-iodine, and iodophors before and after each use.
The third station dealt specifically with the correct method of inserting a needle, while at the last station, nurses were taught how to "flush and lock" IV catheters properly to prevent blockages.
Chatchaphon Hengsiri, a deputy head nurse at Maharaj Nakhon Si Thammarat Hospital, said that since the hospital is a referral hospital for smaller medical facilities in the surrounding provinces, nurses there often have to deal with patients in critical condition who require the urgent administration of IV fluids.
"As such, we have to be highly skilled [in administering IV fluids] since it could really be a matter of life of death -- especially for those who are critically ill," she said.
Ms Chatchaphon added that while nurses often have to race against time to prepare patients in critical condition for further treatments, strict procedures still need to be followed to minimise the risk for both the patient and the nurses themselves.
"This is something that cannot be compromised on," she said.
Participants get to grips with new IV technology during the workshop. photos by Penchan Charoensuthipan
Ms Chatchaphon said an accidental needle prick can occur at any time and it may result in a serious infection that may not only be costly to treat, but may also cause stress and emotional trauma for those affected.
"Regular training will help raise awareness about the importance of safety -- a key element in our goal to achieve zero mistakes associated with needles," she said.
"Every step in the administration of IV fluids must be executed with meticulous care and caution."
For example, the deputy head nurse said, the patch of skin where the needle will be inserted must be thoroughly disinfected, and upon inserting the needle, nurses have to keep an eye out for signs of infection -- which could range from mild skin inflammation to high fever.
"Even after the IV drip is removed, patients should be kept under observation for 48 hours," she said.
Ms Chatchaphon added that selecting the right needle size for the patient will also prevent injuries and other health complications.
According to Suphattra Uppanisakon -- a senior nurse at Songklanagarind Hospital and a training assistant in the refresher course -- nurses only have about four minutes on average to attach an IV drip for patients with life-threatening illnesses and/injuries.
"This underscores the need for nurses to be a team player within the emergency room," she said.
"They have to support each other in their race to save a patient's life."