Effect of 'Moist Heat Therapy' on the visibility and

palpability
of before peripheral venous cannulation of
peripheral
veins
patients
undergoing chemotherapy
Maninderdeep Kaur, Sukhpal Kaur, Firuza D Patel
Abstract :Peripheral intravenous catheter insertion is a common nursing procedure
often
required
for the
administration
of chemotherapy, antibiotics, blood products, fluids, and other
medical
therapies.
Insertion
of intravenous cannula can be extremely difficult, particularly in individuals
receiving
courses
of repeated
chemotherapy. The current study attempts to provide information about the
effect
of therapy on the visibility and palpability of peripheral veins. Using
moist heat
purposive sampling
technique,
60 subjects were selected who were scheduled for IV cannulation for the
purpose
of
chemotherapy
administration and whose veins were not visible and palpable. Moist heat
wasthe
applied
at
forearm, hands and wrist for 10 minutes prior to IV cannulation. Following the
intervention
vein
assessment was
done by using Vein Assessment Scale. Permission to conduct the study was
sought from Ethics Review Committee of the institute. Mean age (yrs) SD of the
47 range of 20-75. 65% subjects were females. 27% were suffering from
subjects
12.46yrswas
with
cervicalMean duration of getting chemotherapy treatment was 4.073.86 months with range
cancer.
of
to
24 1months.
40% subjects had clearly visible and palpable veins after the intervention.
Intervention
was significantly more effective in the patients with shorter duration of chemotherapy
(p<0.05).

Key words :
Introduction
Moist heat therapy, peripheral
Chemotherapy is
the use
cytotoxic
99Nursing
and of
Midwifery
veins,
chemotherapy, visibility
&
drugs
in
thedose
treatment
of
cancer.
is 3,
Research
Journal,
Vol-7,
cancer
aintravenously.
and
very
irritants
treatment
high
which
Themodalities
of
main
chemotherapy
cause
purpose
skin
thatreactions
is
provide
toIt
toNo.
palpability
of veins.
one
July
2011
cure,
deliver
tumor
chemotherapeutic
like
control,
Chemotherapeutic
or palliation.
drugs
sites1.
drugs
are
Most
delivered
areofvesicants
the
Correspondence
Maninderdeep
Sri
Lecturer
Mehta
Guru
Road,
RamAmritsar
Dass
Kaur
at College
:
of of
Nursing,

tenderness, warmth,
vasodilator
rednessactivity.11,12
and itching The various
along the vein warming
methods
or at the
include
injection
immersion
site. of patients
The get
veins
may
damage,hand
and
which
arm causes
in warmthe
water and then wrapping
cannulation difficult.2,3
the arm withCommonly
a moist used
towel, application
veins
of
drychemical warmare
for chemotherapy
heat
administration
pack and use of a
cephalic,
median and basilic
microwaved
veins of
wheat-filled
forearms and
bag.13 Others
dorsal veins ofprocedures
dorsum of which
hands4.
have
Thebeen demonstrated
vein
needs be palpable
to improve
before cannulation.
venous visibility include
Bruised
gently
or inflamed areas
tapping
should
over
be the
avoided.
site, applying
tourniquets
or
Venipuncture sites
asking
must
thebepatients
changed to
on clench and relax
their hands
planned basis every
48 hours
and to
by reduce
hanging the arm
the
down.14,15
possibility of phlebitis
and
Fink et al16 examined the effect of
infiltration.4- 6
dry
Cancer patients
versus
need
moist
repeated
heat application on the
courses improvement
of chemotherapy.
Insertion of
of IV insertion rates. They
intravenous
(IV)
cannula
often
is
concluded
a sourcethat
of patient
dry heat was 2.7 times
anxiety
more
and discomfort.7,8
likely
About
than20%
moist
of adults
heat to result in
successful
experience a mild
IV insertion
to moderate
on fear
the first
of
attempt. The
needles
type
of not
and have anxiety
heat
leading
did
to have
bradycardia
any effect on the
and
patients
hypotension9. Thus,
anxiety
because
level.ofLenhardt
the
et al found that
vesicant
local using
nature of chemotherapy
warming
drugs dry
and versus
the
no heat prior to
fear
of IV insertion,
intravenous
the cancerperipheral
patients cannulation
often
posefor cannulation.
facilitated
a problem
IV insertion Sometimes
and decreased the number of
multiple
attempts may occur, which can further
attempts of
lead
cannulation.17
to distress and anxiety
in the
the beneficial
Though
effects of
patient.
heat
Application
theofvisualization
heat on
at the IV
and insertion of IV
cannula
site insertion
has been shown
have been
to increase
reported,
thebut
vein
there is
of on the
100Nursing
visualization. scarcity
information
Heat applications
have
effect and
of Midwifery
moist heat
four
main
on
the
Research
Journal,
Vol-7,
No. 3,
effects
on
body
accessibility
tissues,
including
of
peripheral
pain
veins.
Thus
muscle
connective
the
blood
increase
during
in
to
cutaneous
withdrawal
blood
flow
relaxation,
the
invessels
periods
tissue
to
the
blood
of
the
objective
therapy
Nehru
cutaneous
sympathetic
relaxation.
leads
injured
of
blood
flow
hospital
heating.
onis
to
peripheral
to
vessel
the
blood
part.
the
attributed
assess
PGIMER,
visibility
The
This
increase
flow
10 the
There
veins
by
Chandigarh.
effect
and
for
of moist
In
relief, andofand
the Thein
2011
dilatation,
dilatation
in
is
70%
increase
initially
activity
vasoconstrictor
increase
heat
current
palpability
Radiotherapy
these
study
study
cannulation.
sympathetic
ofward
was
wasJuly
Materials
undertaken
and
conducted
Day care
&in
with
Methods
centre
an of

areas patientsdipped
are admitted
in lukewarm
on daily
water & reapplied for
basis
for ofanother
the purpose
administration
five minutes. Total for 10
minutes
heat sampling was applied.
of chemotherapy.
Purposive
technique was adopted.
patients
AfterSixty
10 minutes
the towel was
whose
veins neither visible
and
nor
palpable
removed
and skin
was dried by using a dry towel
were
included in theand
study.
Only
of
visibility of one
veinvein
was reassessed.
On one
one
patient was taken
as
sample.
Veins
of
patient
the
heat therapy was applied only once.
forearm, hand All
or
wrist
were
the precautions
were taken regarding the
taken.
An interview
application
scheduleofwas
heat
used
therapy.
to
Investigator
closely
gather the data
monitored
regardingthe
age,
subject
gender,
during the
marital
intervention
status and educational
in order not
status
to cause
of theany untoward
subjects.
effects.
Cycles and duration
SPSS
16ofwas
getting
used to analyze the data.
chemotherapy
Both
was also noted.
descriptive
Protocol on
andmoist
inferential
heat
statistics
was
therapy was developed.
applied. AThe
5 point
variousscale
statistical measures
usedtosuch
(1 5) was used
were
assess
as measures
the
of central
visibility
palpabilityand
oftendency,
measures
the veins.
of Maximum
dispersion, percentage, and
attainable
nonscore was 5. Score
parametric
1 was tests
given i.e.
when Fissure
the
exact test.
Apermission
written
vein was neither
visible nor
was palpable,
taken from Head of
score
2 was given when
Department
vein wasofvisible
Radiotherapy
but
of Nehru
not
hospital,
palpable, score
PGIMER,
3 was Chandigarh.
given when vein
Written consent was
was
barely visible obtained
and palpable,
from the
score
patient
4 was in his/her own
given
when vein was language.
visible and
Study
palpable
was approved
and
by the
score
Ethics
5 was given when
the vein
Review
was Committee
clearly of the
visible
institute.
and easily palpable. (Lenhardt
2002)17.
Results
The
content validity of the tools was
subjects
established
by circulating the The
tools
amongstwere
the in the range of 20
to of age with the mean age of
experts
in the related 75 years
101Nursing and Midwifery
4712.46 yrs. 33.3%
of the study
fields.
Research
Journal,
In
the
selected
subjects
the
status
visibility
heat
small
continuously.
was
towel
applied
of
diped
were
the
Then
vein
the
on
subjects
in
age
between
towel
was
the
lukewarn
group
assessed.
vein
was
51were
of
by
teken
water
60
41-50
females
applying
Then
yrs,
outyrs.
followed
(65%).
MoreVol-7,
91.7%
than
by No.
25%3,
subjects
of
2011
amoistmoist
The
(39.5C).
again
heatin
were
wives,
half
married.
was of
applied
unemployed)
66.7%
for
undergraduates
were
5July
and
minutes
not
43.3%
working
were
(Table
(house
1).

Table 1: Socio demographic

characteristics
Mean duration
of getting chemotherapy
of
subjectsN=60
treatment was 4.073.86 months with the

range from 1-24 months. 66.7% were

n (%) from 1- 3 months. 20%
getting
chemotherapy
subjects had completed the treatment of
Age(yrs)*
4-6
months. Only 5% subjects were getting
<306(10.0)
chemotherapy treatment from more than 10
31-4012(20.0)
months
41-5015(25.0)
Table
2 : Distribution of subjects
51-6020(33.3) duration
as per of getting chemotherapy
N=60
>607(11.7)
Duration of getting
Gender
chemotherapy (months)n (%)
Male21(35.0)
Female39(65.0) 1-340(66.7)
4-612(20.0)
Marital Status
7-9 5 ( 8.3)
Married55(91.7)
>10
3 ( 5.0)
Unmarried5( 8.3)
Variable

Mean SD 4.073.86

Range 1-24

Occupation
Working20(33.3) Effect of the intervention on the
vein
status
Not working40(66.7)
Prior to intervention none of the
Education
patients had visible and palpable veins.
Then
Illiterate15(25.0)
therapy
was used for 10 minutes i.e.,
application of small
towelanddipped
in
Just literate9(15.0)
102Nursing
Midwifery
lukewarm
water
(39.5C)
on
the
vein
10
Research
Journal,
Vol-7,
No.
Undergraduate26(43.3)
Distribution
Table 2 depicts
ofveins.
after
subjects
had
peripheral
subjects
the
removing
the
Inscore
had
11.7%
duration
asveins
clearly
per
of
the
subjects
4(score
towel
i.e.
ofvisible
visible
5).
thefor
One
status
veins
and
and
third
easily
were
and3,
minutes
July
2011
duration
getting
chemotherapy
Graduate
getting
chemotherapy
of & among
above10(16.7)
vein
palpable
visible
but
was
(33.3%)
the
not
assessed.
study
palpable
subjects.
After
after
the
(Table
the
intervention
intervention.
3)
40%
*Mean
age
(yrs)SD
4712.46
Range
20-75
yrs

Table 3 : Effect of the intervention on the vein statusN=60

Score

Peripheral veins

statusPrior toAfter
interventionIntervention
n (%) n (%)

1Neither visible nor palpable60 (100)-------2Visible but not palpable--------7(11.7)

3Barely visible and palpable--------9(15.0)
4Visible and palpable--------20(33.3)
5Clearly visible and easily palpable--------24(40.0)
Effect of intervention
on status
months, their
veinsofwere clearly visible
veinthe
as duration
andof chemotherapy
per
easily
palpable. This percentage
decreased
to in the subjects who were
10% and
Table 4 shows
the 1.7%,
vein status
of
getting
chemotherapy
from last 4-6 and 7
the according to the duration of
subjects
respectively. the
Numbers of patients
getting
chemotherapy. months
After administering
with
visible
and palpable
veins were
moist
heat therapy 28.3%
subjects
who were
significantly
more with
shorterfrom
duration
getting chemotherapy
treatment
last of
chemotherapy
as per fisher test (F= 16.10, p=
3
0.004)
Table 4: Effect of intervention
on the vein status according to the
duration of
chemotherapyN=60
Effect of intervention
on the vein status
Duration ofvisible but notbarely visiblevisible andclearly visible or
chemotherapypalpableand palpablepalpableeasily palpable
(months)n(%)n(%)n(%)n(%)
103Nursing and Midwifery
Research
Journal,
Vol-7,
Fisher test value
hospitalized
patients.
16.10,
But,patients.
df=6,
sometimes
Usually
it maythe
be No. 3,
1-31(1.7)7(11.7)15(25)17(28.3)
July
More
4-61(1.7)1(1.7)4(6.7)6(10)
than 75(8.3)1(1.7)1(1.7)1(1.7)
Discussion
common
p=0.004
Insertion
invasive
insertion
difficult
easy
ofprocedure
IVand
cannula
causes
is in is
the
only
the2011
mild
most distress in the

especially in cancer
Thepatients
results requiring
are supported by the
repeated courses
of another
offinding
chemotherapy.
study16 which
Nurses
was carried out
to
use various techniques
determine including
the effectheat
of dry
to versus moist
heat
improve the visualization
application
on
of the
veins
IV to
insertion rate.
enhance
Participants
the success rates
were of
randomly
IV
assigned to dry or moist
insertion.
heat.
In moist
heat
groupofthe mean pre warming
In the current
study
effect
statuson
wasthe
31.4 and the mean status
moist heat
application
wasvein
observed
after
visibility and
palpability
ofwas
the3.81.2
veins for
thethe warming. In case of
dry heat group the mean pre warming vein
insertion
of IV
cannula. Moist
heat application produces
status was 3.41.3 and the post warming
vasodilatation which increases the blood
vein
status was 41.2 16. Nurses rating of
flow
to the affected area by bringing more
vein
status improved from pre to post
oxygen
and nutrients. The temperature elevation
insertion,
regardless of the modality used. No
appears to have direct effects on the
significant were observed between the
state
of
dilatation
of differences
the capillaries,
groups
in pre and
post warming
arterioles
venules.
Theand
increased
metabolism
leadstemperatures on
the status. Lenhardt et al17 conducted
vein
to
release of carbon
dioxide, lactates and
single- randomized controlled and
blinded,
promotes movements of waste products
crossover
trialarea.18
to seeStatus
the effect
from the affected
of of dry verses no
heat on
peripheral
Fifteen
veins wasby using
assessed
5 pointvenous
scale cannulation.
in which
minutes
of warming
significantly
score 1 was given
when veins
neither increased vein
scores.
(>3).
visible
nor palpable and score 5 was given when
the veins were clearly
It was
visible
found and
that intervention was
easily
palpable. Before
effective
the intervention
in the patients
100% with shorter
of
the
duration
subjects
had mean
of chemotherapy
vein status score
treatment.
of
This could be
0.
by the
The moistexplained
heat therapy
in fact
the that
chemotherapeutic
drugs are
vesicants the
and irritating which
studycurrent
was effective
in improving
causes
tenderness,
or redness
on the
status
104Nursing
of veins, though
differentwarmth
percentage
ofand Midwifery
skin.
It
was observed
that
as the Journal,
cycle and
Research
Vol-7,
3,
subjects
had
different
vein
status
status
visible
warm
cannula
patients
for
score
and
insertion
the
thermal
easily
of
success
of
reported
and
effect
5
chemotherapy
had
palpability
i.e.
It
control
palpable.
of
on
was
a
by
their
positive
IV
the
the
concluded
and
insertion
visibility
Keeping
veins
increases
study
was
effect
decreasing
were
subjects.
that
the
has
and
the
there
palpability
vein
due
All
is toNo.the
duration
score.
July
2011
Following
clearly
patient
been
also
al19
warming
on
wellbeing.
suggested
had
the
further
thearm
visibility
subjects
intervention
effect
comfort
study
of
by
ofsupported
chemotherapeutic
Rosenthal.
significant
the
butlevel
were
patients
no 40%
incidence
comfortable
the
was
9 had
Wagner
fact
not
fordrugs.
vein
assessed
IV
that
ofetwith
discomfort
Although
moist
in current
heat.
the
was

Journalof
of Clinical Practice
peripheral veins with International
the application
2005;
59 93): 276-280.
moist
heat at the site prior to peripheral
9.Rosenthal K. Tailor your IV insertion
intravenous
cannulation.

technique for special populations. Nursing

2005
safe and easy to May: 35(5):36-41.

Heat therapy was

administer. The cost
of S,
the
procedure
10.Perry
Tepperman
M. Thewas
therapeutic
use of and
heat towels
and cold. 1986 May;32: 1110not
calculated. Only warm water
14.
11.David A, Roscoe
EM,be
Samuel TJ,
were
used for the intervention.
It may
Yuonne
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as an option in hospital
andB, day
care
oxygen uptake and tissue temperature
centres
for the visibility andproduced
of the of wet heat.
by palpability
the topical application
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outMedtoRehabil
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J. Venodilatation
enhance
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IV
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