PU : Experiencing from

Thailand

Nutcharee Jungvanichar
RN, MBA
Vice president : Infusion Nurse Network of Thailand
 Current Situation
• A variety of standard of practice in Thailand
• National Benchmarking is not available
• Technology is beyond frontier, current standard of practice need to review
and revise
From Infusion Nurse Society (INS) standard of practice

INS : Infusion team

• The infusion nurse team is structured through its scope of service to meet patient
and organization needs for safe, effective, and high-quality infusion therapy
 Practice Criteria
IV nurse is accountable for
 Inserting short peripheral catheter increase the success rate for cannulation
on the first attempt
Decrease hospital acquired blood stream infection, local site infection,
occlusion and accidental removal
Manage VADs including daily assessment, dressing change
IV team is a resource for infusion therapy product evaluation, education
 IV standard is about process compliance
• Hand hygiene
• Skin preparation
• Site selection / IV catheter selection
• IV/IV site maintenance
• IV catheter Removal
• Post infusion monitoring
IV catheter selection
 PIV catheter ( Available in Thailand)
• Butterfly needle
• Tavlon
• ETFE (Tetrafluroethelene)
• Polyurethane
• Silicone
 Benefits of Butterfly Needles

• While straight needles are much easier to use, butterfly needles offer a variety
of benefits, including:
• Minimal pain for the patient
• Ability to reach more body surface
• Designed for angle insertion
• Able to be used on wrist, hand, and scalp veins
 A Challenging of Using Polyurethane
• Large Internal diameter
• Increase flow rate due to large internal lumen
• Softens upon warning to body temperature which may reduce vein trauma (
decrease mechanical phlebitis rate)
• More difficult to modify
• Initial stiffness than Tavlon and ETFE
• May be more pain compare with butterfly , tavlon, ETFE
 Important things we need to do
Nurse Client
Need more practice for PU catheter insertion Pain as a beginning
Let them know exactly benefit for that After insertion everything is fine
To get experienced nurse to be a role model
Pilot and expand to hospital wide
Pulsatile Flushing
• Skin preparation Pitfall during insertion

• Insertion

• Remove stylet

• Dressing
 Phlebitis rate
Infiltration rate
Extravasation

Process& outcome
Flushing protocol Harvest
Monitoring (outcome)
Dressing
Site cleaning management
Port cleaning
Maintenance
Skin preparation
Site selection
Proper equipmentpreparation

“Do the right thing right at the first time”