Speaker For Nursing World Conference 2019- Dararat Chuwongin

Title: Delphi Technique for Intravenous Assessment among Oncologic Patients Receiving Chemotherapy

Dararat Chuwongin

Chulabhorn Hospital, Thailand


Ms. Dararat Chuwongin, a registered nurse of Nursing Departemnt at Chulabhorn Hospital, is interested in intravenous therapy and care for cancer patients. She has obtained Bachelor degree in Nursing in 1994 worked for Chulalongkorn Mememorial Hospital of Thai Red Cross Society 1995-2004, worked as medical reporter for Bumrungrad Hospital accredited by Joint Commission International (JCI) 2005-2006, and worked as Registerred Nurse at JPS health network, Texas, USA from 2008-2012.


Cancer is a leading cause of life threatening. There are several methods for chemotherapy administration consisting of oral, intramuscular, and intravenous form.  Though intravenous technique is widely accepted, it still has a risk of extravasation during administration, approximately 2% receiving anaesthetics and 5% obtaining chemotherapy.
In general, the severity of extravasations is divided into 4 levels; 0 = no skin change, 1= having rash but no itching, 2= vein inflammation and itching, and 4 = severe inflammation and necrotic tissue as surgery needed.  The signs and symptoms of skin manifestation including inflammation, necrosis and surrounding organs involvement can be observed.
Though metacarpal, cephalic, basilic and median veins are available for venous cannulation, veins at dorsum of hand are recommended by Clinical Nursing Practice Guideline for long-term chemotherapy. However, large veins locating on the upper arm, should not be considered at the first attempt. In addition, either vein at bifurcation, metastatic cancerous area, feet, legs or arms particularly post mastectomy, has a high incidence of phebitis.
Investigators set up a questionnaire, by means of Delphi’s technique, to survery opinions on venous cannulation. Ten experts on chemotherapy and related fileds volunteered to join the study. The tool was tried out in 3 registered nurses for its item of index congruence. The appropriateness of the test would be established as nurse competency guideline on venipuncture with less complications and a high standard of care.