White Girls Not Heeding Prevention Message

Racial differences and HIV risk in teenage girls.

According to University of Rochester researcher Dianne Morrison-Beedy, PhD, RNC, WHNP, 25% of all new HIV infections occur in adolescents and 89% of those in girls and young women. Female teens also have the highest rates of sexually transmitted diseases of any age group or either sex-an important statistic because sexually transmitted diseases are associated with a greater risk of HIV transmission. Morrison-Beedy and her colleagues conducted a pilot study to examine "HIV risk behaviors" and rates of HIV testing among sexually active female adolescents who were clients at a family planning center. Forty-three black and 73 white girls and young women between 15 and 19 years of age were given $10 to complete a confidential questionnaire about their sexual habits during the preceding three months.

The researchers found that the white subjects were engaged in more sexual activity and more unprotected sex than the black subjects were. The white teenagers also reported more partners and more partners who abused IV drugs. Even though they knew more than their black counterparts about HIV prevention, the white study subjects were less likely to have been tested for HIV. Morrison-Beedy worries that white adolescent girls and women are not heeding the message on HIV prevention and urges the development of new interventions targeting that population. -MSK

When Should IVs Be Discontinued?

'Dwell time' is not the best predictor.

With most clinical nursing research being conducted by academic investigators, it's refreshing to come across a clinical study whose primary investigator is a hospital staff nurse. Paulette Gallant, BSN, RNC, a weekend-night nurse, and Maine Medical Center's research director (during the study), Alyce A. Schultz, PhD, RN, FAAN, initiated a study examining whether it was safe to discontinue IVs on the basis of assessment for phlebitis rather than the time from insertion (dwell time). Several factors prompted the study: the number of patients receiving IV therapies had increased, the medications being used were more irritating, patients were older and sicker, often several attempts were required to initiate IV therapy, and peripheral IV sites were being maintained longer than the 96 hours recommended by the Centers for Disease Control and Prevention.

With a team of 10 nurses trained in the use of the Visual Infusion Phlebitis (VIP) scale in assessing IV sites for phlebitis, the researchers gathered data on more than 400 peripheral IV sites and types of medications infused in patients on the cardiac surgical intensive care and step-down units. All sites were assessed daily until discharge or the IVs were discontinued. IVs were left intact unless the VIP score was 2 or higher (indicating the presence of phlebitis symptoms) or until therapy was completed.

In the course of the investigation, the researchers discovered that dwell time was not predictive of phlebitis but that the infusion of medications considered irritating to veins-including amiodarone, diltiazem, potassium chloride, and antibiotics-was. IV sites maintained longer than 96 hours produced no adverse effects, but they were linked to less discomfort than was the restarting of IVs. Gallant suggested that toxic drugs, especially amiodarone, would be best infused through central lines rather than through peripheral catheters. (The study has been published; see the January 2005 issue of Evidence Based Nursing.) -MSK