The Effect of Arm Massage on the Success of Peripheral Intravenous Catheter Insertion in Breast Cancer Patients Undergoing Chemotherapy: A Randomized Controlled Study

The Effect of Arm Massage on the Success of Peripheral Intravenous Catheter Insertion in Breast Cancer Patients Undergoing Chemotherapy: A Randomized Controlled Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Effect of Arm Massage on the Success of Peripheral Intravenous Catheter Insertion in Breast Cancer Patients Undergoing Chemotherapy: A Randomized Controlled Study Handan Eren, Yasemin Karacan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8012876/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Peripheral intravenous catheter access becomes difficult in patients diagnosed with breast cancer who receive chemotherapy treatment because vein visibility decreases. The study aims to determine the effect of arm massage on the success of peripheral intravenous catheter insertion in breast cancer patients undergoing intravenous chemotherapy. Methods This randomized controlled study included 60 breast cancer patients undergoing intravenous chemotherapy (experimental = 30, control = 30). The patients in the experimental group received arm massage before the procedure, while those in the control group did not receive any intervention. Data were collected using a record form for peripheral intravenous chemotherapy administration. Results Successful peripheral intravenous catheter insertion time was statistically shorter in the experimental group (p = 0.000). Post-procedure anxiety levels were significantly lower in the experimental group (p = 0.000). While the level of satisfaction with the procedure increased statistically significantly in the experimental group (p = 0.000), it decreased statistically significantly in the control group (p = 0.012). The nurses in the groups stated that arm massage facilitated catheter insertion in 90% of the procedures. Conclusion Massage shortened the peripheral intravenous catheter insertion process and positively affected the patients' anxiety of and satisfaction with the procedure. Cost-effective arm massage was recommended for use in patients undergoing intravenous chemotherapy. Massage Vein visibility Peripheral catheter insertion Figures Figure 1 Introduction Cytotoxic drugs administered to patients using intravenous (IV) chemotherapy disrupt the endothelial structure of the vein, reducing both vein visibility and the number of veins that can be used in subsequent cycles [ 1 ]. Patients with breast cancer experience a decrease in vein visibility, potentially due to impaired lymph circulation [ 2 ]. Intervention becomes difficult in veins with poor visibility, which may increase the number of interventions that are required for successful catheter insertion and prolong the procedure time [ 3 , 4 ]. Extended procedure time and repeated attempts cause patients to experience anxiety during the procedure, and anxiety further reduces vein visibility with peripheral vasoconstriction [ 2 , 5 ]. Due to decreased vein visibility, it is often not possible to determine the appropriate vein for IV chemotherapy. Different methods can be used to avoid problems with inserting a peripheral IV catheter and to make it easier to see the veins for IV catheter insertion. These methods include tourniquet application, holding the arm below the level of the heart, isometric arm exercise application, tapping, fist clenching, local warm application to the area, drinking hot drinks, essential oil application, and massaging along the vein [ 4 , 5 , 6 , 7 ]. There are studies in the literature that examined the effect of the use of methods other than massage on the success of peripheral IV catheter insertion [ 5 , 7 , 8 ]. The arm massage, which is different from the massaging along the vein, is performed on the arm, forearm, and hand. The massage is emphasized to be effective in the management and prevention of the development of lymphedema, which is frequently encountered in patients with breast cancer, and should be taught to patients during discharge education [ 9 , 10 ]. Massaging helps to maintain venous drainage by increasing muscle pump activity [ 11 ]. Therefore, it is thought that its application before catheter insertion will increase vein visibility. In a descriptive study conducted by Santos-Costa et al. (2022) with nurses, it was reported that one of the nurses massaged the patient's arm before the PIVC insertion procedure. However, this study did not examine the effect of that massage [ 12 ]. In the study conducted by Yasuda et al. (2023) with healthy individuals aged 20 to 29 years, tourniquets were applied to the patients in all groups where the patients in one of the experimental groups were massaged after the tourniquet was applied, and the patients in the other group were subjected to vein tapping. The vein depth and diameter of each patient were then examined with the help of an ultrasound and it was found that there was no statistical difference in vein diameter and palpation score in any of the groups [ 13 ] The fact that there is only one study on the subject in the literature and that the patient group consisted of healthy individuals suggested that a study should be conducted in patients undergoing IV chemotherapy with low vein visibility. Based on our observations, nurses need reliable, useful, and easy-to-use interventions to reduce the negative effects of the problems experienced by patients undergoing chemotherapy during IV catheter insertion and to increase patient satisfaction. However, they are required to have knowledge about the evidence that forms the basis of the practices to apply these techniques that increase vein visibility [ 14 ]. Evidence-based nursing practices are crucial for enhancing care outcomes, for influencing clinical practices and patient results, and for standardizing care protocols. Moreover, the standardization of care will contribute to patient and nurse satisfaction [ 15 ]. Therefore, this study aims to examine the effect of arm massage on the success of peripheral IV catheter insertion in patients with breast cancer undergoing IV chemotherapy. Hypotheses of the study H 0 : Arm massage performed on patients with breast cancer undergoing chemotherapy has no effect on the success of peripheral IV catheter insertion. H 1 : Arm massage performed on breast cancer patients undergoing chemotherapy has an effect on the success of peripheral IV catheter insertion. Methods Study design and participants This study was conducted as a randomized controlled experimental study to determine the effect of arm massage on the success of peripheral IV catheter insertion in breast cancer patients undergoing chemotherapy. The figure depicts the CONSORT-guided process for study randomization. The study population consisted of all patients diagnosed with breast CA undergoing chemotherapy in the outpatient chemotherapy unit of a hospital. The inclusion criteria were: patients who underwent IV chemotherapy and received their first course of chemotherapy (since chemotherapy courses disrupt the vein structure) and whose vein visibility was evaluated as 1, 2, or 3 according to the vein grading scale (since catheter insertion can be easily performed in veins with vein grades of 4 and 5). Patients who did not have a diagnosed chronic disease other than cancer; did not have acute trauma, inflammation, ecchymosis, hematoma, scar tissue, edema, metal prosthesis, or paralysis around the extremity; did not have deformity or thrombocytopenia noticeable by inspection; did not have any communication problems; and were mentally fit to participate in the study. The exclusion criteria were: patients who experienced more than two unsuccessful attempts at PIVC insertion and the participant's desire to leave the study. This research was approved by the Health Sciences Non-Interventional Research Ethics Committee of X University (224/187, 12.07.2024) and the Provincial Directorate of Health (2024/12, 30.07.2024). Informed consent was obtained from all eligible participants. Before starting the study, the nurses in the chemotherapy unit were informed about it. Written consent was obtained from a single nurse who volunteered to participate in the study. All study procedures were conducted following the Declaration of Helsinki. For this study, only one nurse completed the PIVC insertion for all study participants across all groups. This nurse had two years of experience in the chemotherapy unit. Sample size and randomization This study did not involve direct sample selection as patients visited the unit multiple times during their chemotherapy treatment. Instead, sample calculation was based on a previous similar study (Eren et al. 2022a). Using the G.Power-3.17 program, an effect size of 0.4 with 95% confidence and a statistical test power of at least 80% were calculated. Accordingly, 60 patients (control group = 30, experimental group = 30) were reached. The study used a simple randomization method. In this context, a randomization table was prepared using the SPSS program before the patients with vein grades 1, 2, and 3 were included in the study, and the patients were randomly assigned to the groups according to this table. The vein grade was assessed by the nurse practitioner who inserted the IV catheter to prevent bias in the study. The screening for vein visibility was performed using a vein assessment scale [ 16 ]. This scale has 5 grades, and as the grades increase, the visibility and palpability of the veins increase. The 5 grades are as follows: (1) veins are neither visible nor palpable, (2) veins are visible but not palpable, (3) veins are barely visible and palpable, (4) veins are visible and palpable, and (5) veins are visible and palpable. Blinding was not ensured because the investigator and patients knew which group they were in. Interventions The study was conducted in two phases, namely pre-implementation and implementation, from August 2024 to February 2025. In the pre-implementation phase of the study, nurses working in the outpatient chemotherapy unit were interviewed after ethical approval and institutional permission were obtained where the purpose of the study and the implementation phase were explained and the nurses were invited to the study. An information and training meeting was held with the nurse practitioner who agreed to participate in the study. In the meeting, the nurse was informed about the steps of the peripheral IV catheter insertion procedure and data collection forms. Since vein grading would be performed by the nurse practitioner who would insert the PIVC to prevent bias in the study, the nurse was also informed about vein grading. The nurse practitioner was observed by the same researcher during 8 to 16 shifts for one week until the nurse practitioner performed the catheter insertion steps without any errors. Afterwards, the pre-application was performed with a total of 10 patients, five in the control group and five in the experimental group, which constituted approximately 15% of the sample size. Following the pre-application phase, the research forms remained unchanged and the implementation phase commenced. During the study's implementation phase, patients were greeted at the entrance, their files were reviewed, and they were informed about the study. The veins of the patients were evaluated by the nurse practitioner according to the vein grading scale. Both verbal and written informed consent were obtained from the patients who met the inclusion criteria and agreed to participate in the study. Since ambient temperature may affect body temperature and vein visibility, a thermometer was inserted in the room to control the room temperature before the procedure. Tourniquets were applied in all groups to visualize the veins before the procedure. However, since a constant tightening in a tourniquet application is not possible in every patient, a sphygmomanometer cuff was used instead of a tourniquet to prevent differences, and it was inflated at the individual's own diastolic pressure value as recommended in the literature [ 8 ]. Implementation of the study in the control group : The welcomed patient was taken to the chemotherapy administration chair and was allowed to rest. The patient's vital signs and skin color were evaluated and recorded on the peripheral IV chemotherapy record. Since it was stated in the literature that insertion of the PIVC in the arm that had not undergone breast surgery and was not actively used was important in preventing complications, the PIVC was inserted on the side of the patient that had not undergone breast surgery and/or on the arm that was not actively used [ 17 ]. The cuff applied to the patient's arm was inflated to the predetermined diastolic blood pressure level, and when the needle reached the patient's diastolic blood pressure level with the inflation of the cuff, a timer was started by opening the stopwatch by the researcher. The stopwatch was closed after successful insertion of the PIVC, which stopped the timer. Successful catheter insertion was evaluated as the arrival of blood in the catheter chamber. The satisfaction of both the patient and the nurse practitioner with the procedure, the catheter number used, the duration of successful catheter insertion, the number of interventions performed for successful catheter insertion, and the vein in which the catheter was inserted were recorded on the form for IV chemotherapy administration. Implementation of the study in the experimental group : The welcomed patient was taken to the chemotherapy administration chair and allowed to rest. The patient's vein degree, skin color, and vital signs were recorded on the record form for peripheral IV chemotherapy administration. The patient's blood pressure was measured and their diastolic blood pressure value was determined. An arm massage was then performed by the investigator for 20 minutes on the arm where the catheter was to be inserted. Classical massage consisting of effleurage, petrissage, and superficial friction was performed on the forearm and hand below the elbow of the participants. The vein was re-graded by the nurse practitioner immediately after the massage. The following process was carried out in the same way as in the control group. Measures Data were collected using the Peripheral Intravenous Chemotherapy Administration Record Form. The data collection form was created by the researchers by reviewing the literature [ 5 , 8 , 18 ]. Peripheral intravenous chemotherapy administration record form This form includes questions regarding the gender, age, body mass index, skin turgor, skin color, number, and duration of chemotherapy courses, chemotherapy medications administered, time from the last IV catheter insertion to the present day, blood pressure, body temperature, vein temperature, catheter number used, time from cuff application to successful catheter insertion, number of punctures for successful catheter insertion, the vein into which the catheter was inserted, the room temperature where the procedure was performed, patients' satisfaction with IV catheter insertion and their anxiety levels before and after the procedure, and whether the massage, which will be answered by the nurse in the experimental group, made the procedure easier. The form was completed by the researcher and the nurse during the implementation process. The skin color of the patients was evaluated by the nurse practitioner using the Fitzpatrick scale for skin type [ 19 ]. In the form, patients' satisfaction levels with and anxiety levels towards the procedure were evaluated using a visual comparison scale that was graded from 1 to 10. Data analysis The Statistical Product and Service Solutions version 24.0 (IBM Corp., Armonk, New York) package program was used for data analysis. Some demographic and treatment process data were summarized as the means (SDs) for continuous variables and as frequency counts (percentages) for categorical variables. The normality of the data was examined using the 1-sample Kolmogorov-Smirnov test. The chi-square test, the independent t-test and the Mann-Whitney U test were used. The data were evaluated at the meaningfulness level of P < 0.05 within the confidence interval of 95%. Results This study, which examined the effect of arm massage on breast cancer patients undergoing chemotherapy, found no statistically significant differences between the groups in terms of mean age, body mass index, skin type, mean diastolic blood pressure, or mean room and body temperature ( p > 0.05) (Table 1 ). Regarding the characteristics of the patients regarding chemotherapy and peripheral IV catheter procedures, there was no statistically significant difference between the groups in terms of number of chemotherapy cycles, duration of chemotherapy, time elapsed after the last catheter insertion, pre-procedure vein grade, catheter number used in the PIVC procedure, and number of attempts made for successful catheter insertion in the PIVC procedure ( p > 0.05). The duration of successful catheter insertion was statistically significantly shorter in patients in the experimental group ( p < 0.05). There was also a significant difference between the veins in which the PIVC was inserted in the groups. Additionally, the cephalic vein was most preferred in the experimental group and the basilic vein was most preferred in the control group (Table 2 ). Table 1 Distribution of the characteristics of the patients according to group assignment( N = 60) Experimantal Group Control Group test p Age (years) Mean ± SD 54,3 ± 10,1 52,2 ± 12,6 t = 0,687 0,495 BMI Mean ± SD 27,8 ± 5,96 28,5 ± 5,19 t=-0,495 0,623 Skin color Type 1 4 2 X 2 = 1,889 0,389 Type 2 14 11 Type 3 12 17 Diastolic blood pressure Mean ± SD 78,3 ± 7,08 73,8 ± 12,4 t = 1,735 0,089 Body temperature Mean ± SD 36,4 ± 0,27 36,4 ± 0,40 t=-0,262 0,794 Room temperature Mean ± SD 22,2 ± 0,62 22,0 ± 0,43 t = 1,360 0,179 SD Standard deviation t independent t test X 2 ki square test Table 2 The distribution of the characteristics of chemotherapy treatment and peripheral intravenous catheter ıntervention according to the group assisgment ( N = 60) Experimantal Group Control Group Test p Courses of chemotherapy Mean SD 5,97 ± 5,31 7,17 ± 6,01 t=-0,819 0,416 Chemotherapy treatment period (day) Mean SD 153,13 ± 106,04 228,37 ± 197,52 Z=-1,133 0,257 Period passing since the date of last placement of peripheral intravenous catheter (day) Mean ± SD 13,7 ± 8,51 12,20 ± 7,20 t = 0,753 0,454 Vein scale 1 15 11 X 2 = 2,932 0,231 2 12 11 3 3 8 Catheter size 20–22 18 26 X 2 = 2,857 0,158 24 12 6 Vein Dorsal metacarpal 8 6 X 2 = 7,902 0,048 Basilic 7 11 Cephalic 9 13 Brakiyal 6 0 Attemps made for having a succesful insertion Mean ± SD 1,27 ± 0,52 1,33 ± 0,66 t=-0,434 0,666 Time to successfully place catheter (second) Mean ± SD 26,4 ± 13,9 35,5 ± 13,9 t=-2,548 0,014 SD Standard deviation t independent t test X 2 ki square test Z Mann-Whitney U test Table 3 Ven grades of the participants according the groups Vein grade Experimantal Group (n = 30) Control Group (n = 30) Test/p Before the massage n(%) After the massage n(%) 1(veins are neither visible nor palpable 15(50) 3(10) 11(36,6) X 2 = 2,932 p = 0,231 2(veins are visible but not palpable) 12(40) 7(23,3) 11(36,6) 3(veins are barely visible and palpable) 3(10) 7(23,3) 8(26,8) 4(veins are visible and palpable) - 11(36,7) - 5(veins are clearly visible and easily palpable) - 2(6,7) - Test/p X 2 = 19,828 p = 0,011* X 2 ki square test p < 0,05 After analyzing the vein grades, it was found that there was no statistically significant difference in the vein grades before the procedure, while there was a statistically significant change after the massage in the experimental group. Furthermore, in the experimental group, the proportion of patients with vein grade 1 decreased from 50% to 10% after the massage, while the proportion of patients with vein grade 2 decreased from 40% to 23.3%, and the proportion of patients with vein grade 3 increased from 10% to 23%. Additionally, some patients had vein grades 4 and 5 after the massage. Considering the anxiety and satisfaction levels of the patients towards the procedure, it was found that although the satisfaction levels before the procedure showed a significant difference between the groups, the anxiety levels of the patients in the experimental group decreased statistically significantly after the procedure. However, this decrease was not significant in the control group. The participants did not show a significant difference in their satisfaction with the previous catheter insertion, but the satisfaction of the patients in the experimental group with the current catheter insertion increased significantly, while the control group showed a significant decrease in satisfaction (Table 4 ). Table 4 Anxiety and satisfaction levels of the participants according to groups Experimantal Group Control Group Test/p Anxiety level before the procedure Mean ± SD 7,37 ± 2,98 4,37 ± 3,20 t = 3,753 p = 0,000* Anxiety level after the procedure Mean ± SD 3,07 ± 3,36 3,87 ± 3,14 t=-0,951 p = 0,345 Test/p t = 5,236 p = 0,000* t=-0,610 p = 0,544 Previous pivk placement process satisfaction Mean ± SD 7,27 ± 2,11 8,10 ± 2,35 t=-1,442 p = 0,155 Current pivk placement process satisfaction Mean ± SD 9,67 ± 0,80 6,30 ± 3,00 t = 5,924 p = 0,000* Test/p t=-5,808 p = 0,000* t=-2,581 p = 0,012* SD Standard deviation t independent t test * p < 0,05 In the experimental group, the nurse answered yes in 90% of the procedures when asked if they thought that massage facilitated catheter insertion. Discussion This study investigated the effect of arm massages on the success of PIVC insertion in patients with breast cancer undergoing IV chemotherapy and found that the massage shortened the time to successful catheter insertion. The shortening of the procedure by 20 minutes using an arm massage may be associated with the acceleration of circulation and venous flow and thus increased venous fullness. The 40% decrease in the proportion of patients with vein grade 1 in the experimental group after the massage supports this conclusion. The study conducted by Yasuda et al. showed that massage applications increased venous diameter, but the vein depth of the patients in the massage group was higher than the patients in the other group. This result shows that visibility is higher in the massage group than in the other groups. Patients with low vein visibility may have increased levels of anxiety about the procedure because peripheral IV catheter intervention becomes difficult [ 8 ]. In the study, the anxiety levels of the participants in the experimental group decreased. This result may be related to the fact that the vein was found more easily after the massage and the catheter was inserted in a shorter time in the experimental group. No similar study could be found in the literature, but it has been shown that shortening the catheter insertion time and reducing the number of attempts for successful catheter insertion reduce the anxiety level of patients [ 8 , 20 ]. Furthermore, the relaxing effect of massage applications bolsters positive emotions in patients. In the study conducted by Aydın et al. (2023), it was observed that patients who received hand massages experienced less pain during the PIVC insertion procedure [ 18 ]. The reduction in pain and anxiety during the PIVC insertion procedure also enhances the patients' satisfaction with it. As a matter of fact, in the study, it was observed that the satisfaction levels of the participants in the experimental group increased, while those in the control group decreased. The decrease in the control group may be related to the fact that the participants in this group saw the massage applications given to the participants in the experimental group. Appropriate vein selection is critical for successful vein catheterization. Therefore, both visible and palpable veins should be preferred. In the study, it was observed that the cephalic vein was mostly preferred in the experimental group and the basilic vein in the control group. A study of 176 patients reported that the basilic vein diameter was larger than other veins [ 21 ]. However, these diameters may be affected by many conditions, such as weight, age, or chronic diseases. The preferred vein may therefore be determined by the patients' anthropometric measurements and health. The experimental group mostly preferred the cephalic vein, likely because it runs lateral to the bicep muscle and becomes more visible when the muscle is stimulated through massage. In this study, it was found that arm massages increased vein visibility and shortened the duration of successful catheter insertion, and the nurse practitioner stated that the massages facilitated the procedure in most of the procedures. In a mixed-type study conducted by Santos-Costa et al. (2022), it was stated that nurses working in the oncology unit experienced stress before inserting a PIVC on a patient diagnosed with breast cancer and that they applied an arm massage to the patient before the procedure in addition to a tourniquet application to increase vein visibility [ 12 ] The fact that there are no other studies on the subject in the literature constitutes the unique value of the research and serves as a guide for future studies. Study limitation This study has limitations that may affect the results. In the study, the fact that the patients arrived at the unit due to recurrent cures, experienced the treatment area and processes, and observed the massage application in the experimental group may have affected the satisfaction levels of the patients in the control group. Secondly, the significant difference in the mean anxiety level before the procedure in the groups may cause variability in the observed results. Despite all these limitations, the findings that the cost-effective and applicable arm massage application shortened the time for catheter insertion and had positive effects on the anxiety and satisfaction levels of the patients, and the fact that a similar study has not been conducted, provides evidence-level information about massage applications in the literature. Conclusion This study demonstrates the effect of massage on patients with breast cancer with poor vein visibility. Findings show that arm massage applied before the PIVC placement procedure increases vein visibility, shortens the procedure time, reduces the patient's anxiety level and increases the patient's satisfaction with the procedure. These results demonstrate that massage therapy, which is cost-effective and easy to implement, improves the quality of chemotherapy treatment in breast cancer patients. Therefore, its routine use before PIVC placement is recommended. Declarations Author Contribution Research idea and study design: HE, YK; data acquisition: HE; data analysis/interpretation: HE; drafting the article: HE, YK; review and editing: HE, YK. All authors reviewed, critically commented and approved the final version of the manuscript. Acknowledgement We would like to thank all patients who participated in this study, and to all nurses in chemotherapy unit. Data Availability The data that support the findings of this study are available on request from the corresponding author. 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Measurement of vein diameter for peripherally inserted central catheter (PICC) insertion: an observational study. J Infus Nurs 38(5), 351–357. 10.1097/NAN.0000000000000125 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8012876","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":538776120,"identity":"aabc4071-95b8-4bec-9e70-80e70a4cd0b4","order_by":0,"name":"Handan 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19:23:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8012876/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8012876/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95104102,"identity":"17160786-de69-4062-84a2-072d07ff8d78","added_by":"auto","created_at":"2025-11-04 10:25:56","extension":"jpg","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":113304,"visible":true,"origin":"","legend":"","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8012876/v1/9b10359891b399b04c7ec49d.jpg"},{"id":95224396,"identity":"c9a467a5-cf25-470d-9042-735acf74cf8d","added_by":"auto","created_at":"2025-11-05 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10:25:56","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":83506,"visible":true,"origin":"","legend":"","description":"","filename":"4b38b0fcf8dc4d89916958506784dd921structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8012876/v1/b2275e1bf5c454797b0504b0.xml"},{"id":95104112,"identity":"91c13722-a034-4f3f-881f-16e2b8619727","added_by":"auto","created_at":"2025-11-04 10:25:57","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":93189,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8012876/v1/1d21c060900a8ac17c2b7761.html"},{"id":95104107,"identity":"155d9f19-dc5e-4a1c-bd81-b3f087fdf8e6","added_by":"auto","created_at":"2025-11-04 10:25:56","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":168483,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8012876/v1/fedfbec6836e1f4c93664300.jpg"},{"id":98622944,"identity":"b9ea4c52-4ad0-4362-9e6a-1b552f71dedb","added_by":"auto","created_at":"2025-12-19 17:03:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1081528,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8012876/v1/42906196-1fc2-4cf5-9d7e-4833a966330d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Effect of Arm Massage on the Success of Peripheral Intravenous Catheter Insertion in Breast Cancer Patients Undergoing Chemotherapy: A Randomized Controlled Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCytotoxic drugs administered to patients using intravenous (IV) chemotherapy disrupt the endothelial structure of the vein, reducing both vein visibility and the number of veins that can be used in subsequent cycles [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Patients with breast cancer experience a decrease in vein visibility, potentially due to impaired lymph circulation [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Intervention becomes difficult in veins with poor visibility, which may increase the number of interventions that are required for successful catheter insertion and prolong the procedure time [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Extended procedure time and repeated attempts cause patients to experience anxiety during the procedure, and anxiety further reduces vein visibility with peripheral vasoconstriction [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Due to decreased vein visibility, it is often not possible to determine the appropriate vein for IV chemotherapy. Different methods can be used to avoid problems with inserting a peripheral IV catheter and to make it easier to see the veins for IV catheter insertion. These methods include tourniquet application, holding the arm below the level of the heart, isometric arm exercise application, tapping, fist clenching, local warm application to the area, drinking hot drinks, essential oil application, and massaging along the vein [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. There are studies in the literature that examined the effect of the use of methods other than massage on the success of peripheral IV catheter insertion [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The arm massage, which is different from the massaging along the vein, is performed on the arm, forearm, and hand. The massage is emphasized to be effective in the management and prevention of the development of lymphedema, which is frequently encountered in patients with breast cancer, and should be taught to patients during discharge education [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Massaging helps to maintain venous drainage by increasing muscle pump activity [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Therefore, it is thought that its application before catheter insertion will increase vein visibility. In a descriptive study conducted by Santos-Costa et al. (2022) with nurses, it was reported that one of the nurses massaged the patient's arm before the PIVC insertion procedure. However, this study did not examine the effect of that massage [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In the study conducted by Yasuda et al. (2023) with healthy individuals aged 20 to 29 years, tourniquets were applied to the patients in all groups where the patients in one of the experimental groups were massaged after the tourniquet was applied, and the patients in the other group were subjected to vein tapping. The vein depth and diameter of each patient were then examined with the help of an ultrasound and it was found that there was no statistical difference in vein diameter and palpation score in any of the groups [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] The fact that there is only one study on the subject in the literature and that the patient group consisted of healthy individuals suggested that a study should be conducted in patients undergoing IV chemotherapy with low vein visibility.\u003c/p\u003e\u003cp\u003eBased on our observations, nurses need reliable, useful, and easy-to-use interventions to reduce the negative effects of the problems experienced by patients undergoing chemotherapy during IV catheter insertion and to increase patient satisfaction. However, they are required to have knowledge about the evidence that forms the basis of the practices to apply these techniques that increase vein visibility [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Evidence-based nursing practices are crucial for enhancing care outcomes, for influencing clinical practices and patient results, and for standardizing care protocols. Moreover, the standardization of care will contribute to patient and nurse satisfaction [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Therefore, this study aims to examine the effect of arm massage on the success of peripheral IV catheter insertion in patients with breast cancer undergoing IV chemotherapy.\u003c/p\u003e\u003cp\u003eHypotheses of the study\u003c/p\u003e\u003cp\u003eH\u003csub\u003e0\u003c/sub\u003e: Arm massage performed on patients with breast cancer undergoing chemotherapy has no effect on the success of peripheral IV catheter insertion.\u003c/p\u003e\u003cp\u003eH\u003csub\u003e1\u003c/sub\u003e: Arm massage performed on breast cancer patients undergoing chemotherapy has an effect on the success of peripheral IV catheter insertion.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and participants\u003c/h2\u003e\u003cp\u003eThis study was conducted as a randomized controlled experimental study to determine the effect of arm massage on the success of peripheral IV catheter insertion in breast cancer patients undergoing chemotherapy. The figure depicts the CONSORT-guided process for study randomization.\u003c/p\u003e\u003cp\u003eThe study population consisted of all patients diagnosed with breast CA undergoing chemotherapy in the outpatient chemotherapy unit of a hospital. The inclusion criteria were: patients who underwent IV chemotherapy and received their first course of chemotherapy (since chemotherapy courses disrupt the vein structure) and whose vein visibility was evaluated as 1, 2, or 3 according to the vein grading scale (since catheter insertion can be easily performed in veins with vein grades of 4 and 5). Patients who did not have a diagnosed chronic disease other than cancer; did not have acute trauma, inflammation, ecchymosis, hematoma, scar tissue, edema, metal prosthesis, or paralysis around the extremity; did not have deformity or thrombocytopenia noticeable by inspection; did not have any communication problems; and were mentally fit to participate in the study. The exclusion criteria were: patients who experienced more than two unsuccessful attempts at PIVC insertion and the participant's desire to leave the study.\u003c/p\u003e\u003cp\u003e This research was approved by the Health Sciences Non-Interventional Research Ethics Committee of X University (224/187, 12.07.2024) and the Provincial Directorate of Health (2024/12, 30.07.2024). Informed consent was obtained from all eligible participants. Before starting the study, the nurses in the chemotherapy unit were informed about it. Written consent was obtained from a single nurse who volunteered to participate in the study. All study procedures were conducted following the Declaration of Helsinki. For this study, only one nurse completed the PIVC insertion for all study participants across all groups. This nurse had two years of experience in the chemotherapy unit.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSample size and randomization\u003c/h3\u003e\n\u003cp\u003eThis study did not involve direct sample selection as patients visited the unit multiple times during their chemotherapy treatment. Instead, sample calculation was based on a previous similar study (Eren et al. 2022a). Using the G.Power-3.17 program, an effect size of 0.4 with 95% confidence and a statistical test power of at least 80% were calculated. Accordingly, 60 patients (control group\u0026thinsp;=\u0026thinsp;30, experimental group\u0026thinsp;=\u0026thinsp;30) were reached.\u003c/p\u003e\u003cp\u003eThe study used a simple randomization method. In this context, a randomization table was prepared using the SPSS program before the patients with vein grades 1, 2, and 3 were included in the study, and the patients were randomly assigned to the groups according to this table. The vein grade was assessed by the nurse practitioner who inserted the IV catheter to prevent bias in the study. The screening for vein visibility was performed using a vein assessment scale [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This scale has 5 grades, and as the grades increase, the visibility and palpability of the veins increase. The 5 grades are as follows: (1) veins are neither visible nor palpable, (2) veins are visible but not palpable, (3) veins are barely visible and palpable, (4) veins are visible and palpable, and (5) veins are visible and palpable. Blinding was not ensured because the investigator and patients knew which group they were in.\u003c/p\u003e\n\u003ch3\u003eInterventions\u003c/h3\u003e\n\u003cp\u003eThe study was conducted in two phases, namely pre-implementation and implementation, from August 2024 to February 2025. In the pre-implementation phase of the study, nurses working in the outpatient chemotherapy unit were interviewed after ethical approval and institutional permission were obtained where the purpose of the study and the implementation phase were explained and the nurses were invited to the study. An information and training meeting was held with the nurse practitioner who agreed to participate in the study. In the meeting, the nurse was informed about the steps of the peripheral IV catheter insertion procedure and data collection forms. Since vein grading would be performed by the nurse practitioner who would insert the PIVC to prevent bias in the study, the nurse was also informed about vein grading.\u003c/p\u003e\u003cp\u003eThe nurse practitioner was observed by the same researcher during 8 to 16 shifts for one week until the nurse practitioner performed the catheter insertion steps without any errors. Afterwards, the pre-application was performed with a total of 10 patients, five in the control group and five in the experimental group, which constituted approximately 15% of the sample size. Following the pre-application phase, the research forms remained unchanged and the implementation phase commenced.\u003c/p\u003e\u003cp\u003eDuring the study's implementation phase, patients were greeted at the entrance, their files were reviewed, and they were informed about the study. The veins of the patients were evaluated by the nurse practitioner according to the vein grading scale. Both verbal and written informed consent were obtained from the patients who met the inclusion criteria and agreed to participate in the study. Since ambient temperature may affect body temperature and vein visibility, a thermometer was inserted in the room to control the room temperature before the procedure. Tourniquets were applied in all groups to visualize the veins before the procedure. However, since a constant tightening in a tourniquet application is not possible in every patient, a sphygmomanometer cuff was used instead of a tourniquet to prevent differences, and it was inflated at the individual's own diastolic pressure value as recommended in the literature [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eImplementation of the study in the control group\u003c/span\u003e: The welcomed patient was taken to the chemotherapy administration chair and was allowed to rest. The patient's vital signs and skin color were evaluated and recorded on the peripheral IV chemotherapy record. Since it was stated in the literature that insertion of the PIVC in the arm that had not undergone breast surgery and was not actively used was important in preventing complications, the PIVC was inserted on the side of the patient that had not undergone breast surgery and/or on the arm that was not actively used [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The cuff applied to the patient's arm was inflated to the predetermined diastolic blood pressure level, and when the needle reached the patient's diastolic blood pressure level with the inflation of the cuff, a timer was started by opening the stopwatch by the researcher. The stopwatch was closed after successful insertion of the PIVC, which stopped the timer. Successful catheter insertion was evaluated as the arrival of blood in the catheter chamber. The satisfaction of both the patient and the nurse practitioner with the procedure, the catheter number used, the duration of successful catheter insertion, the number of interventions performed for successful catheter insertion, and the vein in which the catheter was inserted were recorded on the form for IV chemotherapy administration.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eImplementation of the study in the experimental group\u003c/span\u003e: The welcomed patient was taken to the chemotherapy administration chair and allowed to rest. The patient's vein degree, skin color, and vital signs were recorded on the record form for peripheral IV chemotherapy administration. The patient's blood pressure was measured and their diastolic blood pressure value was determined. An arm massage was then performed by the investigator for 20 minutes on the arm where the catheter was to be inserted. Classical massage consisting of effleurage, petrissage, and superficial friction was performed on the forearm and hand below the elbow of the participants. The vein was re-graded by the nurse practitioner immediately after the massage. The following process was carried out in the same way as in the control group.\u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003eData were collected using the Peripheral Intravenous Chemotherapy Administration Record Form. The data collection form was created by the researchers by reviewing the literature [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003ePeripheral intravenous chemotherapy administration record form\u003c/h3\u003e\n\u003cp\u003eThis form includes questions regarding the gender, age, body mass index, skin turgor, skin color, number, and duration of chemotherapy courses, chemotherapy medications administered, time from the last IV catheter insertion to the present day, blood pressure, body temperature, vein temperature, catheter number used, time from cuff application to successful catheter insertion, number of punctures for successful catheter insertion, the vein into which the catheter was inserted, the room temperature where the procedure was performed, patients' satisfaction with IV catheter insertion and their anxiety levels before and after the procedure, and whether the massage, which will be answered by the nurse in the experimental group, made the procedure easier. The form was completed by the researcher and the nurse during the implementation process. The skin color of the patients was evaluated by the nurse practitioner using the Fitzpatrick scale for skin type [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In the form, patients' satisfaction levels with and anxiety levels towards the procedure were evaluated using a visual comparison scale that was graded from 1 to 10.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eThe Statistical Product and Service Solutions version 24.0 (IBM Corp., Armonk, New York) package program was used for data analysis. Some demographic and treatment process data were summarized as the means (SDs) for continuous variables and as frequency counts (percentages) for categorical variables. The normality of the data was examined using the 1-sample Kolmogorov-Smirnov test. The chi-square test, the independent t-test and the Mann-Whitney U test were used. The data were evaluated at the meaningfulness level of \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 within the confidence interval of 95%.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThis study, which examined the effect of arm massage on breast cancer patients undergoing chemotherapy, found no statistically significant differences between the groups in terms of mean age, body mass index, skin type, mean diastolic blood pressure, or mean room and body temperature (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Regarding the characteristics of the patients regarding chemotherapy and peripheral IV catheter procedures, there was no statistically significant difference between the groups in terms of number of chemotherapy cycles, duration of chemotherapy, time elapsed after the last catheter insertion, pre-procedure vein grade, catheter number used in the PIVC procedure, and number of attempts made for successful catheter insertion in the PIVC procedure (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The duration of successful catheter insertion was statistically significantly shorter in patients in the experimental group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was also a significant difference between the veins in which the PIVC was inserted in the groups. Additionally, the cephalic vein was most preferred in the experimental group and the basilic vein was most preferred in the control group (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of the characteristics of the patients according to group assignment(\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExperimantal Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003etest\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54,3\u0026thinsp;\u0026plusmn;\u0026thinsp;10,1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52,2\u0026thinsp;\u0026plusmn;\u0026thinsp;12,6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0,687\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,495\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27,8\u0026thinsp;\u0026plusmn;\u0026thinsp;5,96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28,5\u0026thinsp;\u0026plusmn;\u0026thinsp;5,19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et=-0,495\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,623\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSkin color\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1,889\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0,389\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiastolic blood pressure\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e78,3\u0026thinsp;\u0026plusmn;\u0026thinsp;7,08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73,8\u0026thinsp;\u0026plusmn;\u0026thinsp;12,4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;1,735\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,089\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBody temperature\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36,4\u0026thinsp;\u0026plusmn;\u0026thinsp;0,27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36,4\u0026thinsp;\u0026plusmn;\u0026thinsp;0,40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et=-0,262\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,794\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRoom temperature\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22,2\u0026thinsp;\u0026plusmn;\u0026thinsp;0,62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22,0\u0026thinsp;\u0026plusmn;\u0026thinsp;0,43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;1,360\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0,179\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eSD\u003c/em\u003e Standard deviation\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003et\u003c/em\u003e independent t test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e ki square test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe distribution of the characteristics of chemotherapy treatment and peripheral intravenous catheter ıntervention according to the group assisgment (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExperimantal Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTest\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eCourses of chemotherapy\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5,97\u0026thinsp;\u0026plusmn;\u0026thinsp;5,31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7,17\u0026thinsp;\u0026plusmn;\u0026thinsp;6,01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et=-0,819\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0,416\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eChemotherapy treatment period (day)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e153,13\u0026thinsp;\u0026plusmn;\u0026thinsp;106,04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e228,37\u0026thinsp;\u0026plusmn;\u0026thinsp;197,52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eZ=-1,133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0,257\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePeriod passing since the date of last placement of peripheral intravenous catheter (day)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13,7\u0026thinsp;\u0026plusmn;\u0026thinsp;8,51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12,20\u0026thinsp;\u0026plusmn;\u0026thinsp;7,20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0,753\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0,454\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVein scale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2,932\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0,231\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCatheter size\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u0026ndash;22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2,857\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0,158\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVein\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDorsal metacarpal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;7,902\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0,048\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBasilic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCephalic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBrakiyal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAttemps made for having a succesful insertion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,27\u0026thinsp;\u0026plusmn;\u0026thinsp;0,52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,33\u0026thinsp;\u0026plusmn;\u0026thinsp;0,66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et=-0,434\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0,666\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTime to successfully place catheter (second)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26,4\u0026thinsp;\u0026plusmn;\u0026thinsp;13,9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35,5\u0026thinsp;\u0026plusmn;\u0026thinsp;13,9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et=-2,548\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0,014\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eSD\u003c/em\u003e Standard deviation\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003et\u003c/em\u003e independent t test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e ki square test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eZ Mann-Whitney U test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eVen grades of the participants according the groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVein grade\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eExperimantal Group (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eControl Group\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTest/p\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBefore the massage\u003c/p\u003e\u003cp\u003en(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAfter the massage\u003c/p\u003e\u003cp\u003en(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1(veins are neither visible nor palpable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15(50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3(10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11(36,6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2,932\u003c/p\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,231\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2(veins are visible but not palpable)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12(40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(23,3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11(36,6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3(veins are barely visible and palpable)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3(10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(23,3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8(26,8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4(veins are visible and palpable)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11(36,7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5(veins are clearly visible and easily palpable)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(6,7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTest/p\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;19,828\u003c/p\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,011*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e ki square test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0,05\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAfter analyzing the vein grades, it was found that there was no statistically significant difference in the vein grades before the procedure, while there was a statistically significant change after the massage in the experimental group. Furthermore, in the experimental group, the proportion of patients with vein grade 1 decreased from 50% to 10% after the massage, while the proportion of patients with vein grade 2 decreased from 40% to 23.3%, and the proportion of patients with vein grade 3 increased from 10% to 23%. Additionally, some patients had vein grades 4 and 5 after the massage.\u003c/p\u003e\u003cp\u003eConsidering the anxiety and satisfaction levels of the patients towards the procedure, it was found that although the satisfaction levels before the procedure showed a significant difference between the groups, the anxiety levels of the patients in the experimental group decreased statistically significantly after the procedure. However, this decrease was not significant in the control group. The participants did not show a significant difference in their satisfaction with the previous catheter insertion, but the satisfaction of the patients in the experimental group with the current catheter insertion increased significantly, while the control group showed a significant decrease in satisfaction (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAnxiety and satisfaction levels of the participants according to groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExperimantal Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTest/p\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eAnxiety level before the procedure\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7,37\u0026thinsp;\u0026plusmn;\u0026thinsp;2,98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4,37\u0026thinsp;\u0026plusmn;\u0026thinsp;3,20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;3,753 p\u0026thinsp;=\u0026thinsp;0,000*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAnxiety level after the procedure\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3,07\u0026thinsp;\u0026plusmn;\u0026thinsp;3,36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3,87\u0026thinsp;\u0026plusmn;\u0026thinsp;3,14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003et=-0,951 p\u0026thinsp;=\u0026thinsp;0,345\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest/p\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;5,236 p\u0026thinsp;=\u0026thinsp;0,000*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003et=-0,610 p\u0026thinsp;=\u0026thinsp;0,544\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrevious pivk placement process satisfaction\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7,27\u0026thinsp;\u0026plusmn;\u0026thinsp;2,11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8,10\u0026thinsp;\u0026plusmn;\u0026thinsp;2,35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et=-1,442 p\u0026thinsp;=\u0026thinsp;0,155\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCurrent pivk placement process satisfaction\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9,67\u0026thinsp;\u0026plusmn;\u0026thinsp;0,80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6,30\u0026thinsp;\u0026plusmn;\u0026thinsp;3,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;5,924 p\u0026thinsp;=\u0026thinsp;0,000*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTest/p\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003et=-5,808 p\u0026thinsp;=\u0026thinsp;0,000*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003et=-2,581 p\u0026thinsp;=\u0026thinsp;0,012*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eSD\u003c/em\u003e Standard deviation\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003et\u003c/em\u003e independent t test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e*\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0,05\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn the experimental group, the nurse answered yes in 90% of the procedures when asked if they thought that massage facilitated catheter insertion.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study investigated the effect of arm massages on the success of PIVC insertion in patients with breast cancer undergoing IV chemotherapy and found that the massage shortened the time to successful catheter insertion. The shortening of the procedure by 20 minutes using an arm massage may be associated with the acceleration of circulation and venous flow and thus increased venous fullness. The 40% decrease in the proportion of patients with vein grade 1 in the experimental group after the massage supports this conclusion. The study conducted by Yasuda et al. showed that massage applications increased venous diameter, but the vein depth of the patients in the massage group was higher than the patients in the other group. This result shows that visibility is higher in the massage group than in the other groups.\u003c/p\u003e\u003cp\u003ePatients with low vein visibility may have increased levels of anxiety about the procedure because peripheral IV catheter intervention becomes difficult [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In the study, the anxiety levels of the participants in the experimental group decreased. This result may be related to the fact that the vein was found more easily after the massage and the catheter was inserted in a shorter time in the experimental group. No similar study could be found in the literature, but it has been shown that shortening the catheter insertion time and reducing the number of attempts for successful catheter insertion reduce the anxiety level of patients [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Furthermore, the relaxing effect of massage applications bolsters positive emotions in patients. In the study conducted by Aydın et al. (2023), it was observed that patients who received hand massages experienced less pain during the PIVC insertion procedure [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The reduction in pain and anxiety during the PIVC insertion procedure also enhances the patients' satisfaction with it. As a matter of fact, in the study, it was observed that the satisfaction levels of the participants in the experimental group increased, while those in the control group decreased. The decrease in the control group may be related to the fact that the participants in this group saw the massage applications given to the participants in the experimental group.\u003c/p\u003e\u003cp\u003eAppropriate vein selection is critical for successful vein catheterization. Therefore, both visible and palpable veins should be preferred. In the study, it was observed that the cephalic vein was mostly preferred in the experimental group and the basilic vein in the control group. A study of 176 patients reported that the basilic vein diameter was larger than other veins [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. However, these diameters may be affected by many conditions, such as weight, age, or chronic diseases. The preferred vein may therefore be determined by the patients' anthropometric measurements and health. The experimental group mostly preferred the cephalic vein, likely because it runs lateral to the bicep muscle and becomes more visible when the muscle is stimulated through massage.\u003c/p\u003e\u003cp\u003eIn this study, it was found that arm massages increased vein visibility and shortened the duration of successful catheter insertion, and the nurse practitioner stated that the massages facilitated the procedure in most of the procedures. In a mixed-type study conducted by Santos-Costa et al. (2022), it was stated that nurses working in the oncology unit experienced stress before inserting a PIVC on a patient diagnosed with breast cancer and that they applied an arm massage to the patient before the procedure in addition to a tourniquet application to increase vein visibility [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] The fact that there are no other studies on the subject in the literature constitutes the unique value of the research and serves as a guide for future studies.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eStudy limitation\u003c/h2\u003e\u003cp\u003eThis study has limitations that may affect the results. In the study, the fact that the patients arrived at the unit due to recurrent cures, experienced the treatment area and processes, and observed the massage application in the experimental group may have affected the satisfaction levels of the patients in the control group. Secondly, the significant difference in the mean anxiety level before the procedure in the groups may cause variability in the observed results. Despite all these limitations, the findings that the cost-effective and applicable arm massage application shortened the time for catheter insertion and had positive effects on the anxiety and satisfaction levels of the patients, and the fact that a similar study has not been conducted, provides evidence-level information about massage applications in the literature.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates the effect of massage on patients with breast cancer with poor vein visibility. Findings show that arm massage applied before the PIVC placement procedure increases vein visibility, shortens the procedure time, reduces the patient's anxiety level and increases the patient's satisfaction with the procedure. These results demonstrate that massage therapy, which is cost-effective and easy to implement, improves the quality of chemotherapy treatment in breast cancer patients. Therefore, its routine use before PIVC placement is recommended.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eResearch idea and study design: HE, YK; data acquisition: HE; data analysis/interpretation: HE; drafting the article: HE, YK; review and editing: HE, YK. All authors reviewed, critically commented and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank all patients who participated in this study, and to all nurses in chemotherapy unit.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are available on request from the corresponding author. 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J Infus Nurs 38(5), 351\u0026ndash;357. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/NAN.0000000000000125\u003c/span\u003e\u003cspan address=\"10.1097/NAN.0000000000000125\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Massage, Vein visibility, Peripheral catheter insertion","lastPublishedDoi":"10.21203/rs.3.rs-8012876/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8012876/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePeripheral intravenous catheter access becomes difficult in patients diagnosed with breast cancer who receive chemotherapy treatment because vein visibility decreases. The study aims to determine the effect of arm massage on the success of peripheral intravenous catheter insertion in breast cancer patients undergoing intravenous chemotherapy.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis randomized controlled study included 60 breast cancer patients undergoing intravenous chemotherapy (experimental\u0026thinsp;=\u0026thinsp;30, control\u0026thinsp;=\u0026thinsp;30). The patients in the experimental group received arm massage before the procedure, while those in the control group did not receive any intervention. Data were collected using a record form for peripheral intravenous chemotherapy administration.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eSuccessful peripheral intravenous catheter insertion time was statistically shorter in the experimental group (p\u0026thinsp;=\u0026thinsp;0.000). Post-procedure anxiety levels were significantly lower in the experimental group (p\u0026thinsp;=\u0026thinsp;0.000). While the level of satisfaction with the procedure increased statistically significantly in the experimental group (p\u0026thinsp;=\u0026thinsp;0.000), it decreased statistically significantly in the control group (p\u0026thinsp;=\u0026thinsp;0.012). The nurses in the groups stated that arm massage facilitated catheter insertion in 90% of the procedures.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eMassage shortened the peripheral intravenous catheter insertion process and positively affected the patients' anxiety of and satisfaction with the procedure. Cost-effective arm massage was recommended for use in patients undergoing intravenous chemotherapy.\u003c/p\u003e","manuscriptTitle":"The Effect of Arm Massage on the Success of Peripheral Intravenous Catheter Insertion in Breast Cancer Patients Undergoing Chemotherapy: A Randomized Controlled Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-04 10:25:51","doi":"10.21203/rs.3.rs-8012876/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dba21bb9-1013-4dfd-aa02-219f6b86af28","owner":[],"postedDate":"November 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-12T21:53:35+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-04 10:25:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8012876","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8012876","identity":"rs-8012876","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}