Post-injection thrombophlebitis in patients undergoing peripheral IV catheterization in a tertiary care hospital: incidence and risk factors
DOI:
https://doi.org/10.18203/issn.2454-2156.IntJSciRep20201271Keywords:
Thrombophlebitis, Peripheral venous thrombosis, IV cannula, Infusion thrombophlebitisAbstract
Background: Intravenous catheters cause endothelial damage and trauma, which can predispose to venous thrombosis. Peripheral vein infusion thrombophlebitis occurs in 25- 35% of hospitalized patients with intravenous catheters and has both patient-related implications (e.g., sepsis) and economic consequences (e.g., extra nursing time). This study is designed to address this issue, by assessing the potential risk factors in those who have developed phlebitis, and deriving conclusions based on the same.
Methods: A total of 830 patients were observed over a period of 2 months. All details of the patient were collected. Thrombophlebitis was graded using Visual Infusion Phlebitis Score. Each case was compared with a matching control.
Results: 53 of 830 patients observed, developed thrombophlebitis giving an incidence of 6.4%. 92.5% had IV cannulation flushed after insertion. IV cannula had to be changed at least 2 times during the hospital stay. All had an average IV cannulation for 5 days. All had insertion of same size cannula (20G). Level 1 Phlebitis was identified in 64.15% patients, level 2 Phlebitis in 33.96% patients and Level 3 Phlebitis was seen 1.88% patients.
Conclusions: Significant association was noted between the number of times the catheter was changed since admission and administration of Potassium chloride and Certain Medications such as Piperacillin through the cannula.
Metrics
References
Franklin KJ. An introduction to the earlier history of phlebitis, Annals of Sci. 1939;4:147-60.
Sharifi J, Ghavami F, Nowrouzi Z. Oral versus intravenous rehydration therapy in severe gastroenteritis. Arch Dis Child.1985;60:856-60.
Oliveira AS, Parreira PM. Nursing interventions and peripheral venous catheter related phlebitis. Systemic literature review. Referencia: Scientific J of the Health Sci Res Unit: Nursing. 2010;3(2):137-47.
Urbanetto JS, Muniz FM, Silva RD, Freitas AC. Incidence of phlebitis and postinfusion phlebitis in hospitalised adults. Revista Gaucha de-enfermagem. 2017;38(2):58793.
Decousus H, Quere I, Presles E. Superficial venous thrombosis and venous thromboembolism: a large, prospective epidemiologic study. Ann Intern Med. 2010;152(4):218.
Nisio M, Wichers IM, Middeldorp S. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev Epub. 2018;2:004982.
Atlanta GA. Guidelines for the prevention of intravascular catheter-related infections: centers for disease control and prevention; 2011.
Fernandez AL, Mier SB, Ortega MD. Incidence and risk factors of phlebitis associated to peripheral intravenous catheters. Enfermeria Clinica. 2017;27(2):79-86.
Webster J, Grail M, Marsh N. Postinfusion Phlebitis: Incidence and Risk Factors. Nurs Res Pract. 2015;2015:691934.
Urbanetto JS, Freitas AC, Oliveira AR. Risk factors for the development of phlebitis: an integrative review of literature. Rev Gaucha Enferm. 2018;38(4):57489.
Atay S, Sen S, Cukurlu D. Phlebitis-related peripheral venous catheterization and the associated risk factors. Nigerian J of Clin Prac. 2018;21(7):827-31.
Karadag A, Gorgulu S. Devising an intravenous fluid therapy protocol and compliance of nurses with the protocol. J Intraven Nurs. 2000;23:232-8.
Karadeniz G, Kutlu N, Tatlisumak E, Ozbakkaloglu B. Nurses' knowledge regarding patients with intravenous catheters and phlebitis interventions. J Vasc Nurs. 2003;21:44-7.
Cicolini G, Manzoli L, Simonetti V, Flacco ME, Comparcini D, Capasso L, et al. Phlebitis risk varies by peripheral venous catheter site and increases after 96 hours: A large multicentre prospective study. J Adv Nurs. 2014;70:2539-49.
Oliveira SA, Parreira P. Incidence of phlebitis in patients with peripheral intravenous catheters: The influence of some risk factors. Aust J Adv Nurs. 2013;30:32-9.
Nyika ML, Mukona D, Zvinavashe M. Factors contributing to phlebitis among adult patients admitted in the medical-surgical units of a central hospital in Harare, Zimbabwe. J of Infusion Nurs. 2018;41(2):96-102.
Washington M, Georgita T. Peripheral phlebitis: a point-prevalence study. J of Infusion Nurs. 2012:35(4);252-8.
Abolfotouh MA, Salam M, Mustafa BA, White D, Balkhy HH. Prospective study of incidence and predictors of peripheral intravenous catheter-induced complications. Ther Clin Risk Manag. 2014;10(8):993-1001.
Gabor M. Phlebitis signs and symptoms with peripheral intravenous catheters: incidence and correlation study. J of Infusion Nurs. 2018:41(4);260-3.
Saber W, Moua T, Williams EC. Risk factors for catheter-related thrombosis (CRT) in cancer patients: a patient-level data (IPD) meta-analysis of clinical trials and prospective studies. J Thromb Haemost. 2011;9:312.
Leebeek FW, Stadhouders NA, Stein VD. Hypercoagulability states in upper extremity deep venous thrombosis. Am J Hematol. 2001;67:15.
Decousus H, Bourmaud A, Fournel P. Cancer-associated thrombosis in patients with implanted ports: a prospective multicenter French cohort study (ONCOCIP). Blood. 2018;132:707.
White P, Sherrill A. Peripheral intravenous therapy-related phlebitis rates in an adult population. J of Intravenous Nurs. 2001;24(1):19-24.
Catney M, Michael R, Hillis N. Relationship between peripheral intravenous catheter dwell time and the development of phlebitis and infiltration. J of Infusion Nurs. 2001:24(5);332-41.
Chang WP, Peng YX. Occurrence of Phlebitis: A Systematic Review and Meta-analysis. Nurs Res. 2018;67(3):252-60.
Ansel M, Brenda J, Boyce D. Extending Short Peripheral Catheter Dwell Time: A Best Practice Discussion. J of Infusion Nurs. 2017;40(3):143-6.
Maki DG, Ringer M. Risk factors for infusion-related phlebitis with small peripheral venous catheters. A randomized controlled trial. Ann Intern Med. 1991;114(10):845-54.
Brien JO, Paquet F, Lindsay R, Valenti D. Insertion of PICCs with minimum number of lumens reduces complications and costs. J Am Coll Radiol. 2013;10:864.
Zavareh NM, Ghorbani R. Peripheral intravenous catheter-related phlebitis and related risk factors. Singapore Med J. 2007;48(8):733-6.
Singh R, Bhandary S, Pun KD. Peripheral intravenous catheter related phlebitis and its contributing factors among adult population at KU Teaching Hospital. Kathmandu Univ Med J (KUMJ). 2008;6(24):443-7.
Tripathi S, Kaushik V, Singh V. Peripheral IVs: factors affecting complications and patency - a randomized controlled trial. J Infus Nurs. 2008;31(3):182-8.
Brook I, Frazier EH. Aerobic and anaerobic microbiology of superficial suppurative thrombophlebitis. Arch Surg. 1996;131:95.
Grady NP, Alexander M, Dellinger EP. Guidelines for the prevention of intravascular catheter-related infections, Centre for Disease Control and Prevention. MMWR Recomm Rep. 2002;51:1.
Skillman JJ. Superficial phlebitis: Inflammatory, infectious associated with deep vein thrombosis. In: Decision Making in Vascular Surgery, Cronenwett JL, Rutherford RB (Eds), WB Saunders, Philadelphia 2001.
Ervin SM. The Association of Potassium Chloride and Paniculate Matter with the Development of Phlebitis NITA. J of the National Intrav Therapy Assoc. 1987;10(2):145-9.
Dragana M, Dragana S, and Davor Z. Risk factor for phlebitis: a questionnaire study of nurses' perception. Rev Lat Am Enfermagem. 2015;23(4):677-84.
Zhang BN, Wan E. Notoginseny Cream in the Treatment of Phlebitis. J Infusion Nurs. 2003;26(1):49-54.
Lu Y, Hao C, He W. Experimental research on preventing mechanical phlebitis arising from indwelling needles in intravenous therapy by external application of mirabilite. Exper and Therap Medi. 2018;15(1):276-82.
Guangzong L, Gerhard L, Pang H. Experimental Study of Phlebitis Ointment Administration in Acute Superficial Thrombophlebitis. Evidence-Based Complem and Alternative Medi. 2018;11:2983195.
