[Incidence of phlebitis due to peripherally inserted venous catheters: impact of a catheter management protocol]

Reducing the Incidence of Amiodarone-related Phlebitis Through Utilization of Evidence-based Practice

BACKGROUND

Intravenous (IV) amiodarone has multiple indications including treatment of hemodynamically unstable patients and the prevention of atrial or ventricular arrhythmias after thoracic surgery. Inflammation of the vein, or phlebitis, is the most common adverse event associated with peripherally administered amiodarone. In 2017, a rise in reported phlebitis incidents was occurring at one large academic medical center.

AIM

This evidence-based quality improvement initiative aimed to decrease and enhance early detection of phlebitis in patients receiving amiodarone.

METHODS

Due to the variation in assessment and management standards, evidence-based practice (EBP) methodology was utilized to establish a process for quality improvement. A thorough literature search was completed, identifying evidence-based interventions to decrease phlebitis and enhance early detection. Thorough critiques of the literature and synthesis of the evidence were completed. Multidisciplinary guidelines based on the literature were created. The guidelines included interventions such as an increase in IV assessment frequency, vein selection criteria, and the utilization of a standardized grading tool for assessment.

RESULTS

Phlebitis was reduced by 30%-88%. In the first 6 months post-intervention, there was a 48% reduction in phlebitis cases. In addition, the severity of phlebitis and the quality of reporting also improved dramatically.

LINKING EVIDENCE TO ACTION

This evidence-based quality improvement process led to identifying relevant knowledge gaps in care that could be streamlined into everyday nursing practice to decrease patient harm. This paper describes an in-depth process of how EBP helped to quickly take a clinical inquiry and adapt change based on findings from the evidence. Other organizations can utilize EBP to solve patient safety concerns using similar processes.

Formación en una estrategia multimodal sobre el cuidado de los catéteres venosos periféricos: impacto en la preservación del árbol vascular de pacientes de una unidad de nefrología

Introducción: Un desarrollo adecuado de las fístulas arteriovenosas está relacionado con el estado del árbol vascular y el uso previo de dispositivos de acceso venoso periférico (CVP). Objetivo: Evaluar el impacto de la formación en una estrategia multimodal para reducir las complicaciones relacionadas con el CVP en una unidad de hospitalización de nefrología. Material y Método: Estudio cuasi-experimental pre-post intervención, en pacientes portadores de CVP en una unidad de hospitalización de nefrología. La intervención consistió en la formación en una estrategia multimodal para el manejo de CVP basada en 5 medidas basadas en evidencia. Para determinar el impacto se analizaron los registros electrónicos de los CVP insertados en los 3 meses previos a la actividad formativa (PRE) vs 3 meses posteriores (POST). Se realizó un análisis descriptivo e inferencial de las variables a estudio. Resultados: CVP estudiados: PRE n=96, POST n=120. Número medio de CVP/paciente: PRE 2,07 vs POST 1,75 (p=0,02). Calibre: PRE 18G 1%, 20G 18%, 22G 80%, 24G 1%; POST 20G 20%, 22G 80% (p=NS). Duración media: PRE 192h, <7 días 26% vs POST 171h, <7 días 30% (p=NS). Causas de retirada: Alta / no precisa PRE 41% vs POST 38% (p=NS), Flebitis PRE 27% vs POST 13% (p=NS). Conclusiones: la formación en una estrategia multimodal ha conseguido reducir: número de CVP por paciente, número de flebitis, uso de CVP de mayor calibre y tiempo que permanecen insertados. Una estrategia multimodal sobre el manejo de los CVP puede ayudar a preservar el árbol vascular en pacientes nefrológicos.

Incidence and risk factors of peripheral venous catheter-related adverse events in cardiology department of a Tunisian university hospital: A prospective observational study

AIM

The purpose of our study was to determine the incidence and risk factors of Peripheral Venous Catheter-Related Adverse Events (PVCAEs) in a cardiology department of a university hospital.

PATIENTS AND METHODS

We carried out a prospective observational study from Mars 2017 to May 2017 in the cardiology department of the University Hospital of Farhat Hached in Sousse, Tunisia. During this period, we actively followed-up all inserted PVCs (every 12hours) from insertion up to 48hours after removal. Regression analyses were applied and significance limits were set at P<0.05.

RESULTS

Data were analysed for 210 PVCs (794 PVC-days) in 148 patients. The incidence of PVCAEs was 33.33% with density of incidence of 8.81/1000 PVC-days. PVCAEs were mainly pain (50%) and mechanical events (31.42%). Infections accounted for 11.42%. The most frequent mechanical PVCAEs, was haematoma (15.71%). Multivariate analysis revealed as independent factors for the occurrence of PVCAEs: the hydro electrolytic nature of the injected product (OR=13.42, P<10-3), the medicinal nature of the injected product (OR=5.08, P=0.003), bad cutaneous state (OR=8.08, P=0.003), admission during nightshift (OR=3.76; P=0.014) and advanced age (OR=1.04, P=0.042).

CONCLUSION

Multicenter studies would be very useful to better analyze risk factors associated with PVCAEs.

Complications related to the insertion and maintenance of peripheral venous access central venous catheter

OBJECTIVE

To evaluate the rates and nature of the complications related to the Central Peripheral Access Catheter (CVCAP or PICC) from its insertion to its withdrawal.

METHODS

Prospective observational study. All patients older than 14 years of age with a PICC inserted in the polyvalent intensive care unit (ICU) during the period between May 1, 2015 and April 30, 2016 were included. Data collected included: demographic data, insertion details, reason for insertion and removal, maintenance unit, total dwell time, incidence of complications and related factors and infection rate.

RESULTS

144 PICCs were inserted, of which 94 corresponded to the ICU group (65.28%) and 50 (34.72%) to the non-ICU group. The most important complication was the suspicion of infection: 17.36% (rate of 15.2 per 1000 days of PICC). The total number of confirmed infections was 6.25% (5.5 per 1000 days of PICC), 1.39% (1.2 per 1000 days) being in the ICU group and 4.86% (4.2 per 1000 days) in the non-ICU group. There were 5 bacteraemias, all in the non-ICU group (3 per 1000 days). The most frequent germ was Staphylococcus epidermidis (6 cases). Phlebitis had an incidence of 9.03% (7.9 per 1000 days of PICC).

CONCLUSIONS

PICC, effective device for central venous access due to the minimal incidence of risks in implantation and to its advantages with regard to the classic central venous catheters, is a further nursing technique.

Incidence of phlebitis associated with the use of peripheral IV catheter and following catheter removal

Objective:

to investigate the incidence of phlebitis and its association with risk factors when using peripheral IV catheters (PIC) and following their removal - (post-infusion phlebitis) in hospitalized adults.

Method:

a cohort study of 171 patients using PIC, totaling 361 punctures. Sociodemographic variables and variables associated with the catheter were collected. Descriptive and analytical statistical analyses were performed.

Results:

average patient age was 56.96 and 51.5% of the sample population was male. The incidence of phlebitis was 1.25% while using PIC, and 1.38% post-infusion. The incidence of phlebitis while using PIC was associated with the length of time the catheter remained in place, whereas post-infusion phlebitis was associated with puncture in the forearm. Ceftriaxone, Clarithromycin and Oxacillin are associated with post-infusion phlebitis.

Conclusions:

this study made it possible to investigate the association between risk factors and phlebitis during catheter use and following its removal. The frequency of post-infusion phlebitis was larger than the incidence of phlebitis with the catheter in place, with Phlebitis Grade III and II being the most frequently found in each of these situations, respectively. Aspects related to post-infusion phlebitis can be explained, given the limited number of studies addressing this theme from this perspective.

The incidence of phlebitis in a Medical Clinical Unit

The objective of this study was to verify the incidence of phlebitis in a clinical medical unit. A prospective cohort study was conducted using nonparticipatory observations guided by a structured questionnaire, with 100 patients admitted to the clinical medical unit, in whom 234 peripheral venous accesses were used. Phlebitis was identified in 60% of patients and in 55.6% of the peripheral venous accesses, and most of them remained intact for more than 72 hours (53%). The presence of phlebitis per patient was associated with longer hospitalization on the clinical unit (p=0.002) and a greater number of accesses per patient (p<0.001). Length of retention of venous access for more than 72 hours was also associated with the presence of phlebitis (p<0.001). Phlebitis occurred in the majority of the patients and peripheral venous accesses analyzed. Therefore, it is necessary to intensify the training protocols for nursing staff in order to reduce the rates of phlebitis.

[Complications of peripheral parenteral nutrition. Clinical observations of 2 cases]

INTRODUCTION

Peripheral parenteral nutrition (PPN) is artificial nutrition used when digestive absorption is insufficient. It supplies the nutritional needs of the patient and permits administration through a peripheral catheter. WE PRESENT 2 CLINICAL CASES: The first one entails an epidermolisis through extravasation masked by temporo-spatial disorientation of the patient with appearance of flictenes (blisters). Prolonged treatment and consultation with plastic surgery were required. The second case entails a chemical phlebitis with early detection by nursing professionals. It was resolved with short term treatment and did not require consultation with the plastic surgeon.

PLANNING CARE

We elaborated a care plan aimed at identifying real or potential problems related with possible complications of intravenous PPN administration, such as phlebitis and extravasation. The aim of this research was prevention, early detection and treatment.

DISCUSSION

Phlebitis is related with catheter characteristics, in-dwelling time and high osmolarity of PPN. Early action decreases injury of the affected tissue. In case 1, the patient requires 19 days of curing. This was only 72 h in case 2.

CONCLUSION

The nursing staff plays an essential role in catheter election, localization, administration and preventing complications. Staff training and a procedure protocol greatly reduce the incidence of phlebitis, avoid discomfort for the patient and reduce health care cost.

Associação entre flebite e retirada de cateteres intravenosos periféricos

Estudo de coorte prospectivo, com objetivo de verificar a incidência de flebite em pacientes com cateter intravenoso periférico e identificar possíveis associações dessa complicação com variáveis relativas a estes cateteres. Foram avaliados 76 pacientes adultos internados em enfermaria de um hospital universitário, utilizando-se de uma ficha contendo variáveis relativas aos pacientes, ao cateter intravenoso periférico e à terapia farmacológica. A flebite foi avaliada segundo classificação proposta pela Infusion Nurses Society. Utilizou-se estatística descritiva e inferencial. Observou-se incidência de 25,8% de flebite, das quais 40% apresentaram manifestações clínicas de dor, com eritema e ou edema. Dentre os pacientes com flebite, 60% desenvolveram um episódio da complicação, e o tempo de permanência médio dos cateteres intravenosos periféricos com flebite foi de 3,10 dias. Constatou-se associação da flebite à retirada do cateter intravenoso periférico por ocorrência adversa (p<0,001). São necessárias ações educativas e capacitação da equipe de enfermagem para o manejo da terapia intravenosa, principalmente no que tange à detecção precoce da flebite.