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Antequera IG, Saba A, Furlan MDS. Phlebitis in Medical-Surgical Units: A Case-Control Study in a Brazilian Hospital. JOURNAL OF INFUSION NURSING 2024; 47:132-141. [PMID: 38422406 DOI: 10.1097/nan.0000000000000541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The most commonly used vascular access is the peripheral intravenous catheter (PIVC). However, it can trigger complications and the occurrence of adverse events, such as phlebitis. This study evaluated the variables that are associated with the occurrence of phlebitis in medical and surgical inpatient units. This is an observational, retrospective, case-control study in medical and surgical hospitalization units of a private general hospital in the city of São Paulo. Participants were an average age of 66.3 years, and 71% were hospitalized in medical units. The risk variables associated with phlebitis were medical hospitalization (odds ratio [OR] = 4.36; P = .002), presence of comorbidity (OR = 10.73; P < .001), and having 5 or more PIVCs (OR = 53.79; P = .001). Regarding intravenous therapy, the use of contrast was a risk variable (OR = 2.23; P = .072). On the other hand, patient education regarding PIVCs was a protective measure against the development of phlebitis. The nursing team plays an essential role in the care of patients with PIVCs, inpatient guidance, planning, and device choice, taking into account the risk factors for phlebitis to maintain the preservation of vascular health and reduce adverse events.
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Affiliation(s)
- Isabela Granado Antequera
- Hospital Sírio Libanês, São Paulo, Brazil (Granado Antequera); Graduate Program in Nursing Management, School of Nursing (da Silva Furlan), University of São Paulo (Saba), São Paulo, Brazil
- Isabela Granado Antequera, RN, is an RN at Hospital Sírio Libanês, São Paulo. She graduated in Nursing from Federal University of São Paulo, and she is a specialist in intensive care unit and medical-surgical nursing with experience in this area
- Amanda Saba, MMS, CRNI®, RN, is a researcher at University of São Paulo. She graduated in nursing from the University Center São Camilo, and she is also a specialist in cardiology and master in medical sciences. She has 8 years of experience in vascular access in the field of infusion therapy. She also worked as a professor in the critical care discipline and as residency tutor in the medical-surgical nursing program
- Maryana da Silva Furlan, MS, RN, is a doctoral student at the Graduate Program in Nursing Management at the School of Nursing of the University of São Paulo. She graduated in nursing from the State University of Maringá. She is a specialist in medical-surgical nursing and in care for patients with pain and has 9 years of experience, 5 in medical-surgical units and 4 in pain care/management. She worked as a residency tutor/preceptor in a medical-surgical nursing program
| | - Amanda Saba
- Hospital Sírio Libanês, São Paulo, Brazil (Granado Antequera); Graduate Program in Nursing Management, School of Nursing (da Silva Furlan), University of São Paulo (Saba), São Paulo, Brazil
- Isabela Granado Antequera, RN, is an RN at Hospital Sírio Libanês, São Paulo. She graduated in Nursing from Federal University of São Paulo, and she is a specialist in intensive care unit and medical-surgical nursing with experience in this area
- Amanda Saba, MMS, CRNI®, RN, is a researcher at University of São Paulo. She graduated in nursing from the University Center São Camilo, and she is also a specialist in cardiology and master in medical sciences. She has 8 years of experience in vascular access in the field of infusion therapy. She also worked as a professor in the critical care discipline and as residency tutor in the medical-surgical nursing program
- Maryana da Silva Furlan, MS, RN, is a doctoral student at the Graduate Program in Nursing Management at the School of Nursing of the University of São Paulo. She graduated in nursing from the State University of Maringá. She is a specialist in medical-surgical nursing and in care for patients with pain and has 9 years of experience, 5 in medical-surgical units and 4 in pain care/management. She worked as a residency tutor/preceptor in a medical-surgical nursing program
| | - Maryana da Silva Furlan
- Hospital Sírio Libanês, São Paulo, Brazil (Granado Antequera); Graduate Program in Nursing Management, School of Nursing (da Silva Furlan), University of São Paulo (Saba), São Paulo, Brazil
- Isabela Granado Antequera, RN, is an RN at Hospital Sírio Libanês, São Paulo. She graduated in Nursing from Federal University of São Paulo, and she is a specialist in intensive care unit and medical-surgical nursing with experience in this area
- Amanda Saba, MMS, CRNI®, RN, is a researcher at University of São Paulo. She graduated in nursing from the University Center São Camilo, and she is also a specialist in cardiology and master in medical sciences. She has 8 years of experience in vascular access in the field of infusion therapy. She also worked as a professor in the critical care discipline and as residency tutor in the medical-surgical nursing program
- Maryana da Silva Furlan, MS, RN, is a doctoral student at the Graduate Program in Nursing Management at the School of Nursing of the University of São Paulo. She graduated in nursing from the State University of Maringá. She is a specialist in medical-surgical nursing and in care for patients with pain and has 9 years of experience, 5 in medical-surgical units and 4 in pain care/management. She worked as a residency tutor/preceptor in a medical-surgical nursing program
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Jian W, Zhou W, Zhang L. The impact of centralized coronary stent procurement program on acute myocardial infarction treatments: evidence from China. Front Public Health 2023; 11:1285558. [PMID: 38098831 PMCID: PMC10720903 DOI: 10.3389/fpubh.2023.1285558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
Background The advent of coronary stents has resulted in many more many lives being saved from acute myocardial infarction (AMI). However, the high price associated with this method of treatment also imposes a heavy economic burden on healthcare systems. As a country making significant use of coronary stents, in 2021, China introduced a program around this method of treatment grounded in centralized procurement and it is the focus of this paper to assess the impact of this policy on AMI treatments. Methods The patients with AMI are selected as the study group, and the patients with pre-cerebral vascular stenosis are selected as the control group, and individual-level medical insurance settlement data are collected from the years 2018, 2019, and 2021. Differences-in-differences methodology is used to analyze the impacts of this program on the probability changes in respect of AMI patients receiving stent therapy, as well as changes relating to cost, length of stay and 30-day readmission. Results The results show that the reform has led to a reduction in the probability of AMI patients using stents to 51% of the original rate. Additionally, the average cost is shown to have decreased by 41%, and no significant changes can be found in respect of the length of stay and 30-day readmission. Conclusion In sum, the centralized procurement program is shown to reduce not only the medical expenses incurred by treating patients with AMI, but also the use of coronary stents, resulting in changes to the treatment patterns of patients with AMI.
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Affiliation(s)
- Weiyan Jian
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
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Kao CL, Chuang CC, Hwang CY, Lee CH, Huang PC, Hong MY, Chi CH. The risk factors of the 72-h unscheduled return visit admission to emergency department in adults below 50 years old. Eur J Med Res 2023; 28:379. [PMID: 37759319 PMCID: PMC10523721 DOI: 10.1186/s40001-023-01317-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/26/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND An unscheduled return visit (URV) to the emergency department (ED) within 72-h is an indicator of ED performance. An unscheduled return revisit (URV) within 72-h was used to monitor adverse events and medical errors in a hospital quality improvement program. The study explores the potential factors that contribute to URV to the ED within 72-h and the unscheduled return revisit admission (URVA) in adults below 50 years old. METHODS The case-control study enrolled 9483 URV patients during 2015-2020 in National Cheng-Kung University Hospital. URVA and URV non-admission (URVNA) patients were analyzed. The Gini impurity index was calculated by decision tree (DT) to split the variables capable of partitioning the groups into URVA and URVNA. Logistic regression is applied to calculate the odds ratio (OR) of candidate variables. The α level was set at 0.05. RESULTS Among patients under the age of 50, the percentage of females in URVNA was 55.05%, while in URVA it was 53.25%. Furthermore, the average age of URVA patients was 38.20 ± 8.10, which is higher than the average age of 35.19 ± 8.65 observed in URVNA. The Charlson Comorbidity Index (CCI) of the URVA patients (1.59 ± 1.00) was significantly higher than that of the URVNA patients (1.22 ± 0.64). The diastolic blood pressure (DBP) of the URVA patients was 85.29 ± 16.22, which was lower than that of the URVNA (82.89 ± 17.29). Severe triage of URVA patients is 21.1%, which is higher than the 9.7% of URVNA patients. The decision tree suggests that the factors associated with URVA are "severe triage," "CCI higher than 2," "DBP less than 86.5 mmHg," and "age older than 34 years". These risk factors were verified by logistic regression and the OR of CCI was 2.42 (1.50-3.90), the OR of age was 1.84 (1.50-2.27), the OR of DBP less than 86.5 was 0.71 (0.58-0.86), and the OR of severe triage was 2.35 (1.83-3.03). CONCLUSIONS The results provide physicians with a reference for discharging patients and could help ED physicians reduce the cognitive burden associated with the diagnostic errors and stress.
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Affiliation(s)
- Chia-Lung Kao
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 704, Taiwan
| | - Chia-Chang Chuang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 704, Taiwan
| | - Chi-Yuan Hwang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 704, Taiwan
| | - Chung-Hsun Lee
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 704, Taiwan
| | - Po-Chang Huang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 704, Taiwan
| | - Ming-Yuan Hong
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 704, Taiwan.
| | - Chih-Hsien Chi
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 704, Taiwan
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