Surgical Management of Peripheral Vein Thrombophlebitis in the Upper Extremity.

Purpose: Peripheral vein thrombophlebitis has a reported overall incidence ranging from 20% to 80%. Thrombophlebitis can progress despite antibiotic therapy to become a challenging clinical problem requiring surgical intervention. There is currently no consensus on its optimal management. We reviewed our experience of surgical intervention with analyses of the indications for intervention, descriptions of the surgical procedures, and outcomes. We aimed to provide guidance on the management of this potentially serious complication. Methods: This is a retrospective review of 51 patients with thrombophlebitis refractory to conservative management between January 2017 and August 2020. Results: Analyses revealed a high prevalence of comorbidities, including diabetes mellitus, malignancy, and chronic kidney disease. A total of 60% of patients had concurrent bacteremia, and the decision to operate had a low threshold in the presence of these factors. On exploration, 80% of patients had intraluminal thrombus, 47% had intraluminal pus, and 29% had pus beyond the veins or extending proximally. The surgical approach employed in 98% of patients involved an extensile incision in those with several morbidity factors (diabetes mellitus, chronic kidney disease, or bacteremia). One patient presented with severe clinical signs of local infection, and on exploration, there was intraluminal pus and thrombus up to 10 cm. A novel technique of a minimally invasive approach of intermittent stab incisions was employed in a young and healthy patient without comorbidities. Conclusions: We developed an algorithm to guide the indications for intervention and surgical approach to thrombophlebitis. The threshold for intervening surgically should be lowered by the presence of comorbidities. The failure of antibiotics to resolve the clinical signs of infection or the suspicion of abscess formation should mandate intervention. Thrombosed sections of the vein should be ligated proximally and distally and excised and surrounding collections of pus drained. Delayed secondary wound closure is usual. Stab incisions may limit surgical dissection and subsequent scarring in less severe cases. Type of study/level of evidence: Prognostic IV.

Peripheral Vein Thrombophlebitis in the Upper Extremity: A Systematic Review of a Frequent and Important Problem.

BACKGROUND: The acceptable incidence of thrombophlebitis following intravenous cannulation is 5%, as recommended by the Intravenous Nurses Society guidelines, but publications have reported startling figures of 20% to 80%. Given the frequency of intravenous lines, this presents a potential clinical problem. We aimed to determine the predisposing patient, catheter, and health care-related factors of peripheral vein thrombophlebitis in the upper extremity. METHODS: In this systematic review, we used a comprehensive search strategy to identify risk factors of thrombophlebitis from inception to May 20, 2019. Studies reporting risk factors of peripheral vein thrombophlebitis of adult patients admitted to the hospital and receiving an intravenous cannulation were included. The Quality of Prognostic Studies tool was used in the assessment for risk of bias to determine the study quality. RESULTS: Of the 6910 studies initially identified, 25 were eligible for inclusion. Qualitative syntheses revealed that patient-related factors that confer a higher risk included intercurrent illness, immunocompromised state, comorbidities such as diabetes mellitus, malignancy, previous thrombophlebitis, burns, and higher hemoglobin levels. Catheter-related risk factors included catheter size, duration, and site of insertion. Intravenous antibiotics and potassium chloride predisposed to thrombophlebitis. Cannulation by an intravenous therapy team and more nursing care were associated with a decreased risk. A P-value < .5 was considered to be statistically significant. CONCLUSION: Recognition of the predisposing factors would allow for targeted strategies to aid in the prevention of this iatrogenic infection, which may include closer monitoring of patients who are identified to be vulnerable. Based on this systematic review, we developed an algorithm to guide clinical management. Further research is warranted to validate this algorithm.

[An investigation of fast thermolysis of GAP/AP system by FTIR spectroscopy].

The rapid pyrolysis of GAP/AP system under simulated combustion conditions was investigated by an on-line analysis, i. e. so called T-Jump/FTIR. The results show that the compositions of the main gaseous products for pyrolysis are changed, in comparison with the pyrolyses of single, which indicates that the interactions occur between the components of GAP/AP system. From an obvious effect of pressure on the main gaseous products for GAP/AP pyrolysis it is shown that the interactions between GAP and AP components arise from the gaseous products of AP and both the reactions in gas phase and in gas/condensed phase occur in the GAP/AP mixed system. The interactions between GAP and AP are not affected by test temperature. It is considered that the real time analysis of gaseous products of energetic material pyrolysis under simulated combustion conditions would be carried out by T-Jump/FTIR on-line analysis technique and from microcosmic reaction a technical approach used to explore the rapid pyrolysis of energetic materials and interactions between their components at high temperature and pressure would be developed by the on-line analysis technique from microcosmic reaction.

[An investigation on fast thermolysis of ammonium perchlorate (AP) by FTIR spectroscopy].

The fast thermolysis processes of ammonium perchlorate (AP) and its chemical reaction mechanism under certain simulated conditions of combustion were systematically studied by means of T-Jump/FTIR technique. AP was flash-pyrolyzed under different pressure nitrogen atmosphere, with the heating rate of 1000 K x s(-1) and the set temperatures of 874 and 1 274 K. Thereafter, the real time species and concentration of its gaseous products were obtained and identified by using rapid scanning Fourier transform infrared (FTIR) in-situ spectroscopy. It was indicated that the main gaseous products of AP thermolysis is composed of NO2, N2O, NO, HCl and NClO. Interestingly, the values of N2O/NO2, NO/NO2 and NO/NClO are increased while the test temperature or pressure is elevated. It is suggested that the transformation of condensed phase and heterogeneous gas/condensed phase was probably arises and the "following reactions" among the main gaseous products may also take place in the fast thermolysis process of AP.