Impact of an interventional bundle on complications associated with peripheral venous catheters in elderly patients.

PURPOSE: Elderly patients admitted to geriatrics departments often require peripheral venous catheters (PVC), which should be inserted and maintained following a series of preventive recommendations. Our objective was to evaluate the impact of a training bundle comprising measures aimed at reducing complications associated with the use of PVC in elderly patients admitted to a tertiary teaching hospital. METHODS: We performed a prospective study of patients who received a PVC within 24 h of admission to a geriatrics department. After a 10-month pre-interventional period, we implemented an educational and interventional bundle over a 9-month period. Follow-up was until catheter withdrawal. We analyzed and compared clinical and microbiological data between both study periods. RESULTS: A total of 344 patients (475 PVC) were included (pre-intervention period, 204 patients (285 PVC); post-intervention period, 140 patients (190 PVC)). No statistically significant differences in demographic characteristics were observed between the study periods. The colonization and phlebitis rates per 1000 admissions in both periods were, respectively, 36.7 vs. 24.3 (p = 0.198) and 81.5 vs. 65.1 (p = 0.457). The main reason for catheter withdrawal was obstruction/malfunctioning (33.3%). Obstruction rate was higher for those inserted in the hand than for those inserted at other sites (55.7% vs. 44.3%, p = 0.045). CONCLUSIONS: We found no statistically significant differences regarding phlebitis and catheter tip colonization rates. It is necessary to carry out randomized studies assessing the most cost-effective measure to reduce complications associated with PVC.

Comparison of the physicochemical properties of branded and generic glucose-added maintenance hypotonic infusion fluids to assess the potential for phlebitis and incompatibility with other drugs.

In Japan, the switch from branded to generic infusion fluids has been promoted as a national policy. Recently, as generic products have been in short supply, the switch from generic to branded infusion fluids has increased. However, certain additives for injectable infusion fluids, such as nonvolatile acids like acetic acid and hydrochloric acid, are not required to be listed in the package insert. We hypothesized that the addition of nonvolatile acids may be one of the reasons for the differences in physicochemical properties between the branded and generic infusion fluids. We have previously reported that in other types of electrolyte infusion fluids, a variation in pH can cause incompatibility with other drugs, and variation in titratable acidity and osmolality can lead to phlebitis. Glucose-added maintenance hypotonic infusion fluid (listed as type-3G) is commonly used as a maintenance solution when energy support is needed. However, nonvolatile acid is added to prevent the caramelization of glucose, resulting in higher osmolality and titratable acidity and lower pH. Therefore, we hypothesized that both phlebitis and incompatibility with other drugs are likely to occur; hence, we measured and evaluated the physicochemical properties of branded and generic type-3G infusion fluids. We show that the osmolality, pH, and titratable acidity of all evaluated branded and generic products differed significantly and that these properties should be evaluated together to avoid phlebitis and incompatibility with other drugs when switching between branded and generic type-3G infusion fluids.

The effect of warm moist compresses in peripheral intravenous catheter-related phlebitis.

PURPOSE: Phlebitis is a common complication in palliative patients. There are limited nursing practices in phlebitis care. The study was conducted to determine the effect of warm moist compresses in patients with peripheral intravenous catheter-related phlebitis. METHODS: 70 patients (35 control and 35 experimental) with phlebitis symptoms who were hospitalized in the palliative clinic of a training and research hospital were recruited for the study. The phlebitis site of the patients in the control and experimental groups were followed for three days. While the control group received routine nursing care, the experimental group received a warm moist compresses at 28 °C for 15 min three times a day for three days in addition to routine nursing care. RESULTS: According to the results, there was a decrease in the initial and final phlebitis grades between the control and experimental groups, but the difference was not statistically significant (p = 0.957, p = 0.078). In the final evaluation of the phlebitis site, a statistically significant difference was observed in redness, edema width, and pain intensity between the control and experimental groups in favor of the experimental group (p˂0.001, p = 0.006, p˂0.001, respectively). CONCLUSIONS: It was determined that applying warm water compresses three times a day in phlebitis care had a positive effect on healing.

The pharmacist's role in reducing infusion-related phlebitis.

PURPOSE: Pharmacists oversee parenteral drug preparation and administration in hospitals, clinics, infusion centers, and home infusion settings. Infusion-related phlebitis (IRP), the most common complication of intravenous infusion therapy, significantly impacts therapeutic outcomes, patient satisfaction, cost of care, and provider workload. Here we review the major etiologies of IRP and describe potential pharmacological and nonpharmacological interventions for preventing and managing the condition as well as for improving vascular access health in multiple-drug administration settings. SUMMARY: Many parenterally administered drugs cause phlebitis due to mechanical, chemical, or infectious etiologies. Pharmacists can recommend nonpharmacological strategies to mitigate phlebitis, including -judicious device selection and placement; adjustment of the drug concentration, flow rate, or formulation; infusion site rotation; and use of inline filters to minimize contaminant particulates. Pharmacological treatments for phlebitis include topical, local, and systemic anti-inflammatory and analgesic agents that can reduce symptom severity and prevent further treatment complications or delays. CONCLUSION: Pharmacists can contribute a unique perspective to interprofessional teams tasked with making policy and formulary decisions that minimize the negative impacts of IRP on drug delivery and patient outcomes.

Implementation of a midline catheter service in a regional setting.

Introduction: Midline catheters have been reported to be an effective and safe means of providing patients with intravenous access within the hospital and community setting. With minimal experience in the introduction of a midline service across the local health network, a regional hospital pursued this task. This observational study assesses the provision of a safe clinical framework for midline insertion, and the improvement of patient care and experiences by avoiding treatment interruptions and unnecessary cannulation attempts from failed traditional peripheral vascular access devices. Methods: From the introduction of the midline service in June 2018, outcome measures of all patients who received a midline over the following two-year period were documented including rate of line success, complication rates, dwell time, and the number of insertion attempts. Results: The midline service provided 207 lines over a two-year period with a total dwell time of 1,585 days. Project goals were achieved with 85% (Aim > 85%) of all lines completing treatment prior to removal. First attempt insertion was 86% (Aim > 80%) with a maximum insertion attempt of two. Rates of line-related complications were less than 8%, with five documented cases of phlebitis (2.5%) and one deep vein thrombosis with no infections documented. Conclusion: Despite limited resources, a successful midline service was introduced. Future expansion will see an increase in insertor numbers providing improved access to the service.

Care bundle for the prevention of peripheral venous catheter blood stream infections at a secondary care university hospital: Implementation and results.

BACKGROUND: Venous catheterization for diagnostic and therapeutic purposes is part of routine hospital practice, as approximately 70% of hospitalized patients have a peripheral venous catheter (PVC). This practice, however, can lead to both local complications, (e.g., chemical, mechanical and infectious phlebitis) and systemic complications (e.g., PVC-related bloodstream infections [PVC-BSIs]). Surveillance data and activities are central to preventing nosocomial infections, phlebitis and improving patient care and safety. The aim of this study was to evaluate the impact of a care bundle on reducing PVC-BSI rates and phlebitis at a secondary care hospital in Mallorca, Spain. METHODS: Three-phase intervention study targeting hospitalized patients with a PVC. The VINCat criteria were used to define PVC-BSIs and calculate incidence. In phase I (August-December 2015), we retrospectively analyzed baseline PVC-BSI rates at our hospital. In phase II (2016-2017), we conducted safety rounds and developed a care bundle with the goal of reducing PVC-BSI rates. In phase III (2018), we expanded the PVC-BSI bundle to prevent phlebitis and analyzed its impact. RESULTS: The incidence of PVC-BSIs decreased from 0.48 episodes per 1000 patient-days in 2015 to 0.17 episodes per 1000 patient-days in 2018. The 2017 safety rounds also detected a reduction in phlebitis (from 4.6% of 2.6%). Overall, 680 healthcare professionals were trained in catheter care and five safety rounds were conducted to assess bedside care. CONCLUSION: Implementation of a care bundle significantly reduced PVC-BSI rates and phlebitis at our hospital. Continuous surveillance programs are needed to adapt measures to improve patient care and guarantee safety.

Peripheral venous catheter-related phlebitis: A meta-analysis of topical treatment.

AIM: To systematically evaluate the efficacy of different topical treatments for PVC-related phlebitis in hospital in-patients. DESIGN: A systematic review and meta-analysis. METHODS: A selection was made of experimental and quasi-experimental studies published in English or Spanish. These should provide data on the degree of phlebitis, pain and infiltration (means and standard deviations, mainly) of hospitalized patients with phlebitis secondary to peripheral venous catheter. All those studies that reflected systemic or exclusive prevention treatments were excluded. Searches were from inception to April 2020. The date of data collection was from December 2020 to May 2021. The selection criteria were based on the PICOS model. Risk of bias was assessed using the Cochrane Collaboration tool. RESULTS: Twelve studies (726 patients) met the inclusion criteria. With respect to the decrease in the degree of phlebitis, was found ichthammol glycerine, followed by heparinoids. As for degree of pain, sesame oil obtained the most marked reduction. In terms of degree of infiltration, heparinoids and ichthammol glycerine were the only products to achieve a statistically significant reduction. The most important limitations are the low quantity and quality of the trials included. Insufficient data are available to draw valid conclusions about the efficacy of any treatment.

Escala Portuguesa de Flebite: adaptação transcultural, validade e confiabilidade para uso no Brasil / Portuguese Phlebitis Scale: cross-cultural adaptation, validity and reliability for use in Brazil / Escala Portuguesa de Flebitis: adaptación transcultural, validez y confiabilidad para uso en Brasil

Objetivos: Adaptar a Escala Portuguesa de Flebite para a cultura brasileira e verificar as propriedades psicométricas da versão adaptada. Métodos: Estudo metodológico envolvendo análise da equivalência semântica, cultural e idiomática para adaptação transcultural, cognitive debriefing, verificação da consistência interna e validade de construto. Equivalência foi analisada utilizando percentual de acordos. Validade de construto foi testada utilizando análise fatorial exploratória.A confiabilidade foi avaliada pela consistência interna (α de Cronbach e Ω de McDonald). Resultados: No processo de adaptação transcultural, envolvendo dez especialistas, dois itens não alcançaram concordância ≥ 80% e sofreram ajustes conforme as sugestões recebidas. Doze participantes do cognitive debriefing aprovaram a versão adaptada. Participaram da análise de confiabilidade e de validação do construto 244 adultos em uso de cateter venoso periférico. Análise fatorial exploratória identificou um único fator incluindo todos os itens testados (dor, eritema, edema, rubor no trajeto da veia e cordão venoso palpável) e carga fatorial > 0,743. Consistência interna do conjunto de itens foi alta (α de Cronbach = 0,771 e Ω de McDonald = 0,853). Conclusão: A Escala Portuguesa de Flebite ­ Versão adaptada para o Brasil mostrou-se válida e confiável. Alcançou propriedades que permitem sua utilização na prática clínica, no ensino e pesquisas no país.

Objectives: To adapt the Portuguese Phlebitis Scale to the Brazilian culture and verify the adapted version's psychometric properties. Methods: Methodological study involving analysis of semantic, cultural, and idiomatic equivalence for cross-cultural adaptation, cognitive debriefing, verification of internal consistency, and construct validity. The equivalence was analyzed considering the percentage of agreement among experts. Exploratory factor analysis was used to test construct validity. Reliability was assessed by internal consistency (Cronbach's α and McDonald's Ω). Results: In the cross-cultural adaptation process involving ten experts, two items did not reach an agreement ≥ 80% and underwent adjustments according to the suggestions received. Twelve cognitive debriefing participants approved the adapted version. Adults (n = 244) using a peripheral venous catheter participated in the reliability and construct validation analysis. Exploratory factor analysis identified a single factor, including all tested items (pain, erythema, edema, streak formation along the course of the vein, and palpable venous cord) and factor loading > 0.743. Internal consistency of the set of items was high (Cronbach's α = 0.771 and McDonald's Ω = 0.853). Conclusion: The Portuguese Scale of Phlebitis - Version adapted for Brazil proved valid and reliable. It achieved properties that allow use in Brazil's clinical practice, teaching, and research.

Objetivos: Adaptar la Escala de Flebitis Portuguesa a la cultura brasileña y verificar las propiedades psicométricas de la versión adaptada. Métodos: Estudio metodológico que involucró análisis de equivalencia semántica, cultural e idiomática para adaptación transcultural, debriefing cognitivo, verificación de consistencia interna y validez de constructo. Para el análisis de la concordancia de la equivalencia se utilizó el porcentaje de concordancias. Para probar la validez de constructo, se utilizó el análisis factorial exploratorio. La fiabilidad se evaluó mediante la consistencia interna (α de Cronbach e Ω de McDonald). Resultados: En el proceso de adaptación transcultural, en el que participaron diez expertos, dos ítems no alcanzaron un acuerdo ≥ 80% y se ajustaron de acuerdo con las sugerencias recibidas. Doce participantes en el debriefing cognitivo aprobaron la versión adaptada. Usuarios de catéter venoso periférico (n = 244) participaron en el análisis de confiabilidad y la validación de constructo. El análisis factorial exploratorio identificó un solo factor que incluía todos los ítems probados (dolor, eritema, edema, enrojecimiento en la vena y el cordón venoso palpable) y una carga factorial > 0,743. La consistencia interna de los ítems fue alta (αde Cronbach = 0,771 y Ω de McDonald = 0,853). Conclusión: La Escala Portuguesa de Flebitis ­ Versión adaptada para Brasil demostró ser válida y confiable. Alcanzó propiedades que permiten su uso en la práctica clínica, la docencia e la investigación en Brasil.

Effect of the Kanghuier Transparent Hydrocolloid Dressing in Preventing Central Venous Catheter Infection and Phlebitis after Cardiac Surgery.

Background: As cardiac surgery is complicated, time-consuming, and traumatic, it may cause great damage to the patient's body. Therefore, postoperative indwelling venous catheters are required for hemodynamic monitoring and rapid fluid replenishment. Intravenous catheterization infection can easily lead to phlebitis, which not only affects the success of the operation and patient recovery but may also lead to death in severe cases. Good perioperative care is key to reducing postoperative infection in patients, and the choice of dressings for patients with catheterization plays an important role in reducing catheter infection. Objective: The Kanghuier transparent hydrocolloid dressing is known to effectively prevent and treat wound infections. This study is aimed at exploring whether it can reduce the incidence of postoperative catheter infection and phlebitis in patients undergoing cardiac surgery. Methods: A total of 196 patients undergoing cardiac surgery in the Department of Cardiothoracic Surgery of Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University) from January 2020 to June 2020 were selected. Among them, 98 patients receiving Kanghuier transparent dressing intervention were selected as group A, and the remaining 98 patients receiving traditional sterile gauze intervention were selected as group B. The incidence of infection and related complications, phlebitis, inflammatory factors, pain at the infusion site, nursing comfort and satisfaction, and quality of life were analyzed and compared between the two groups. Results: It was found that compared with group B, the postoperative central venous catheter infection rate and the incidence of phlebitis were significantly lower in group A. In addition, the inflammatory response of patients in group A was better relieved. Moreover, the nursing comfort and satisfaction and the quality of life of patients in group A were significantly improved. Conclusion: This study suggests that the Kanghuier transparent hydrocolloid dressing is effective in the prevention and treatment of central venous catheter infection and phlebitis in patients after heart surgery.

The effect of a low-color-temperature-based yellow light source on the prevention of phlebitis induced by chemotherapy.

In recent years, light therapy has been gradually applied to the treatment of inflammation. Different from conventional high-color-temperature light sources, low-color-temperature yellow light (1900 K) without a blue light spectrum was selected as the light source to research its preventive effects on chemotherapy-induced phlebitis in this study. Based on a series of inflammatory characterization experiments, the results manifested that the reasonable utilization of 1900 K yellow light had a good effect on the prevention of phlebitis. This study shows that this is a feasible and promising method for preventing phlebitis and relieving pain, while providing a theoretical basis for the further investigation of the anti-inflammatory effects on phlebitis.

Improved Patient Safety and Quality Outcomes With Amiodarone Infusions.

BACKGROUND: Amiodarone is a common intravenous medication and a known irritant to the vessel wall when administered peripherally. LOCAL PROBLEM: Nurses identified an increase in phlebitis associated with peripheral amiodarone leading to multiple catheter replacements and interruptions in drug therapy. Central venous access is recommended by the manufacturer but not practical for a short-term infusion based on the risk to the patient, time, and cost. METHODS: A 4-phased approach was used to identify a more suitable peripheral intravenous catheter. INTERVENTIONS: A collaborative effort between bedside nurses and the vascular access team evolved to look at alternative products for peripheral intravenous catheters. RESULTS: The extended dwell peripheral catheter decreased phlebitis from 54% to 5%. It also decreased interruptions in drug therapy and improved patient comfort and satisfaction. CONCLUSIONS: A practice change was implemented utilizing extended dwell peripheral catheters for intravenous amiodarone and disseminated to other units.

[Randomized experimental study to evaluate the effectiveness of the Flebitis Zero project in Navarre].

BACKGROUND: Phlebitis is one of the most frequent complications in peripheral venous catheters. The aim was to compare the frequency of phlebitis before and after the implementation of the Flebitis Zero project, in order to ascertain its effectiveness and what factors were associated with this complication. METHODS: Randomized pre-post intervention (Flebitis Zero project) study performed in the Hospital Universitario de Navarra (Pamplona, Spain) between 2015 and 2019. The intervention consisted of training of professionals along with the implementation of measures in order to lower the incidence of complications associated with the peripheral venous catheters. The control group (CG) was selected prior the intervention and the Intervention Group (IG) in the subsequent five years. RESULTS: The study included 656 patients, 96 (14.6%) in the CG and 569 in the IG. Lower frequency of complications (49.0 vs 37.1%; p<0.001), especially accidental PVC exit (18.8 vs 8.1%), and of phlebitis (13.5 vs 11.8%). The intervention and the use of fully reinforced dressings were associated to happening of phlebitis. The implantation of the Flebitis Zero project prevented the occurrence of phlebitis (OR = 0.78; IC95%: 0.42-0.86; p = 0.042). CONCLUSION: The implementation of the measures used in the Phlebitis Zero project was associated with a significant reduction of the complications linked to the use of the peripheral venous catheters; the frequency of phlebitis dropped, although nowhere near the recommended level.

Study on Protection of Human Umbilical Vein Endothelial Cells from Amiodarone-Induced Damage by Intermedin through Activation of Wnt/ß-Catenin Signaling Pathway.

Amiodarone (AM) is one of the most effective antiarrhythmic drugs and normally administrated by intravenous infusion which is liable to cause serious phlebitis. The therapeutic drugs for preventing this complication are limited. Intermedin (IMD), a member of calcitonin family, has a broad spectrum of biological effects including anti-inflammatory effects, antioxidant activities, and antiapoptosis. But now, the protective effects of IMD against amiodarone-induced phlebitis and the underlying molecular mechanism are not well understood. In this study, the aim was to investigate the protective efficiency and potential mechanisms of IMD in amiodarone-induced phlebitis. The results of this study revealed that treatment with IMD obviously attenuated apoptosis and exfoliation of vascular endothelial cells and infiltration of inflammatory cells in the rabbit model of phlebitis induced by intravenous infusion of amiodarone compared with control. Further tests in vitro demonstrated that IMD lessened amiodarone-induced endothelial cell apoptosis, improved amiodarone-induced oxidative stress injury, reduced inflammatory reaction, and activated the Wnt/ß-catenin signal pathway which was inhibited by amiodarone. And these effects could be reversed by Wnt/ß-catenin inhibitor IWR-1-endo, and si-RNA knocked down the gene of Wnt pathway. These results suggested that IMD exerted the protective effects against amiodarone-induced endothelial injury via activating the Wnt/ß-catenin pathway. Thus, IMD could be used as a potential agent for the treatment of phlebitis.

Effect of Chahuang ointment on prevention of phlebitis from peripherally inserted central catheter: randomized clinical trial.

OBJECTIVE: To assess the effect of Chahuang ointment, a Chinese herbal ointment, on the prevention of phlebitis in patients with peripherally inserted central catheters. METHOD: This was a multicenter randomized controlled trial, with 171 eligible patients randomly assigned into one of three groups: the Chahuang ointment group, the Mucopolysaccharide Polysulfate cream group, and the control group. The degrees of vein injuries at 72 hours after peripherally inserted central catheter insertion were the primary outcome. Secondary outcomes were the vascular wall thickness, tissue edema and microthrombus evaluated by Color Doppler Flow Imaging, the vascular endothelial growth factor, and endothelin-1 (ET-1) expression in vivo. RESULTS: Compared with the control group, the Chahuang ointment group showed significantly lower incidence of postoperative phlebitis, tissue edema, and microthrombus at 72 hours after peripherally inserted central catheter insertion (all P<0.01). The VEGF and ET-1 expression were significantly inhibited in the Chahuang ointment group after 3 days of treatment (both P<0.01). There were no statistical differences in the degree of vein injuries, microthrombus, or tissue edema between the Chahuang ointment and mucopolysaccharide polysulfate groups (all P>0.05). CONCLUSION: Chahuang ointment was shown to provide effective prevention and protection against phlebitis after peripherally inserted central catheter insertion.

Reducing the incidence of phlebitis in medical adult inpatients with peripheral venous catheter care bundle: a best practice implementation project.

BACKGROUND: One major complication of the insertion of a peripheral venous catheter (PVC) is phlebitis, often resulting in delay of treatment, increased healthcare costs and prolonged hospitalization. AIMS: The current study sought to evaluate the effectiveness of a standardized PVC care bundle in increasing the compliance of PVC care and assessment and reduce the occurrences of phlebitis rates. METHODS: A pre and postimplementation audit approach was used in this study and adopted the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice program. This study was carried out in three phases over a 10-month period, from March 2017 to December 2017 across three medical wards in a hospital in Singapore with a sample size of 90 patients. The study involved educating nurses on phlebitis assessment, implementing a PVC care bundle and monitoring compliance. An audit tool comprising four criteria from the Joanna Briggs Institute Practical Application of Clinical Evidence System was developed. RESULTS: One-month and 3-month postimplementation findings revealed significant improvement in Criteria 1, 3 and 4 (P < 0.001) but no significant improvement in Criterion 2 (P > 0.05). Six-month postimplementation findings showed significant improvement in all four criteria (P < 0.05). An interesting finding was that the number of reported occurrences of phlebitis increased after implementing the PVC care bundle. DISCUSSION: The increase in phlebitis rates could be attributed to the care bundle facilitating prompt and early identification of phlebitis. Despite the initial increase in occurrences 1 month post implementation, the general effectiveness of the care bundle in reducing occurrences of phlebitis was seen 6 months post implementation. The effectiveness of the care bundle to reduce phlebitis rates may be even more evident across a longer implementation period. CONCLUSION: The current study showed that the implementation of a standardized PVC care bundle can significantly enhance the assessment and identification process of phlebitis and can aid in reducing the incidence of phlebitis. The nurses' compliance in practicing the PVC care bundle was determined by the post and preimplementation audits, thus, the audit approach was beneficial in translating evidence into practice.

Effectiveness of topical interventions to prevent or treat intravenous therapy-related phlebitis: A systematic review.

AIMS AND OBJECTIVES: To evaluate the effectiveness of topical interventions in the prevention or treatment of intravenous therapy-related phlebitis. BACKGROUND: Phlebitis is a severe inflammatory reaction that can be caused by intravenous therapy with hyperosmolar drugs. Although a variety of interventions are performed in several different countries, the most efficient method is yet to be established. DESIGN: A systematic review of randomised controlled trials (RCTs) was conducted. METHODS: Following the PRISMA checklist, we conducted a literature search using seven different databases using an individual strategy adapted for each. Studies in which any topical intervention was applied to prevent or treat intravenous therapy-related phlebitis which were published between 1998 and 2019 were analysed. RESULTS: Data were collected of 13 RCTs, which in total collected data from 2,015 patients during hospital treatments with different types of intravenous therapies, such as fluid replacement, antibiotics, chemotherapy and antiarrhythmic drugs. The effectiveness of different topical interventions such as the application of nonsteroidal anti-inflammatory drugs, Sesame indicum oil, heparin sodium formulations, Chamomilla recutita tea and ointment, and Rosmarinus officinalis ointment were identified. RELEVANCE TO CLINICAL PRACTICE: Although the studies suggest a potential to use phytotherapy agents as topical interventions, pharmaceutical preparations, main substrate, and pharmaceutical or phytotherapeutic origins are very different between studies. There are insufficient data to build a solid conclusion that lead us to recommend a specific topical intervention in the prevention or treatment of intravenous therapy-related phlebitis.

The RESPECT trial-Replacement of peripheral intravenous catheters according to clinical reasons or every 96 hours: A randomized, controlled, non-inferiority trial.

BACKGROUND: Peripheral intravenous catheters are widely used for infusion therapy. To prevent phlebitis, routine catheter replacement at 72 or 96 hours remains widely practiced. OBJECTIVE: To investigate the non-inferiority of clinically indicated peripheral intravenous catheter replacement compared with routine replacement every 96 hours to prevent phlebitis. Phlebitis severity, catheter indwelling time, and other catheter failure types were also compared. SETTING: Multi-center trial in wards at two hospitals in Sao Paulo, Brazil. DESIGN: The REplacement of PEripheral intravenous CaTheters according to clinical signs or every 96 hours (RESPECT) trial was a Randomized, non-blinded, controlled, non-inferiority trial. PARTICIPANTS: 1319 patients were enrolled with the following inclusion criteria: aged ≥18 years, expected peripheral intravenous therapy for ≥96 hours; peripheral intravenous catheters inserted in the selected wards, intensive care units, or surgical centers; and informed consent provided. Exclusion criteria were: bloodstream infection and/or sepsis, neutrophil count of ≤1000/mm3, and simultaneous use of more than one peripheral intravenous catheter. Recruitment occurred within 96 hours of peripheral intravenous catheter insertion. Randomization was performed using a computer-generated, concealed list. METHODS: As intervention, clinically indicated replacement group patients underwent peripheral intravenous catheter removal only at the end of therapy or in the presence of phlebitis, infiltration, occlusion, displacement, accidental removal, or bloodstream infection. Routine 96-h replacement group patients (control) had their catheters replaced every 96-h, unless clinical reasons required earlier replacement. The primary outcome was Phlebitis and the analyses were carried out on intention-to-treat and per-protocol bases. RESULTS: Demographic and clinical variables were similar between groups, with the exception to type of admission (p = 0.025) more frequent in clinically indicated patients and surgical on routine replacement group. Of the 1319 patients, 119 (9.0%) developed phlebitis with no between-group difference (p = 0.162); these patients used 2747 peripheral intravenous catheters, being that 134 presented phlebitis. Phlebitis/1000 catheter-days, was 14.9 in the clinically indicated group and 23.8 in the routine replacement group (p = 0.006). The survival analysis showed no significant between-group difference in the occurrence of the first phlebitis episode. CONCLUSIONS: Clinically indicated peripheral intravenous catheter replacement was not inferior to routine (96 hours) replacement regarding phlebitis occurrence, and was associated with significantly less phlebitis per 1000 days. TRIAL REGISTRATION: Registered with www.clinicaltrials.gov (NCT02568670).

Effectiveness of vialon biomaterial versus teflon catheters for peripheral intravenous placement: A randomized clinical trial.

AIM: This study was to determine the effects of the two types of catheter material (vialon biomaterial and teflon) on pain intensity, dwell time, and phlebitis score for peripheral intravenous catheter (PIVC) placement. METHODS: Participants (N = 208) were randomly assigned to the vialon biomaterial group (n = 104), the teflon group (n = 104). After the PIVC placement, the intensity of pain and phlebitis score were evaluated. Catheter dwell mean time was determined. RESULTS: The pain intensity scores were similar immediately after inserting the PIVC. No difference was observed between the pain scores in both groups (p ≥ .050). Catheter dwell mean time for the vialon biomaterial catheter group (4.72 ± 1.20 days) was significantly longer compared to the teflon catheter group (4.10 ± 0.92 days) (p ≤ .001). It was determined that the catheter was removed due to phlebitis development in 16.3% of the vialon biomaterial catheter group and 53.8% of the teflon catheter group. An advanced level of statistically significant difference was found between the two groups in terms of phlebitis development scores (p ≤ .001). CONCLUSIONS: This study concluded that vialon biomaterial catheter (BD Insyte™ Autoguard™ BC winged) demonstrates longer dwell time of PIVC, lower phlebitis rate and phlebitis score than teflon catheter (BD Venflon™).

Randomized clinical trial analyzing maintenance of peripheral venous catheters in an internal medicine unit: Heparin vs. saline.

BACKGROUND: Peripheral venous catheters (PVCs) require adequate maintenance based on heparin or saline locks in order to prevent complications. Heparin has proven effective in central venous catheters, although its use in PVCs remains controversial. Our hypothesis was that saline locks are as effective as heparin locks in preventing problems with PVCs. The objective of the present study was to compare phlebitis and catheter tip colonization rates between PVCs locked with saline and those locked with heparin in patients admitted to an internal medicine department (IMD). METHODS: We performed a 19-month prospective, controlled, open-label, randomized clinical study of patients with at least 1 PVC admitted to the IMD of our hospital. The patients were randomized to receive saline solution (PosiFlush®, group A) or heparin (Fibrilin®, group B) for daily maintenance of the PVC. Clinical and microbiological data were monitored to investigate the frequency of phlebitis, catheter tip colonization, and catheter-related bloodstream infection (C-RBSI), as well as crude mortality, days of hospital stay, and days of antimicrobial treatment. RESULTS: We assessed 339 PVCs (241 patients), of which 192 (56.6%) were locked with saline (group A) and 147 (43.4%) with heparin (group B). The main demographic characteristics of the patients were distributed equally between the 2 study groups. The median (IQR) catheter days was 5 (3-8) for both groups (p = 0.64). The frequency of phlebitis was 17.7% for group A and 13.3% for group B (p = 0.30). The frequency of colonization of PVC tips was 14.6% and 12.2% in groups A and B, respectively (p = 0.63). Only 2 episodes of C-RBSI were detected (1 patient in group A). Saline lock was not an independent factor for phlebitis or catheter colonization. CONCLUSIONS: Our study revealed no statistically significant differences in the frequency of phlebitis and catheter tip colonization between PVCs locked with saline and PVCs locked with heparin. We suggest that PVC can be maintained with saline solution, as it is safer and cheaper than heparin.

In-line filtration reduced phlebitis associated with peripheral venous cannulation: Focus on cost-effectiveness and patients' perspectives.

BACKGROUND: In a previous trial, in-line filtration significantly prevented postoperative phlebitis associated with short peripheral venous cannulation. This study aims to describe the cost-effectiveness of in-line filtration in reducing phlebitis and examine patients' perception of in-hospital vascular access management with and without in-line filtration. METHODS: We analysed costs associated with in-line filtration: these data were prospectively recorded during the previous trial. Furthermore, we performed a follow-up for all the 268 patients enrolled in this trial. Among these, 213 patients responded and completed 6 months after hospital discharge questionnaires evaluating the perception of and satisfaction with the management of their vascular access. RESULTS: In-line filtration group required 95.60€ more than the no-filtration group (a mean of € 0.71/patient). In terms of satisfaction with the perioperative management of their short peripheral venous cannulation, 110 (82%) and 103 (76.9%) patients, respectively, for in-line filtration and control group, completed this survey. Within in-line filtration group, 97.3% of patients were satisfied/strongly satisfied; if compared with previous experiences on short peripheral venous cannulation, 11% of them recognised in-line filtration as a relevant causative factor in determining their satisfaction. Among patients within the control group, 93.2% were satisfied/strongly satisfied, although up to 30% of them had experienced postoperative phlebitis. At the qualitative interview, they recognised no difference than previous experiences on short peripheral venous cannulation, and mentioned postoperative phlebitis as a common event that 'normally occurs' during a hospital stay. CONCLUSION: In-line filtration is cost-effective in preventing postoperative phlebitis, and it seems to contribute to increasing patient satisfaction and reducing short peripheral venous cannulation-related discomfort.