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 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.

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).

The intervention research on treatment by Xianchen to rabbits model of chemotherapeutic phlebitis.

PURPOSE: To develop a chemotherapeutics induced phlebitis and explore the effects of Xianchen on the phlebitis treatment. METHODS: Forty-eight rabbits were divided into two series. Phlebitis model induced by vincristine was established at each series. The first series had 24 rabbits, which were divided into four groups (6 hours, 12 hours, 18 hours, 24 hours) after vincristine infusion. The grades of phlebitis through visual observation and histopathological examination were observed. The second series had also 24 rabbits. Interventions were performed 12 hours after vincristine infusion. These rabbits were randomly divided into four groups, according to treatment: Hirudoid (bid), Xianchen (daily), Xianchen (tid), Xianchen (five times a day). Four days after intervention, the venous injury through visual observation and histopathological examination were evaluated. RESULTS: Series 1: Phlebitis appeared 12 hours after infusion of vincristine through visual observation. There was a significant difference (p<0.05) between 6 hours and 24 hours, 6 hours and 18 hours through visual observation. However, the inflammation happened 6 hours after infusion, the loss of venous endothelial cells demonstrated differences among four groups through histopathological evaluation (p<0.05). There were significant differences (p<0.05) after 4 days among the intervention groups through visual observation, the effects of Xianchen group (five times a day) were better than Xianchen group (tid) (p<0.01). The treatment of edema demonstrated differences among groups through histopathological evaluation (p<0.05), Xianchen (five times a day) better relieved the degree of edema (p<0.05). CONCLUSIONS: The study showed that inflammatory reaction of phlebitis appeared early. Xianchen can treat vincristine induced phlebitis, as well as Hirudoid. It is particularly effective in the treatment of edema, and there is a remarkable dose-response relationship.

The intervention research on treatment by Xianchen to rabbits model of chemotherapeutic phlebitis

ABSTRACT PURPOSE: To develop a chemotherapeutics induced phlebitis and explore the effects of Xianchen on the phlebitis treatment. METHODS: Forty-eight rabbits were divided into two series. Phlebitis model induced by vincristine was established at each series. The first series had 24 rabbits, which were divided into four groups (6 hours, 12 hours, 18 hours, 24 hours) after vincristine infusion. The grades of phlebitis through visual observation and histopathological examination were observed. The second series had also 24 rabbits. Interventions were performed 12 hours after vincristine infusion. These rabbits were randomly divided into four groups, according to treatment: Hirudoid (bid), Xianchen (daily), Xianchen (tid), Xianchen (five times a day). Four days after intervention, the venous injury through visual observation and histopathological examination were evaluated. RESULTS: Series 1: Phlebitis appeared 12 hours after infusion of vincristine through visual observation. There was a significant difference (p<0.05) between 6 hours and 24 hours, 6 hours and 18 hours through visual observation. However, the inflammation happened 6 hours after infusion, the loss of venous endothelial cells demonstrated differences among four groups through histopathological evaluation (p<0.05). There were significant differences (p<0.05) after 4 days among the intervention groups through visual observation, the effects of Xianchen group (five times a day) were better than Xianchen group (tid) (p<0.01). The treatment of edema demonstrated differences among groups through histopathological evaluation (p<0.05), Xianchen (five times a day) better relieved the degree of edema (p<0.05). CONCLUSIONS: The study showed that inflammatory reaction of phlebitis appeared early. Xianchen can treat vincristine induced phlebitis, as well as Hirudoid. It is particularly effective in the treatment of edema, and there is a remarkable dose-response relationship.

Flebite em acessos venosos periféricos de pacientes de um Hospital do Vale do Paraíba / Phlebitis associated with peripheral intravenous catheter among in-patients of a Hospital in Vale do Paraíba

A flebite caracteriza-se por uma inflamação aguda da veia, causando edema, dor, desconforto, eritema ao redor da punção e um "cordão" palpável ao longo do trajeto. Objetivou-se identificar a presença ou ausência de flebite em pacientes internados em um hospital geral, bem como os fatores que influenciam as complicações em punção venosa e o tempo de permanência dos cateteres intravenosos periféricos. Trata-se de um estudo prospectivo, quantitativo, do tipo descritivo-exploratório, que analisou 76 pacientes. Destes, 24 (31,6%) evoluíram com flebite, sendo que 10 (41,6%) foram classificados como flebite grau I, nove (37,5%) grau II, quatro (16,7%) grau III e apenas um (4,2%) como grau IV. O tempo de permanência do cateter variou entre três e 120 horas, com a média de 49 horas. A Enfermagem desenvolve importante papel na prevenção das complicações associadas à manutenção do acesso venoso periférico, devendo avaliar criteriosamente os riscos de flebite.

La flebitis se caracteriza por una inflamación aguda de la vena, causando hinchazón, dolor, malestar, enrojecimiento alrededor de la punción, y una "cadena" palpable a lo largo del trayecto. El objetivo de este estudio fue identificar la presencia de flebitis en pacientes de un hospital general, así como los factores que influyen en las complicaciones de la punción venosa y el tiempo de permanencia de los catéteres venosos periféricos. Se trata de un estudio prospectivo, cuantitativo, descriptivo y exploratorio, que analizó 76 pacientes. De este total 24 (31,6%) tuvieron flebitis: 10 (41,6%) sujetos fueron clasificados como flebitis grado I, nueve (37,5%) grado II, cuatro (16,7%) Grado III y sólo uno (4,2%) como grado IV. El tiempo de uso de los catéteres varió de tres a 120 horas, con un promedio de 49 horas. Enfermería tiene un papel importante en la prevención de complicaciones asociadas con el acceso venoso periférico y debe evaluar cuidadosamente los riesgos de la flebitis.

Phlebitis is an acute inflammation of the vein that causes swelling, pain, discomfort, redness around the puncture and a palpable cord-like vein. The objective of the study was to identify the incidence or absence of phlebitis in patients in a general hospital, the complications associated with venipuncture and the length of time the catheters remained in situ. This is a prospective quantitative study with an exploratory and descriptive nature which analyzed 76 patients. Of these, 24 (31.6%) developed phlebitis; 10 (41.6%) were classified as Grade I phlebitis, 9 (37.5%) as Grade II, 4 (16.7%) as Grade III and 1 (4.2%) as Grade IV. The length of time the device remained in situ ranged from 3 to 120 hours with an average of 49 hours. Nursing has an important role in preventing complications associated with peripheral intravenous access. Furthermore, the risk of phlebitis should be carefully evaluated.

The strategic role of the nurse in the selection of IV devices.

Use of vascular devices represents one of the most common procedures used as a complementary measure in the treatment of patients. An indication algorithm was established to serve as a guideline for nurses in choosing the best intravenous device, considering the main variables of drug therapy. A protocol approved by the Institute of Orthopedics and Traumatology of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), where the authors work, was subsequently established and the nurse carried out the evaluation for the indication of both the peripheral device and the central device, whether a peripherally inserted central catheter (PICC) or other device inserted by the physician. As a result, there was a decrease in the incidence of phlebitis from 0.77% in 2010 to 0.17% in 2011, with an annual curve of negative tendency. The nursing team also appeared more satisfied, diminishing stress related to puncture failure.

Predisposing factors for infiltration in children submitted to peripheral venous catheterization.

AIMS: The aims were to compare characteristics of children with peripheral intravenous catheters who developed infiltration and those who did not and to identify risk factors for developing this complication. METHOD: A retrospective cohort study carried out at a university hospital, with 338 children with peripheral intravenous catheters. Variables related to the children and therapies were investigated. RESULTS: Researchers identified infiltration in 54 children (16%). Characteristics statistically different in those who developed infiltration were the following: intravenous therapy for more than 5 days, presence of predisposing factors to peripheral venipuncture failure, history of previous infiltration, catheter readjustment to vein insertion, use of infusion pump, intermittent administrations, and shorter dwell time. CONCLUSION: Only intravenous therapy variables showed a significant relation with the occurrence of infiltration and represented risk factors for its occurrence.

Flebitis postinfusión en catéteres venosos periféricos: Una actualización del arte / Post infusion phlebitis in peripheral venous catheters; An actualization of the art

Las diferentes patologías y su manejo actual hacen que la terapia endovenosa sea frecuentemente utilizada en un gran número de pacientes admitidos en unidades de hospitalización, y más aún, sean fundamentales en las unidades de cuidados intensivos. No obstante, pesar de los beneficios, su utilización no está exenta de complicaciones, siendo una de las más frecuentes la flebitis post infusión o flebitis química, asociándose a una alta incidencia (alrededor de un 15 a 80% de los pacientes con accesos venosos periféricos) y se atribuye principalmente a la irritación provocada por medicamentos administrados por esta vía. Es responsabilidad de enfermería la instalación de una vía venosa periférica y sus cuidados, por lo que es de suma importancia conocer los signos y síntomas de flebitis para su detección precoz y, además, formas de prevención y su manejo una vez que esté presente. Sin embargo, pese a que existen numerosos estudios referentes a su prevención y tratamiento, aún no hay resultados concluyentes que permitan recomendar una medida determinada.

Different pathologies and their current management make intravenous therapy frequently used for the majority of patients admitted to hospital units and are even more critical in intensive care units. Still, despite of the benefits, Its use is not free of complications, being one of the most frequent post infusion phlebitis or chemical phlebitis, associated with a high incidence (around 15 to 80% of patients with peripheral venous access) and is mainly attributed to the irritation caused by medication administered by this route. Is responsibility of nursing staff the installation of peripheral venous catheters and its care, so it is important to recognize the signs and symptoms of phlebitis for early detection and also forms of prevention and handling this once it is present. However, while there are numerous studies concerning the prevention and treatment, there are no conclusive results yet to recommend a particular measure.

Benefits of establishing an intravenous team and the standardization of peripheral intravenous catheters.

The purpose of this study was to show the importance of a team dedicated to intravenous (IV) insertion and the standardization of peripheral IV catheters in reducing venipuncture attempts, reducing cases of phlebitis, and optimizing costs. The benefits achieved by the team were a decrease in venipuncture attempts, a decrease of phlebitis (from 0.47% to 0.35%), the optimization of the team's time, and a 29.47% reduction in the use of catheters. The study corroborates the IV team's importance in the process of managing nurses' workflow, since it provides important indicators for quality management.

Factores de Riesgo asociados con la aparición de flebitis en pacientes ingresados en el servicio de medicina interna del HALF, durante el período de enero a diciembre 2005 / Factors of Risk associated with the phlebitis appearance in patients entered in the service of internal medicine of the HALF, during the period of January to December 2005

El presente trabajo se realizó en el Hospital Escuela Antonio Lenin Fonseca durante el período de enero a diciembre del año 2005. Se trata de un estudio de casos y controles para determinar los factores de riesgo en la aparición de flebitis en los pacientes ingresados al servicio de medicina interna en el período antes mencionado. Sedeterminaron los criterios de inclusión y exclusión tanto para los casos como para los controles. Se elaboró una ficha de recolección de datos. La muestra se constituyó por el universo o totalidad de los casos de flebitis presentados en el servicio y período ya mencionado siendo de 32 pacientes, los controles homogéneos a los casos en edad y sexo se constituyeron en 64 pacientes para un total de 94 sujetos en estudio. Lo recolectado en la ficha de datos se procesó en el programa EPI-INFO obteniendose el OR (Odd Ratio) y el valor de p para determinar que variables en estudio se constituían en factores de riesgo para la aparición de flebitis. Se encontró como factores de riesgo el sitio de venopunción (antebrazo), la ausencia de medidas de asepsia y el uso inadecuado de las técnicas de venopunción, también la dificultad o imposibilidad del paciente para deambular.

Criterio enfermero en accesos venosos periféricos / Nurse criteria and cath peripheral

La flebitis es una de las complicaciones mas frecuentes que se presentan en la terapeutica intravenosa. En nuestra practica diaria, hemos observado que la mayoria de los pacientes presentaron signos y sintomas de flebitis dentro de las primeras 24 hs de internacion. Esta primera flebitis responde a causas quimicas y/o mecanicas. Cabe señalar que la flebitis bacteriana comienza a manifestarse despues de las 24 hs de instaurado el cateter venos periferico. Esta situacion llevo a indagar como se aplica el criterio enfermero durante la administracion de medicamentos endovenosos y durante la seleccion e instauracion del cateter venoso periferico.[AU]

Criterio enfermero en accesos venosos periféricos / Nurse criteria and cath peripheral

La flebitis es una de las complicaciones mas frecuentes que se presentan en la terapeutica intravenosa. En nuestra practica diaria, hemos observado que la mayoria de los pacientes presentaron signos y sintomas de flebitis dentro de las primeras 24 hs de internacion. Esta primera flebitis responde a causas quimicas y/o mecanicas. Cabe señalar que la flebitis bacteriana comienza a manifestarse despues de las 24 hs de instaurado el cateter venos periferico. Esta situacion llevo a indagar como se aplica el criterio enfermero durante la administracion de medicamentos endovenosos y durante la seleccion e instauracion del cateter venoso periferico.[AU]

Criterio enfermero en accesos venosos periféricos / Nurse criteria and cath peripheral

La flebitis es una de las complicaciones mas frecuentes que se presentan en la terapeutica intravenosa. En nuestra practica diaria, hemos observado que la mayoria de los pacientes presentaron signos y sintomas de flebitis dentro de las primeras 24 hs de internacion. Esta primera flebitis responde a causas quimicas y/o mecanicas. Cabe señalar que la flebitis bacteriana comienza a manifestarse despues de las 24 hs de instaurado el cateter venos periferico. Esta situacion llevo a indagar como se aplica el criterio enfermero durante la administracion de medicamentos endovenosos y durante la seleccion e instauracion del cateter venoso periferico.