[Infectious or noninfectious phlebitis: lessons from a an interventional programm on phlebitis associated to peripheral venous catheter]. / Flebitis infecciosa o no infecciosa: lecciones de un programa intervencional sobre flebitis asociada a catéter venoso periférico.

BACKGROUND: There is no consensus definition to distinguish infectious from non-infectious phlebitis associated to peripheral venous catheter. AIMS: To evaluate the impact of an intervention program on the rate of infectious (those associated to bacteremia or local purulent discharge) and non-infectious phlebitis (the rest) and identify differential features. METHODS: Interventional study developed in three stages: basal measurement, intervention, and evaluation. RESULTS: Ten infectious and 186 non-infectious phlebitis were registered. Infectious phlebitis diminished after intervention (0.2 to 0.04 events per 1,000 bed-days; p = 0.02) but not the rest (2.3 per 1,000 bed-days before and after). Five of 10 patients with infectious phlebitis had bacteremia, one with infectious endocarditis and valve replacement, and other with septic shock and a fatal outcome. None of the patients in the non-infectious group presented complications. Infectious phlebitis appeared later (mean 4.1 versus 2.4 days; p = 0.007) and were associated to fever (40% vs 5.9%, p = 0.004). Non-infectious phlebitis was associated to irritating compounds (OR 6.1; IC95 1.3-29, p < 0.05). CONCLUSIONS: The intervention program demonstrated a favorable impact only on the rate of infectious phlebitis. Distinction appears to be relevant because those of infectious origin are associated with fever, complications or death, respond to an intervention program, and emerge lately.

Flebitis infecciosa o no infecciosa: lecciones de un programa intervencional sobre flebitis asociada a catéter venoso periférico / Infectious or noninfectious phlebitis: lessons from a an interventional programm on phlebitis associated to peripheral venous catheter

Resumen Introducción: No hay criterios establecidos para distinguir las flebitis de causa infecciosa de las no infecciosas. Objetivo: Evaluar el impacto de un programa de intervención en la tasa de flebitis de tipo infecciosa (asociada a bacteriemia sin otro foco o pus local) y no infecciosa (el resto). Pacientes y Métodos: Estudio intervencional en tres etapas: diagnóstico de situación basal, intervención y evaluación. Resultados: Se detectaron 10 casos de flebitis infecciosa y 186 no infecciosas. Las flebitis infecciosas disminuyeron con la intervención (0,2 a 0,04 eventos por 1.000 días camas; p = 0,02) pero no las no infecciosas (2,3 a 2,3 por 1.000 días camas). Cinco casos con flebitis infecciosa tuvieron bacteriemia, uno de ellos con endocarditis y reemplazo valvular y otro con shock séptico y desenlace fatal. Ninguno de los casos en el grupo no infeccioso se complicó o falleció. Las flebitis infecciosas se presentaron más tarde que las otras (4,1 versus 2,4 días; p = 0,007) y se asociaron a fiebre (40% vs 5,9%, p = 0,004). Las flebitis no infecciosas se asociaron al uso de compuestos irritantes (OR 6,1; IC95 1,3-29, p < 0,05). Conclusiones: El programa demostró un impacto favorable para disminuir sólo las flebitis de tipo infecciosa. La distinción parece ser relevante porque las infecciosas se asocian a fiebre, complicaciones o letalidad, parecen responder a programas de prevención y son más tardías.

Background: There is no consensus definition to distinguish infectious from non-infectious phlebitis associated to peripheral venous catheter. Aims: To evaluate the impact of an intervention program on the rate of infectious (those associated to bacteremia or local purulent discharge) and non-infectious phlebitis (the rest) and identify differential features. Methods: Interventional study developed in three stages: basal measurement, intervention, and evaluation. Results: Ten infectious and 186 non-infectious phlebitis were registered. Infectious phlebitis diminished after intervention (0.2 to 0.04 events per 1,000 bed-days; p = 0.02) but not the rest (2.3 per 1,000 bed-days before and after). Five of 10 patients with infectious phlebitis had bacteremia, one with infectious endocarditis and valve replacement, and other with septic shock and a fatal outcome. None of the patients in the non-infectious group presented complications. Infectious phlebitis appeared later (mean 4.1 versus 2.4 days; p = 0.007) and were associated to fever (40% vs 5.9%, p = 0.004). Non-infectious phlebitis was associated to irritating compounds (OR 6.1; IC95 1.3-29, p < 0.05). Conclusions: The intervention program demonstrated a favorable impact only on the rate of infectious phlebitis. Distinction appears to be relevant because those of infectious origin are associated with fever, complications or death, respond to an intervention program, and emerge lately.

Histological evaluation of obliterative phlebitis for the diagnosis of autoimmune pancreatitis.

BACKGROUND: Obliterative phlebitis is a useful pathological finding for the diagnosis of lymphoplasmacytic sclerosing pancreatitis (LPSP), or type 1 autoimmune pancreatitis. The present study evaluated histological findings of obliterative phlebitis, including the significance of adding Elastica van Gieson stain (EVG) in comparison with other pancreatic conditions. METHODS: Specimens of LPSP (n = 18), chronic pancreatitis (CP; n = 24), and pancreatic ductal adenocarcinoma (PDA; n = 45) were enrolled. Obliterative venous lesions (OVLs), defined as the presence of inflammatory cells and/or fibrosis inside the tunica adventitia, were counted and compared between hematoxylin and eosin stain (H&E) and EVG. OVLs were classified into three types: OVL-1, lymphoplasmacytic infiltration and fibrosis against a loose textured background; OVL-2, dense fibrosis with minimal or no lymphoplasmacytic infiltration; and OVL-3, densely packed lymphoplasmacytic infiltration without fibrosis. OVL type and OVL size were compared between disease groups. RESULTS: OVL counts in LPSP, CP, and PDA were significantly higher with EVG than with H&E (p < 0.001). OVL-1 was most common in LPSP (H&E 92.4 %, EVG 79.8 %), and was identified in almost all cases of LPSP, but was less common in CP and PDA. Maximum diameter and OVL count in 1 cm(2) of OVL-1 were high for LPSP. Maximum diameter of OVL-1 ≥150 µm was observed in 17 LPSP, 0 CP, and 1 PDA cases (sensitivity 94.4 %, specificity 98.6 %). CONCLUSIONS: Additional EVG is useful for excluding conditions mimicking OVL-1 or detecting OVL in small specimens. The presence of OVL-1 with diameter ≥150 µm is highly diagnostic for LPSP.

Investigation of the roles of fascioliasis and food allergy in intrahepatic eosinophilic proliferative pylephlebitis in Japanese Black cattle.

Intrahepatic eosinophilic proliferative pylephlebitis (EPP) in Japanese Black (JB) cattle generally has been considered to be an atypical form of fascioliasis. However, there are many cases of EPP in which no Fasciola spp. have been detected in the livers of affected cattle. The aims of this study were to ascertain the relationship between EPP and hepatic fascioliasis and to investigate the role of food allergy in the disease. Histologically, EPP lesions were characterised by severe endothelial proliferation of the interlobular veins, accompanied by varying degrees of fibrosis and eosinophilic infiltration in portal areas, which could be differentiated from chronic cholangiohepatitis, the typical lesion of hepatic fascioliasis. In addition to hepatic lesions, all cases of EPP had varying degrees of eosinophilic infiltration in the perilymphoid red pulp of the spleen, whereas both affected and unaffected animals had eosinophilic infiltrates in the mucosa of the small intestine. Antibodies against Fasciola spp. were detected in 1/14 EPP cases by ELISA; the seropositive case had EPP in combination with chronic cholangitis. There was no significant difference in total concentration of IgE between cases of EPP and unaffected cattle. Serum IgE levels specific to curly dock (Rumex crispus) and oats (Avena sativa) were higher in EPP cases than in unaffected cattle by allergen profiling screening testing and ELISA. The results of this study suggest that hepatic fascioliasis is unlikely to be the cause of EPP in JB cattle and that food allergens should be investigated as possible aetiological agents.

Flebite secundária à inserção de cateter venoso periférico: aspectos relevantes para a assistência de enfermagem / Phlebitis due to the insertion of peripheral venous catheters: issues relevant to nursing care / Flebitis secundaria a la inserción de cateteres venosos periféricos: lãs cuestiones a los cuidados de enfermería

Objetivo: informar aos leitores sobre os mecanismos que conduzem à flebite enquanto complicação da terapia intravenosa. Metodologia: artigo de atualização, o qual apresenta os aspectos epidemiológicos, fatores predisponentes,medidas preventivas e métodos de avaliação da flebite decorrente de inserção de cateter venoso periférico, com vistas a subsidiar as condutas de enfermagem. Resultados: a flebite consiste em fenômeno bastante prevalente em pacientes hospitalizados, relacionado a múltiplos fatores, tais como hiperosmolaridade e ph da solução infundida, tipo de dispositivo venoso utilizado e o cuidado de enfermagem no que se refere ao procedimento de venopunção e manutenção do acesso venoso. É fundamental que o enfermeiro conheça os métodos disponíveis para diagnosticar a flebite, identificando sinais e sintomas flogísticos, podendo assim intervir de acordo com o grau evidenciado, prevenindo a ocorrência de fleboesclerose. Conclusão: conhecer os tipos de flebite e, consequentemente, seus fatores de risco contribui para que o enfermeiro tenha melhor embasamento para a tomada de decisão no que concerne à construção de protocolos específicos visando à prevenção desta complicação.(AU)

Objective: to contribute to the reflection on the mechanisms leading to phlebitis as a complication of intravenous therapy. Methodology: this is about an update paper, which presents the epidemiology, predisposing factors, preventive measures and evaluation methods of phlebitis due to insertion of peripheral venous catheter, in order to subsidize the nursing plan. Results: the phenomenon of phlebitis is quite prevalent in hospitalized patients, related to multiple factors such as hyperosmolarity and pH of the solution infused, type of device used venous and nursing care with regard to the procedure of venipuncture and venous access. It is important for nurses to learn the tools to diagnose phlebitis, identifying signs and symptoms of inflammation, thus being able to intervene according to the degree shown, preventing the occurrence of phlebosclerosis. Conclusion: knowing the types of phlebitis and, consequently, their risk factors helps the nurse to have a better basis for decision making regarding the construction of specific protocols aimed at preventing this complication.(AU)

Objetivo: contribuir a la discusión de los mecanismos que conducen a la flebitis como complicación de la terapia intravenosa. Metodología: documento de actualización, que presenta la epidemiología, factores predisponentes, las medidas preventivas y métodos de evaluación de flebitis debido a la inserción de catéter venoso periférico, con el fin de subsidiar el plan de enfermería. Resultados: el fenómeno de la flebitis es muy frecuente en pacientes hospitalizados, relacionado con múltiples factores tales como hiperosmolaridad y el pH de la solución infundida, el tipo de dispositivo utilizado atención venosa y de enfermería en relación con el procedimiento de punción venosa y el acceso venoso. Es importante para las enfermeras aprender las herramientas para disgnosticar la flebitis, la identificación de signos y síntomas de inflmación, con lo que haya podido intervenir en función del grado se muestra, evitando la aparición de phlebosclerosis. Conclusión: conocer los tipos de flebitis y, en consecuencia, sus factores de riesgo ayuda a la enfermera para tener una mejor base para la toma de decisiones respecto a la construcción de protocolos específicos para prevenir esta complicación.(AU)

New classification system-based visual outcome in Eales' disease.

PURPOSE: A retrospective tertiary care center-based study was undertaken to evaluate the visual outcome in Eales' disease, based on a new classification system, for the first time. MATERIALS AND METHODS: One hundred and fifty-nine consecutive cases of Eales' disease were included. All the eyes were staged according to the new classification: Stage 1: periphlebitis of small (1a) and large (1b) caliber vessels with superficial retinal hemorrhages; Stage 2a: capillary non-perfusion, 2b: neovascularization elsewhere/of the disc; Stage 3a: fibrovascular proliferation, 3b: vitreous hemorrhage; Stage 4a: traction/combined rhegmatogenous retinal detachment and 4b: rubeosis iridis, neovascular glaucoma, complicated cataract and optic atrophy. Visual acuity was graded as: Grade I 20/20 or better; Grade II 20/30 to 20/40; Grade III 20/60 to 20/120 and Grade IV 20/200 or worse. All the cases were managed by medical therapy, photocoagulation and/or vitreoretinal surgery. Visual acuity was converted into decimal scale, denoting 20/20=1 and 20/800=0.01. Paired t-test / Wilcoxon signed-rank tests were used for statistical analysis. RESULTS: Vitreous hemorrhage was the commonest presenting feature (49.32%). Cases with Stages 1 to 3 and 4a and 4b achieved final visual acuity ranging from 20/15 to 20/40; 20/80 to 20/400 and 20/200 to 20/400, respectively. Statistically significant improvement in visual acuities was observed in all the stages of the disease except Stages 1a and 4b. CONCLUSION: Significant improvement in visual acuities was observed in the majority of stages of Eales' disease following treatment. This study adds further to the little available evidences of treatment effects in literature and may have effect on patient care and health policy in Eales' disease.

A new staging system for idiopathic retinal periphlebitis.

PURPOSE: To develop and standardize a universally acceptable new staging system for idiopathic retinal periphlebitis (Eales disease). METHODS: A new staging system was established and standardized based on standard terminology and features. Idiopathic retinal periphlebitis was classified as peripheral and central types. Peripheral disease consisted of four stages. Stage 1 is periphlebitis of small (1a) and large (1b) caliber vessels with superficial retinal hemorrhages. Stage 2a denotes capillary nonperfusion and 2b neovascularization elsewhere/of the disc. Stage 3a is classified as fibrovascular proliferation and 3b vitreous hemorrhage. Stage 4a is traction/combined rhegmatogenous retinal detachment whereas 4b is rubeosis iridis, neovascular glaucoma, complicated cataract, and optic atrophy. A total of 253 cases of idiopathic retinal periphlebitis (mean age, 24.7 +/- 4.7 years, all male) presenting at this tertiary care center were classified prospectively according to the new staging system, by two independent observers (interobserver correlation = 0.7). RESULTS: The new staging system was consistent, simple, and easy to recall. Peripheral and central types of idiopathic retinal periphlebitis were found in 94.07% and 5.93% of cases, respectively. The new staging system also defined the severity of the disease. Vitreous hemorrhage was found to be the commonest presenting feature (51.68%), whereas traction/combined rhegmatogenous detachment was found in 5.88% of cases. CONCLUSIONS: The new staging system is useful in classifying and assessing the severity of disease. Management strategy can also be defined according to the stage of the disease. It is designed to promote the use of standard assessment with applications to clinical management and research.

[Mondor's disease: study of two topographic localizations]. / Enfermedad de Mondor: estudio de dos formas topográficas.

Superficial thoracic wall and dorsal vein of the penis phlebitis are uncommon diseases. Both are known as Mondor's disease. Two cases have been diagnosed in a short period of time in a Southern. Spain primary care clinics.

Notoginseny cream in the treatment of phlebitis.

This study investigated the curative effects of notoginseny cream versus Hirudoid cream in the treatment of postinfusion phlebitis. Sixty-five patients who received peripheral infusion therapy during a 20-month period and had developed phlebitis were divided randomly into two groups. Group A was treated with notoginseny cream, a topical Chinese medicine developed and produced by the pharmacological department of The Second Affiliated Hospital of Sun Yat-Sen University. Group B was treated with heparinoid cream (Hirudoid, a commercial product from Germany). Significantly fewer applications of notoginseny cream were required to bring about the disappearance of signs and symptoms of phlebitis in the group A patients as compared with the group B patients for the same effect. The actual time of disappearance of the signs and symptoms of phlebitis also were significantly shorter in patients treated with notoginseny cream than with heparinoid cream.

Antibiotics differ in their tendency to cause infusion phlebitis: a prospective observational study.

Intravenous administration of antibiotics is a known risk factor for infusion phlebitis. We have previously demonstrated differences in cell toxicity for 4 antibiotics. Clinical experience indicates that antibiotics differ in their tendency to cause phlebitis. The present study was done prospectively on 550 patients with 1386 peripheral venous catheters. The incidence of phlebitis was 18.5% with antibiotics and 8.8% without (odds ratio 2.34). Dicloxacillin (odds ratio 5.74) and erythromycin (odds ratio 5.33) had the greatest tendency to cause phlebitis in univariate, multivariate and Cox regression analyses. Benzylpenicillin, cefuroxime and cloxacillin were also associated with a greater risk of phlebitis, whereas ampicillin, imipenem/cilastatin, clindamycin, netilmicin and vancomycin were not. Other risk factors were the site of insertion and age 51-60 y. Medication with warfarin was found to be protective, but not with aspirin. Treatment with low molecular weight heparin reduced the risk of phlebitis, but the difference was not significant. With regard to when antibiotics were given, the day-specific risk increased between Days 1 and 2, but no further on subsequent days. The hypothesis that antibiotics differ in their tendency to cause phlebitis was confirmed.

[Surgical indications in the phlebopathic patient. The role of air plethysmography]. / L'indicazione chirurgica nel paziente flebopatico. Ruolo della pletismografia ad aria.

A previous history of deep venous thrombosis (DVT) must be carefully evaluated in every patient affected by chronic venous insufficiency (CVI); the assessment of deep venous system patency is the goal of preoperative diagnosis. Air plethysmography examination allows an outpatient noninvasive testing of calf pump function and deep venous outflow. The authors report the results of a study on 37 patients (40 limbs) with a previous history of DVT, suffering from CVI; in 18 limbs air plethysmography showed a marked increase of calf volume on test exercise, suggesting residual venous obstruction. The authors believe that air plethysmography examination is mandatory before operation in patients with a previous history of DVT.

I.v.-related phlebitis, complications and length of hospital stay: 1.

This article, the first of two-parts, addresses the growing problem of intravenous-related phlebitis in hospitalized patients, and the resultant personal and financial costs to both patient and hospital. Literature on the various types of phlebitis, the factors that increase the patient's risk of developing phlebitis, clinical indicators and severity grading scales, and the complications of phlebitis are examined. Awareness of such factors is considered instrumental in minimizing the incidence of intravenous-related phlebitis. The second article in this series will present a study of 90 patients from a large teaching hospital, which was conducted to determine the incidence and severity of intravenous-related phlebitis, risk factors, associated complications, and the related length of hospital stay. The implications of the results for current and future nursing care of patients receiving i.v. therapy will be discussed, and recommendations for safe practice will be made.

I.v.-related phlebitis, complications and length of hospital stay: 2.

Review of the literature on the various types of phlebitis, risk factors, clinical indicators, severity grading scales, and associated complications of phlebitis, in the first article in this series (Vol 7(21): 1304-12), indicated that an awareness of such factors could reduce the incidence of intravenous (i.v.)-related phlebitis. This article presents a quantitative study, of longitudinal design, conducted to determine the incidence and severity of i.v.-related phlebitis in 90 patients from a large teaching hospital over a 2-month period. The study concluded that although there were multiple risk factors for the development of phlebitis, routine IV site observation and the use of phlebitis severity measurement scales could reduce the incidence and severity of phlebitis. Complications arising from phlebitis can have long-term effects on patient care, satisfaction, and length of hospital stay. If not controlled, these risk factors can increase the personal and financial costs to patients, encourage litigation, and ultimately increase the overall costs to the hospital.

Phlebitides--a survey.

Classification of phlebitides is difficult and none of the suggestions made so far has been internationally recognized. Already the definition of "primary" and "secondary" presents difficulties. For practical purposes the phlebitides are classified in this survey according to their importance as disease entities and their etiology. The role of phlebitis saltans as an idiopathic disease or as an indicator of underlying disorders is emphasized and the differential diagnosis between symptomatic skipping phlebitis and paraneoplastic thrombosis with secondary inflammation is outlined.