Peripheral Intravenous Catheter-Related Phlebitis and Infiltration in an Emergency Department: A Descriptive Study.

This study aims to analyze the incidences of peripheral intravenous catheter-related phlebitis and infiltration and the associated risk factors in emergency departments. This descriptive cross-sectional, nonexperimental study was conducted with 300 participants in the emergency department of a university hospital in Türkiye between January 15 and February 15, 2018. The incidence of peripheral intravenous catheter-related phlebitis was 31%, which was grade 1 in 29.7% and grade 2 in 1.3% of the emergency department participants. Additionally, the incidence of peripheral intravenous catheter-related infiltration was 55.4%, including grades 1, 2, and 3 in 36.0%, 12.7%, and 6.7% of the participants, respectively. Incidences of phlebitis and infiltration were related to age, duration of peripheral intravenous catheterization longer than 24 hours, and repeated use of the catheter insertion site. The findings of this study may draw attention to the factors that trigger phlebitis and infiltration due to peripheral intravenous catheter insertions in the emergency department and may guide practices to prevent these complications before they develop. In this context, the Phlebitis Scale and Infiltration Scale developed by the Infusion Nurses Society are recommended to be used in the emergency department.

Phlebitis in Medical-Surgical Units: A Case-Control Study in a Brazilian Hospital.

The most commonly used vascular access is the peripheral intravenous catheter (PIVC). However, it can trigger complications and the occurrence of adverse events, such as phlebitis. This study evaluated the variables that are associated with the occurrence of phlebitis in medical and surgical inpatient units. This is an observational, retrospective, case-control study in medical and surgical hospitalization units of a private general hospital in the city of São Paulo. Participants were an average age of 66.3 years, and 71% were hospitalized in medical units. The risk variables associated with phlebitis were medical hospitalization (odds ratio [OR] = 4.36; P = .002), presence of comorbidity (OR = 10.73; P < .001), and having 5 or more PIVCs (OR = 53.79; P = .001). Regarding intravenous therapy, the use of contrast was a risk variable (OR = 2.23; P = .072). On the other hand, patient education regarding PIVCs was a protective measure against the development of phlebitis. The nursing team plays an essential role in the care of patients with PIVCs, inpatient guidance, planning, and device choice, taking into account the risk factors for phlebitis to maintain the preservation of vascular health and reduce adverse events.

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.

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.

A safe and effective winged peripheral intravenous cannula for use in clinical practice.

Vascular access continues to be a key factor for the reliable and safe delivery of intravenous (IV) therapy to patients in any healthcare setting. Clinical guidelines advocate for the right vascular access device selection, in order to reduce avoidable complications, eg multiple stabs, phlebitis, thrombophlebitis, insertion site infection, and blood stream infection, while improving efficiency and reducing costs. Peripheral intravenous catheters or cannulas (PIVCs) remain widely used for gaining vascular access in all clinical settings, with both adults and children, because they provide a relatively cheap and simple way to provide blood sampling and the prompt administration of IV medications. Although safe and easy to insert, PIVCs present with associated risks that can be costly to the organisation. The case studies included with this article introduce Nipro's Safetouch Cath Winged with Injection Port as a new cost-effective choice of PIVC, which is now available from NHS Supply Chain.

Phlebitis in Takayasu arteritis: A case-based literature review.

Takayasu arteritis (TAK) is the main type of large vessel arteritis in young adults, which mainly affects the aorta and its main branches, leading to clinical manifestations such as syncope, intermittent limb claudication, hypertension, and abdominal pain. Among them, venous involvement is rarely reported. Here we show a case of TAK presenting as phlebitis. This was a 27-year-old woman, who initially admitted to our hospital with myalgia of the upper and lower extremities and night sweats. She was diagnosed as TAK according to the 1990 American College of Rheumatology TAK criteria. Surprisingly, vascular ultrasonography revealed wall thickening as indicated by macaroni sign of the multiple veins. TAK phlebitis appeared at the active phase, while disappearing rapidly at remission. Phlebitis might have a close relationship with disease activity. By retrospective study in our department, the estimated incidence rate of phlebitis might be 9.1% in TAK. With the literature review, it revealed that phlebitis might be an ignored manifestation in active TAK. However, due to the smaller sample size, it should be noted that a direct cause-effect relationship cannot be established.

Length of hospitalization, APPLE score, and number of intravenous catheters placed at admission are associated with increased odds of peripheral intravenous catheter complications in dogs.

OBJECTIVE: To identify risk factors associated with peripheral intravenous catheter (PIVC) complications in dogs hospitalized in the critical care unit (CCU). ANIMALS: 107 dogs admitted to the CCU between October 2022 and March 2023. METHODS: This prospective, observational clinical trial was performed at a single veterinary teaching hospital. Dogs hospitalized in the CCU for at least 24 hours were evaluated for enrollment. PIVC were placed following a standardized protocol and monitored for complications. PIVC complications were classified as extravasation, phlebitis, dislodgement, occlusion, line breakage, or patient removal. RESULTS: Median PIVC dwell time was 46.50 hours (range, 24.25 to 159.25 hours). Overall PIVC complication rate was 12.1% (13/107), with phlebitis (4/107 [3.7%]) and extravasation (4/107 [3.7%]) being the most frequently recorded complications. Multivariable analysis identified increasing length of hospitalization (LOH; OR, 1.43; 95% CI, 1.04 to 1.97; P = .029), an acute patient physiologic and laboratory evaluation full (APPLEFULL) score > 35 (OR, 4.66; 95% CI, 1.09 to 19.90; P = .038), and having 2 PIVCs placed at admission (OR, 10.92; 95% CI, 1.96 to 60.73; P = .006) as risk factors for PIVC complication. CLINICAL RELEVANCE: Increasing LOH, an APPLEFULL score > 35 and having 2 PIVCs placed at admission were associated with increased odds for PIVC complication in this study. Although these are independent risk factors for PIVC complication, the combination of increasing LOH, an APPLEFULL score > 35, and having 2 PIVCs placed at admission may represent a more severely ill population, drawing attention to a vulnerable group of dogs at risk for PIVC complication.

Peripheral intravenous catheter infection and failure: A systematic review and meta-analysis.

BACKGROUND: Peripheral intravenous catheters are the most frequently used invasive device in nursing practice, yet are commonly associated with complications. We performed a systematic review to determine the prevalence of peripheral intravenous catheter infection and all-cause failure. METHODS: The Cochrane Library, PubMed, CINAHL, and EMBASE were searched for observational studies and randomised controlled trials that reported peripheral intravenous catheter related infections or failure. The review was limited to English language and articles published from the year 2000. Pooled estimates were calculated with random-effects models. Meta-analysis of observation studies in epidemiology guidelines and the Cochrane process for randomised controlled trials were used to guide the review. Prospero registration number: CRD42022349956. FINDINGS: Our search retrieved 34,725 studies. Of these, 41 observational studies and 28 randomised controlled trials (478,586 peripheral intravenous catheters) met inclusion criteria. The pooled proportion of catheter-associated bloodstream infections was 0.028 % (95 % confidence interval (CI): 0.009-0.081; 38 studies), or 4.40 catheter-associated bloodstream infections per 100,000 catheter-days (20 studies, 95 % CI: 3.47-5.58). Local infection was reported in 0.150 % of peripheral intravenous catheters (95 % CI: 0.047-0.479, 30 studies) with an incidence rate of 65.1 per 100,000 catheter-days (16 studies; 95 % CI: 49.2-86.2). All cause peripheral intravenous catheter failure before treatment completion occurred in 36.4 % of catheters (95 % CI: 31.7-41.3, 53 studies) with an overall incidence rate of 4.42 per 100 catheter days (78,891 catheter days; 19 studies; 95 % CI: 4.27-4.57). INTERPRETATION: Peripheral intravenous catheter failure is a significant worldwide problem, affecting one in three catheters. Per peripheral intravenous catheter, infection occurrence was low, however, with over two billion catheters used globally each year, the absolute number of infections and associated burden remains high. Substantial and systemwide efforts are needed to address peripheral intravenous catheter infection and failure and the sequelae of treatment disruption, increased health costs and poor patient outcomes.

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.

Peripheral parenteral nutrition: An evaluation of its use, safety and cost implications in a tertiary hospital setting.

BACKGROUND AND AIMS: Malnutrition is a common challenge among hospitalised patients and its associatiation with poor patient health-related outcomes places a significant financial burden on the healthcare system. Total parenteral nutrition (TPN) is the primary means for providing nutrition to individuals in whom enteral feeding is not possible but is costly and requires invasive central venous access. Peripheral parenteral nutrition (PPN) provides a suitable option for early nutrition provision in select patients; however, its routine use has been limited by safety and tolerability concerns, with high rates of phlebitis reported in previous studies. The objectives of this study were to review the use, safety, and costs of PPN in an Australian tertiary hospital. METHODS: A single-site, prospective observational study was conducted over 15 months in a tertiary hospital. 139 participants (87 male and 52 female) were enrolled in the study. Data collected assessed the indication for PPN initiation, compliance with the hospital's protocols for PPN, total fasting days, the proportion of the patient's total energy and protein requirements provided by PPN, the incidence of phlebitis and potential cost implications associated with the use of PPN. RESULTS: 139 patients (62.6% male), median age 62 years (IQR (interquartile range) 48-74) were enrolled. Most patients had an emergency admission (80.6%) under a general surgical team (84.2%). Forty-eight patients (34.5%) were malnourished, as assessed by the Subjective Global Assessment tool (SGA). Patients fasted for a median of 3 days (IQR 2-5) before PPN commencement, with a median duration of PPN use of 3 days (IQR 2-4). PPN provided an average of 61.6% of the patients' required caloric intake and 46.4% of protein requirements. Progression to TPN was observed in 34.5% of patients. There were low rates of complications with phlebitis observed in 3.7%, extravasation in 1.1%, and no patients developed septicaemia, despite suboptimal compliance with the recommended cannula management guidelines for PPN (66.4% compliant). The cost of PPN was estimated to be AUD$187 per patient day. CONCLUSION: PPN is an effective short-term nutrient delivery solution to facilitate early feeding with small numbers of patients requiring transition to TPN. PPN was safe with low rates of cannula complications. Costs were favourable, with potentially significant cost savings as compared with TPN.

Retinal Periphlebitis May Be a Marker for Subphenotype in Multiple Sclerosis.

Retinal periphlebitis (RPP) is a long-known entity in patients with multiple sclerosis (MS) and has not been revisited in the context of recent developments in MS pathogenesis and heterogeneity. We present six cases of RPP in three female and three male MS patients. They all have relapsing-remitting MS and did not have or had minor ocular symptoms. It is important to perform a thorough retinal examination in patients with MS, as peripheral and sectorial lesions could be unseen. A better knowledge on the concomitant involvement of retinal veins contributes to the understanding of immunopathology, with potentially distinct autoantigenic targets. RPP might serve as a subphenotype marker that may influence treatment choices in MS. Further research is needed.

The safety of intravenous peripheral administration of 3% hypertonic saline: A systematic review and meta-analysis.

BACKGROUND: Three percent hypertonic saline (3% HTS) is used to treat several critical conditions such as severe and symptomatic hyponatremia and increased intracranial pressure. It has been traditionally administered through a central venous catheter (CVC). The avoidance of peripheral intravenous infusion of 3% HTS stems theoretically from the concern about the ability of the peripheral veins to tolerate hyperosmolar infusions. The aim of this systematic review and meta-analysis is to assess the rate of complications associated with the infusion of 3% HTS using peripheral intravenous access. METHODS: We conducted a systematic review and meta-analysis to assess the rate of complications related to the peripheral infusion of 3% HTS. We searched several databases for available studies that met the criteria until February 24th, 2022. We included ten studies conducted across three countries examining the incidence of infiltration, phlebitis, venous thrombosis, erythema, and edema. The overall event rate was calculated and transformed using the Freeman-Tukey arcsine method and pooled using the DerSimonian and Laird random-effects model. I2 was used to evaluate heterogeneity. Selected items from Newcastle-Ottawa Scale2 were used to assess the risk of bias in each included study. RESULTS: A total of 1200 patients were reported to have received peripheral infusion of 3% HTS. The analysis showed that peripherally administered 3% HTS has a low rate of complications. The overall incidence of each of the complications was as follows: infiltration 3.3%, (95% C.I. = 1.8-5.1%), phlebitis 6.2% (95% C.I. = 1.1-14.3%), erythema 2.3% (95% C.I. = 0.3-5.4%), edema 1.8% (95% C.I. = 0.0-6.2%), and venous thrombosis 1% (95% C.I. = 0.0-4.8%). There was one incident of venous thrombosis preceded by infiltration resulting from peripheral infusion of 3% HTS. CONCLUSIONS: Peripheral administration of 3% HTS is considered a safe and possibly preferred option as it carries a low risk of complications and is a less invasive procedure compared to CVC.

Status of Phlebitis in South Korean Hospitals: Focusing on Electronic Incident Reporting Systems.

Peripheral venous catheterization (PVC) is the most commonly used invasive technique, and its importance to patient safety is increasing. And phlebitis is a common complication which can lead to increased costs and extended hospital stays. This study attempted to characterize the current status of phlebitis based on incident reports in the Korea Patient Safety Reporting & Learning System. This retrospective descriptive study analysed 259 phlebitis cases reported in that system from 1 July 2017 to 31 December 2019. The analysis results were summarized using numbers and percentages or means with standard deviations. Among the reported phlebitis cases, antibiotics and high-osmolarity fluids comprised 48.2% of the intravenous inflammatory drugs used. All reported cases presented blood-flow infections. Insufficient observation or management was the most common cause of phlebitis. It was found that interventions for phlebitis were inconsistent with those recommended in evidence-based guidelines. Recommendations for nurses to alleviate complications in PVC must be promoted and educated. It is necessary to provide feedback from the incident reports analysis.

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.

Implementation of Evidence-Based Practice in Peripheral Intravenous Catheter Care.

BACKGROUND: Inserting a peripheral intravenous (PIV) catheter is a common health care procedure; however, risks include phlebitis, extravasation, and accidental dislodgement. Using evidence-based practices (EBPs) can reduce these risks. PURPOSE: The purpose of this study was to implement an evidence-based PIV catheter care bundle and a decision-making algorithm. METHODS: A quasi-experimental study design was used. A care bundle and an evidence-based decision-making algorithm were implemented on a medical unit. Outcomes included length of PIV catheter dwell time, phlebitis and other complications, and health professionals' adherence to the interventions. RESULTS: A total of 364 PIV catheters were assessed. PIV catheter dwell time decreased from 3.6 to 2.9 days ( P < .001), and phlebitis rates decreased from 14.8% to 4.9% ( P < .05). Health professionals' adherence increased from 84.3% to 91.8%. CONCLUSIONS: Implementing EBPs can improve care provided to patients with PIV catheters.

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.

Fracture of an Intravenous Cannula in the Hand: A Case Report.

BACKGROUND: Intravenous cannula insertion is important, given that it is the most common invasive procedure in the emergency department for blood sampling, fluid resuscitation, and intravenous drug administration. Complications of intravenous catheterization include pain, phlebitis, extravasation, inflammation, and embolization. Fracture of an intravenous cannula is rare, but delayed removal may result in secondary damage, such as vasculitis or embolization, with critical consequences. Here, we report a case of intravenous cannula fracture that occurred in our emergency department. CASE PRESENTATION: A 63-year-old woman with a history of left ovarian cancer visited our emergency department owing to poor oral intake and general weakness. Intravenous catheterization using an 18 gauge cannula was attempted for intravenous fluid administration by a skilled operator, but it failed owing to collapsed veins and poor skin condition. After several attempts, a vein in the patient's hand was ruptured, and the patient complained of severe pain. The cannula was removed, but one-third of the cannula tip could not be seen. X-ray imaging was performed to locate the fragment of the cannula, and venotomy was performed for removal of the foreign body in the emergency department. CONCLUSION: Emergency physicians and nurses should be vigilant about potential risk factors that can cause fracture of an intravenous cannula, and after the fracture is discovered, rapid removal of the cannula tip should be performed in the emergency department.

Incidence and type of peripheral intravenous catheter complications documented in hospitalised dogs.

OBJECTIVE: To report the incidence and type of peripheral intravenous catheter complications in hospitalised dogs. METHODS: A prospective, observational trial was performed. Peripheral intravenous catheters were monitored for complications. Complications were documented and classified as extravasation, phlebitis, dislodgement, occlusion and line breakage. If phlebitis was present, the Visual Infusion Phlebitis Scale was used to assign a grade (0 to 5). Fisher's exact test was used to compare the type of complications between the critical care unit and the intermediate care unit. A univariate logistic model was used to compare the incidence of complications between the critical care unit and the intermediate care unit and adjusted odds ratios were used to compare the groups. RESULTS: The incidence of peripheral intravenous catheter complications was 24.2% in the Critical Care Unit and 13.1% in the Intermediate Care Unit, with an overall incidence of 19.9%. Phlebitis was the most common peripheral intravenous catheter complication in the Critical Care Unit, and line breakage was the most common complication in the Intermediate Care Unit. Length of hospitalisation and weight had a significant effect on the likelihood of complication. In a multivariable logistic regression model, the odds of a peripheral intravenous catheter complication was not significantly higher in CCU than IMCU, accounting for length of hospitalisation and weight (adjusted odds ratio, 1.84; 95% confidence interval, 0.98 to 3.48). CLINICAL SIGNIFICANCE: Peripheral intravenous catheter complications are common in hospitalised dogs and may result in an increased expense for owners, failure to deliver prescribed treatments, venous depletion (lack of peripheral vessels for intravenous catheter placement) and pain experienced by the patient. Techniques to reduce peripheral intravenous catheter complications should be further evaluated and may include the use of peripheral intravenous catheter placement and maintenance checklists, use of force-activated separation devices, or patient sedation.