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PubMedDate not supplied

The role of surgery in the treatment of acute phlebitis in the lower members.

UNLABELLED: Most phlebitis responds favorably to medical treatment. Iliofemoral and iliocaval phlebitis, however, involve considerable risk as they may endanger life (pulmonary embolism), limb (ischemic forms) or the functioning of the limb (severe post-phlebitic syndromes). Because of this triple risk it is important to be able to judge when to opt for surgery. Surgical treatment is called for in cases of certain iliofemoral phlebitis developing in spite of medical treatment. Threat of "blue phlebitis" (acute arterial ischemia); threat of severe post-phlebitis syndrome (the thrombosed iliac veins do not easily recover their permeability); threat to life (iliac thromboses producing mortal embolism). These three risks justify emergency phlebography. The aims, means and limitations of surgery. 1. Aim - to maintain the permeability of the femoro-ilio-caval venous axis and to avoid pulmonary embolism. 2. Methods - Thrombectomy is done at the level of the femoral vein using Fogarty's catheter and Esmarch's bandage; this is carried out at an early stage (5 first days). A De W. clamp may be positioned at the level of the vena cava (in case of preexisting pulmonary embolism or incomplete thrombectomy). 3. INDICATIONS: --Phlebitis with ischemia. --Recent severe phlebitis not responding enough to urgent medical treatment particularly in the cases of young patients. --Clamp used in cases of pulmonary embolism or when threats of embolism are visible on the phlebography (floating clots). 4. MATERIALS: --82 patients were operated between 1970-1978. Phlebography showed: 44 iliofemoral phlebites, 11 femoropopliteal phlebites, 27 iliocaval phlebites. --Arterial affection revealed in the cases of 8 patients, four of which had blue phlebitis. --Pulmonary embolism was the symptom showing iliofemoral phlebitis in 7 cases. 5. OPERATIONS: 42 isolated clamps; 40 thrombectomies (in 15 cases completed by a clamp, in 12 cases by arteriovenous fistula; in 10 cases by treatment of an anomaly of the origin of the left common iliac vein. 6. RESULTS: --Two deaths. --In the long term (average interval = 4 years) the results were excellent in 54% of the cases (no oedema), good in 28% (light compression required), and bad in 8%. Conclusion. Certain iliac phlebites can, we believe, be cured by surgery.

Acute Disease↗
PubMedDate not supplied

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.

Adolescent↗
PubMed1991

A prospective and randomised study comparing the incidence of infusion phlebitis during continuous and cyclic peripheral parenteral nutrition.

Phlebitis is a major obstacle to successful and prolonged peripheral parenteral nutrition (PPN). This study evaluated the effects of elective changes of the intravenous cannula and cyclic infusion of PPN on the incidence and the severity of phlebitis. 51 consecutive patients requiring PPN were randomised into three groups. Group 1 received PPN continuously through a line which was changed only on evidence of phlebitis. In Group 2 intravenous lines were changed every 24h. Group 3 patients received PPN as a 12-h infusion after which the intravenous cannula was withdrawn. All patients received 1800 non-protein calories and 9.4g nitrogen daily. Infusion sites were assessed daily for phlebitis and this was scored using a modified Maddox scale. The mean (range) duration of PPN was 7.5 (1-13), 10.0 (2-42) and 8.2 (3-14) days in the three groups respectively. Severe phlebitis occurred more frequently (p < 0.05) in Group 1 compared to Group 2 or Group 3. The overall incidence of phlebitis assessed from the mean value of the Maddox scores for each group was highest in Group 1 and was significantly greater than that observed in either Group 2 (p < 0.05) or Group 3 (p < 0.001). Group 3 patients who received cyclic PPN had the lowest incidence of phlebitis. The results of this study suggest that the incidence of infusion phlebitis is minimised during PPN by the cyclic infusion of nutrient solutions.

Journal Article↗
PubMed1991

Peripheral venous nutrition: the equal relevance of volume load and osmolarity in relation to phlebitis.

This study aimed to investigate the peripheral vein tolerance for total parenteral nutrition (TPN) and to point out the factors which induce phlebitis. TPN was administered from 'all-in-one' bags. Five different types of TPN were investigated, wherein the amounts of amino-acids, dextrose, lipids, osmolarity and volume were varied. Type I (829 mOsm/l) was a low energy (1570 NPE kcal) nutritive mixture of 2425 ml with 9.5 g N. Type II (842 mOsm/l) was an intermediate energy (1800 NPE kcal) mixture of 2525 ml with 9.5 g N. Type III (860 mOsm/l) contained 1800 NPE kcal and 13.5 g N in 2775 ml. Type IV (790 mOsm/l) was only a dilution of Type III with 250 ml water. Type V (1044 mOsm/l) covered normal energy needs (2000 NPE kcal) and 13.5 g N in 2580 ml. All bags contained standard amounts of electrolytes, vitamines, trace elements and heparin (1.000 IE/l). The infusion site was not changed until phlebitis developed or oral feeding could be started. Type I, II, III and IV were given to at least 30 patients, and Type V to only 11 patients because of an unacceptable high phlebitis rate (91% after 2.8 days). The phlebitis rate for Type I, II, III and IV was 4%, 12%, 24% and 27% respectively after 48h increasing to 14%, 37%, 55% and 73% respectively after 14 days. The mean infusion time and phlebitis rate were related to each component of the nutritive mixture. A poor relation was found between the phlebitis rate and the amount of amino-acids, dextrose or lipid respectively. Both osmolarity (with variabl volume) and volume (with variable osmolarity) correlated poorly with the phlebitis rate (r = 0.37 and 0.29 respectively). However, the osmolarity rate, defined as the number of milliOsmols infused per hour, correlated well with the phlebitis rate (r = 0.95). Our results demonstrate that the peripheral route can be used as a practical alternative for central venous administration, if the osmolarity rate is limited.

Journal Article↗
PubMed2006

Prospective surveillance of phlebitis associated with peripheral intravenous catheters.

BACKGROUND: Guidelines have been published for prevention of phlebitis associated with peripheral intravenous catheters (IVC), but this complication continues to occur. We sought to determine the rate of phlebitis associated with peripheral IVCs to identify predictors for phlebitis and to isolate pathogenic bacteria from phlebitic catheter tips. METHODS: Nine-point prevalence studies were conducted during the years 1996-2003 of all hospitalized patients with a peripheral IVC. During the last 3 surveys, conducted in 2003, phlebitic lines were removed, and, for each line, 1 to 2 nonphlebitic lines, in place for 48 to 72 hours, were removed and cultured as controls. In between these surveys, findings and guidelines for improvement were distributed to the staff. RESULTS: During these surveys, 40% +/- 8% of hospitalized patients had a peripheral IVC. The rate of peripheral IVC-associated phlebitis decreased from 12.7% (20/157) in 1998 to 2.6% (5/189) in 2003 (P < .01). Factors significantly associated with phlebitis included pain (P < .001), presence of the catheter for longer than 3 days (P < .05), and cleanliness of the dressing (P < .01). CONCLUSION: The rate of phlebitis associated with peripheral intravenous catheters decreased significantly throughout the study period. The identification of predictors for phlebitis and the dissemination of this information in an educational drive may have contributed to this improvement.

Adult↗
PubMed2003

Nurses' knowledge regarding patients with intravenous catheters and phlebitis interventions.

This study was planned and applied in 2 stages. Stage I was applied to determine the knowledge of nurses working in the internal medicine, surgery, obstetrics and gynecology, pediatrics, and other services in Celal Bayar University Hospital about using intravenous catheter and intravenous fluid treatment, and the symptoms and treatment procedure for phlebitis. Stage II consisted of observation of all patients who had intravenous catheters for symptoms of phlebitis for 5 days and the interventions the nurses used for the patients who had phlebitis. In stage I, questionnaires were used to determine the knowledge of the nurses; in stage II, 2 investigators observed the patients. Results were evaluated using SPSS software with chi(2) statistical analysis. Nurses were found to have high knowledge levels, but their practices were not suitable to their knowledge levels. Of the patients who participated in the study, 67.24% showed symptoms of phlebitis. We found that there was a significant relationship (P <.05) between the selection of the vein and the occurrence of phlebitis in patients who had an intravenous catheter. We also found that the relationships between the age groups of the patients and phlebitis and the relationships between the diagnosis and phlebitis were statistically significant (P <.05).

Adolescent↗
PubMed2002

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.

Adult↗
PubMed1997

The risk of peripheral vein phlebitis associated with chlorhexidine-coated catheters: a randomized, double-blind trial.

OBJECTIVE: To evaluate the risk of phlebitis associated with chlorhexidine-coated polyurethane catheters in peripheral veins. DESIGN: A randomized, double-blinded trial comparing chlorhexidine-coated polyurethane catheters with uncoated polyurethane catheters. SETTING: A university hospital. PATIENTS: Adult medicine and surgery patients. INTERVENTIONS: Certified registered nurse anesthetists or an infusion team consisting of nurses and physicians inserted the catheters. Catheter insertion sites were scored twice daily for evidence of phlebitis. At the time catheters were removed, a quantitative blood culture was performed, and catheters were sonicated for quantitative culture. RESULTS: Of 221 evaluable catheters, phlebitis developed in 18 (17%) of 105 coated catheters, compared to 27 (23%) of 116 uncoated catheters (relative risk [RR], 0.74; 95% confidence interval [CI95], 0.43-1.26; P = .32). By survival analysis, chlorhexidine-coated catheters had a lower risk of phlebitis during the first 3 days (P = .06), but not when all catheters were considered in both patient groups (P = .31). In the absence of catheter colonization, the incidence of phlebitis was 21% (16/76) and 24% (20/86) for coated and uncoated catheters, respectively (P = .85), whereas in the presence of catheter colonization, the incidence of phlebitis was 14% (1/7) and 80% (4/5) for coated and uncoated catheters, respectively (RR, 0.18; CI95, 0.03-1.15; P = .07). CONCLUSION: The risk of phlebitis in the presence of catheter colonization was 82% lower for chlorhexidine-coated polyurethane catheters compared to otherwise identical uncoated catheters.

Adult↗
PubMed2004

Recurrent infusion phlebitis induced by cyclosporine.

OBJECTIVE: To report a case of recurrent infusion phlebitis during cyclosporine treatment, which, as of October 14, 2004, is a previously unreported adverse effect of this drug. CASE SUMMARY: A 28-year-old man previously diagnosed with ulcerative colitis was admitted to the internal medicine department due to exacerbation of the condition and treated with intravenous hydrocortisone, followed by treatment with intravenous cyclosporine. During this treatment, the patient experienced quick, recurrent, and significant infusion phlebitis. The intravenous catheter and its site needed to be replaced repeatedly during the continuum of treatment, eventually leading to complete remission of the ulcerative colitis. After 8 months, the patient was still in remission, with no permanent signs of damage to the involved phlebitic veins. DISCUSSION: Infusion phlebitis induced by drugs is a common phenomenon that causes pain and difficulty in a patient's treatment. Many drugs, mainly antibiotics and cytotoxic drugs, have previously been reported to induce infusion phlebitis. We describe the first report of a patient with cyclosporine-induced recurrent infusion phlebitis. According to the Naranjo probability scale, the relationship of the encountered phlebitis to cyclosporine therapy is probable. CONCLUSIONS: Recurrent infusion phlebitis is a previously unreported adverse effect encountered during treatment with cyclosporine. This important adverse effect must be considered when treating patients with this unique drug.

Adult↗
PubMed1999

Infusion phlebitis in patients with acute pneumonia: a prospective study.

STUDY OBJECTIVES: To prospectively assess the relative risk for phlebitis in a series of consecutive patients with pneumonia and to identify risk factors that predict an increased risk for phlebitis. SETTING: Internal medicine department of a tertiary teaching hospital. PATIENTS: Seven hundred sixty-six consecutive patients with acute pneumonia receiving IV therapy. INTERVENTIONS: Only the first catheter was taken into account. There were 308 short lines (a 51-mm, 18-gauge Teflon catheter); 307 midsized lines (a 28-cm, 16-gauge polyvinyl chloride catheter); and 151 long lines (71-cm, 14-gauge plain polyurethane catheter). Eighteen variables were prospectively evaluated in an open, nonrandomized study for their contribution to the occurrence of phlebitis. RESULTS: The overall phlebitis rate was 39%. Phlebitis developed in 53% of patients with short lines, in 41% of patients with midsized lines, and in 10% of patients with long lines, and these catheters remained in place an average (+/- SD) of 3.0+/-2.4 days, 4.6+/-3.4 days, and 7.8+/-6.6 days, respectively. The variables that influenced the development of phlebitis, as determined by multivariate analysis, were the following: type of catheter; blood hemoglobin levels; and IV therapy with either corticosteroids or erythromycin. CONCLUSIONS: According to our data, when the use of a catheter is expected to be required for < or = 36 h, a short line can be used. If a longer duration is expected, a longer line is warranted. Ours is the first study in which the relationship between blood hemoglobin levels and phlebitis has been reported. Because the use of intravascular devices is increasingly common, a more complete knowledge of the factors that influence their acceptance has become essential.

Acute Disease↗
PubMedDate not supplied

Effect of two different short peripheral catheter materials on phlebitis development.

One of the most common causes of phlebitis in hospitalized patients is intravenous catheters. The material of the catheter is a determining factor in the development of phlebitis, as are factors such as age, gender, and medical diagnosis of the patient. The aim of this study, conducted in the coronary care unit of a 384-bed hospital in Ankara, Turkey, was to determine the effect of two different short peripheral catheters on phlebitis development caused by i.v. treatment. Overall, 255 patients constituted the study sample (130 with Teflon, 125 with Vialon catheters). Both groups were followed up for phlebitis development for 6 days. The total phlebitis rate was 36.8%, with almost half of the patients (49.2%) in the Teflon catheter group and 24.0% of patients in the Vialon catheter group. A significant statistical relationship was found between phlebitis rate and variables such as gender, catheter material, and indwelling time. The results of the study demonstrate that Vialon catheters are associated with less risk of catheter-induced phlebitis than are Teflon catheters.

Adult↗
PubMed1987

Infusion phlebitis associated with a programmable syringe-pump system versus gravity-feed minibottles.

The occurrence of infusion phlebitis in patients receiving intravenous antibiotics via a gravity-feed minibottle system versus a new syringe-pump system was compared. Patients at least 18 years old who had indwelling intermittent injection sites inserted for medication administration were randomized to either the minibottle system or the syringe-pump system. Antibiotics in minibottles were diluted in 50-100 mL of 5% dextrose injection; in the syringe-pump group, aminoglycoside antibiotics were diluted in 0.9% sodium chloride injection and all other antibiotics were diluted in sterile water for injection. Antibiotics were not piggybacked into running primary infusions in any of the study patients, and no other medications except for 0.9% sodium chloride flushes were administered through the catheters. All catheters were inserted in peripheral veins and evaluated for phlebitis by i.v. nurse specialists using standardized criteria. Catheters were changed upon the occurrence of grade 1 phlebitis or after a period of three days without the development of phlebitis. Over an 18-week period, 85 catheter sites (53 syringe-pump group versus 32 minibottle group) were evaluated in 30 patients (14 syringe-pump group versus 16 minibottle group). The mean +/- S.D. catheter life in both groups was 50.6 +/- 20 hours. Phlebitis occurred in 62% of syringe-group sites versus 66% of minibottle-group sites; the incidence and severity of phlebitis were not significantly different between groups. The majority of catheter sites were infused with cefazolin sodium. The potential for phlebitis using the syringe-pump system in this study appears to be similar to that of the gravity-feed minibottle system when appropriate diluents, diluent volumes, and infusion rates are used.

Adult↗
PubMed1986

[Phlebitis of the arm. Apropos of 45 cases].

We report in this retrospective study the data of 45 patients presenting with deep venous thrombosis of the upper extremities. This includes: 22 phlebitis due to strains, 3 traumatic phlebitis, 3 phlebitis combined with an adjacent injury, 7 phlebitis following endovenous therapeutic procedures and 10 spontaneous phlebitis (4 during adjacent medical pathologies), 3 pulmonary embolisms, including a septic one are thus demonstrated. No patient died. The follow-up date of 12 patients out of 32 exhibiting a spontaneous phlebitis or phlebitis due to a thoracic outlet syndrome have been documented: 25 p. 100 of them still presented with severe injuries. All patients underwent heparin therapy, but no fibrinolytic. A surgical procedure of the thoracic outlet syndrome was performed, when liable to the disease. Data of this series was then compared with those of previous reports on the subject.

Adult↗
PubMed1984

The natural history of intravenous catheter-associated phlebitis.

During a controlled evaluation of an intravenous therapy (IVT) team, we had the opportunity to follow up 202 episodes of catheter-associated phlebitis. While the IVT team had a considerable effect on the incidence of phlebitis, the clinical course of this complication was not influenced. More than 40% of catheter-associated phlebitis occurred more than 24 hours after withdrawal of the catheter. Premonitory symptoms were not useful in predicting the development of phlebitis. Factors that influenced the duration of phlebitis included the patient's diagnosis and the administration of vancomycin hydrochloride. The duration of phlebitis was prolonged by delayed removal of the catheter after the development of phlebitis.

Catheterization↗
PubMed1980

Phlebitis associated with the intravenous use of cephapirin and cephalothin in the combination therapy of antibiotics.

Phlebitis related to antibiotic infusion is one of the most frequent causes of morbidity in the debilitated patients with severe infection. There are a number of causes of infusion-induced phlebitis such as pH of intravenous fluid, needle used, and contamination of venipuncture site. Vein used to play an important role, particularly in patients with granulocytopenia receiving intravenous infusion. Cephalothin is an effective antibiotic in the treatment of granulocytopenic infection and is widely used currently. When cephalothin was introduced commercially, the frequency of phlebitis was as high as 50%. The main reason was thought to be acidity of the antibiotic solution. The cephalothin solution used currently is neutral in pH, but prevention of phlebitis is still not perfect. In contrast, cephapirin recently developed cephalosporin antibiotic, which resembles cephalothin in the antimicrobial activity and pharmacological properties caused less phlebitis than cephalothin in initial clinical studies. The patients receiving chemotherapy for malignant diseases frequently die of infections. A cephalosporin antibiotic is administered intravenously for a prolonged time in the presence of thrombocytopenia, and under such circumstances, other antibiotics such as carbenicillin (CBPC) and aminoglycoside are usually used in combination. The influence of these antibiotics injected through the same vein must be considered, but the possibility of phlebitis due to CBPC and aminoglycoside is negligible. In the present clinical study, 24 granulocytopenic patients were treated with the combination of antibiotics, cephapirin-carbenicillin-amikacin and cephalothin-carbenicillin-amikacin. Besides the clinical effect of the antibiotics, the incidence and severity of phlebitis were studied.

Agranulocytosis↗
PubMed1995

Infusion phlebitis in medical and surgical patients in Siriraj Hospital.

A study on infusion phlebitis was done in medical and surgical departments in Siriraj Hospitals from February to April 1992. Two hundred and eighty-one patients and 406 infusion sites were included. The infusion time was 40.6 +/- 31.9 hours. The incidence rate of phlebitis was 25.9%. There was no difference in its occurrence in medical and surgical patients. Dorsum of the hand was the site associated with low incidence and less severe phlebitis. The contrary applied to the forearm and arm. Plastic cannulae were associated with higher incidence, more severe phlebitis than steel needles, but this was not statistically significant. Intravenous antimicrobials were followed by higher incidence and more severe phlebitis. The value of early diagnosis of infusion phlebitis so as to halt its progress was also demonstrated in the study. In no case was the phlebitis, in the most severe form i.e. grade 5, encountered.

Adolescent↗
PubMed1998

[Risk factors for the development of phlebitis in peripheral infusions].

OBJECTIVE: To study the incidence and risk factors of development of phlebitis caused by peripheral infusions. DESIGN: Prospective, descriptive. SETTING: Westindies Hospital, The Hague, the Netherlands. METHODS: For all 348 patients given infusions in a 6-week period the development of phlebitis, if any, and the contributing factors were studied. RESULTS: Phlebitis developed in 136 patients (39%), after an average of 2.9 days (range: 1-14). Risk factors were female sex, earlier phlebitis, insertion on the ventral surface of the forearm and administration of antibiotics via the infusion. These factors were not interdependent. No correlation was found between development of phlebitis and the size of the needle. CONCLUSION: Development of phlebitis depends on a number of factors. Timely removal of the infusion can prevent the development of phlebitis. Infusions should preferably be administered via the hand.

Adolescent↗
PubMed1991

Risk factors for infusion-related phlebitis with small peripheral venous catheters. A randomized controlled trial.

OBJECTIVE: To identify risk factors for infusion-related phlebitis with peripheral intravenous catheters. DESIGN: A randomized trial of two catheter materials, with consideration of 21 potential risk factors. SETTING: A university hospital. PATIENTS: Hospitalized adults without granulocytopenia who received a peripheral intravenous catheter. INTERVENTIONS: House officers or ward nurses inserted the catheters, and each insertion was randomized to a catheter made of tetrafluoroethylene-hexafluoropropylene (FEP-Teflon) or a novel polyetherurethane without leachable additives (PEU-Vialon). MEASUREMENTS: Research nurses scored insertion sites each day for inflammation and cultured catheters at removal. RESULTS: The Kaplan-Meier risk for phlebitis exceeded 50% by day 4 after catheterization. intravenous antibiotics (relative risk, 2.00), female sex (relative risk, 1.88), prolonged (greater than 48 hours) catheterization (relative risk, 1.79), and catheter material (PEU-Vialon: FEP-Teflon) (relative risk, 0.73) strongly predicted phlebitis in a Cox proportional hazards model (each, P less than 0.003). The best-fit model for severe phlebitis identified the same predictors plus catheter-related infection (relative risk, 6.19), phlebitis with a previous catheter (relative risk, 1.54), and anatomic site (hand: forearm, relative risk, 0.71; wrist:forearm, relative risk, 0.60). The low incidence of local catheter-related infection was comparable with the two catheter materials (5.4% [95% CI, 3.8% to 7.6%] and 6.9% [CI, 4.9% to 9.6%]); none of the 1054 catheters prospectively studied caused bacteremia. CONCLUSIONS: Multiple factors, including the infusate and the duration of cannulation, contribute to the development of infusion-related phlebitis. The use of peripheral intravenous catheters made of PEU-Vialon appears to pose the same risk for catheter-related infection as the use of catheters made of FEP-Teflon, and PEU-Vialon can permit longer cannulation with less risk for phlebitis. The risk for catheter-related bacteremia with FEP-Teflon and PEU-Vialon catheters is sufficiently low that it no longer seems justifiable to recommend the use of small steel needles for most peripheral intravenous therapy.

Catheterization, Peripheral↗