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PubMed1987

The natural history of Teflon catheter-associated phlebitis in children.

During a prospective evaluation of intravenous therapy with peripheral Teflon catheters in children, we found 30 episodes of phlebitis (10.4%). This rate is less than that reported in adults. Catheter colonization was not related to phlebitic episodes, and catheter-related infections did not occur. No patient's hospital course was prolonged because of phlebitis. Thirty percent of the episodes developed after the catheter was removed, and premonitory symptoms were not helpful in predicting the onset of phlebitis. Factors associated with an increased phlebitic risk were parenteral nutrition, administration of nafcillin sodium or aminoglycosides, and patient age. Parenteral nutrition prolonged the course of phlebitis. No factors hastened the onset of phlebitis. The duration of cannulation was not significantly related to phlebitis, suggesting that in some children the catheters can remain in place longer than 72 hours.

Adolescent↗
PubMed1990

Three-phase study of phlebitis in patients receiving peripheral intravenous hyperalimentation.

We found clinical phlebitis in 57 of 88 patients with peripheral hyperalimentation (65%). To determine if this was a problem common to all intravenous fluid therapy at our hospital, we performed a point-prevalence study. The prevalence of phlebitis in nonhyperalimentation intravenous patients was 18% (84 of 456 patients). We then performed a randomized, prospective, double-blind trial of sham versus standard in-line filters to determine if bacteria or filterable particulate matter was responsible for phlebitis in the peripheral hyperalimentation group. The standard-filter group had a phlebitis rate of 74% compared with 64% in the sham-filter group. We then eliminated in-line filters and replaced the standard glucose-based solution with a glycerol-based peripheral hyperalimentation solution. The phlebitis rate decreased from 68% to 27% (p less than 0.001). In conclusion, phlebitis in peripheral hyperalimentation patients was probably due to chemical properties of the peripheral hyperalimentation solution rather than bacteria or particulates.

Amino Acids↗
PubMed2000

Enterocolic (lymphocytic) phlebitis: a rare cause of intestinal ischemic necrosis: a series of six patients and review of the literature.

Vasculitis of the gastrointestinal tract is known to occur as part of a systemic process but also may be present in a localized form involving only the digestive tract. We report the clinical and pathologic findings of six patients with intestinal ischemia and necrosis resulting from localized phlebitis associated with fresh and/or organized thrombosis of intramural mesenteric veins. None of the patients showed clinical or laboratory evidence of systemic vasculitis. In all cases the arteries were not involved in the inflammatory process. Follow up ranged between 2 and 15 years without recurrence necessitating reoperation. This form of intestinal phlebitis is described in the literature under different terms but lymphocytic phlebitis, granulomatous phlebitis, necrotizing phlebitis, and myointimal venous hyperplasia are probably morphologic variants of the same entity. We propose to unify the nomenclature and to use for this unusual clinicopathologic entity only the generic term of enterocolic (lymphocytic) phlebitis.

Abdomen, Acute↗
PubMedDate not supplied

Reducing infusion phlebitis in Singapore hospitals using extended life end-line filters.

Two studies were conducted to investigate the impact of the 4-day end-line filter used to treat infusion phlebitis in Singapore. In the first study, conducted in 1997, 200 patients received IV antibiotics and chemotherapy. In the first 100 patients, end-line filters were not used during the infusions. This resulted in a phlebitis rate of 31%. In the second group of 100 patients, end-line filtration was used, resulting in a phlebitis rate of 5%. In 2000, a second study was conducted, measuring the outcome of end-line filtration versus no end-line filtration use. In this case, phlebitis developed in 35% of 100 patients receiving antibiotics, as compared with 8% of 394 patients with the use of 4-day end-line filtration. These are the first such studies performed in Southeast Asia that highlight identical benefits, namely the reduction of phlebitis by elimination of particulates, in two separate patient populations. End-line filtration, when used to deliver antibiotics and chemotherapy, will result in significantly fewer cases of infusion phlebitis, reduce the cost of delivering IV antibiotics and chemotherapy, increase nursing efficiency, and ultimately improve patient comfort.

Equipment Design↗
PubMed2006

Enterocolic lymphocytic phlebitis: statistical analysis of histology features in viable and ischemic bowel.

Enterocolic lymphocytic phlebitis is a rare cause of segmental ischemic enterocolitis. This artery-sparing transmural vasculitis is classically a circumferential phlebitis with perivenular lymphocyte cuffing and thrombi in the absence of systemic manifestations. Myointimal hyperplasia may represent a chronic phase of enterocolic lymphocytic phlebitis. Subclinical or early stage enterocolic lymphocytic phlebitis is not well delineated. We analyzed 600 submucosal and subserosal veins from both ischemic and intact bowel segments to discern if vascular morphology varied between sites. Crescentic and circumferential lymphocytic phlebitis is more common in viable bowel than in the ischemic segment. A nonsignificant trend was found for increased crescentic morphology between intact bowel remote from the ischemic focus compared with that adjacent to the ischemic focus. Hallmarks of ischemic bowel are necrotizing phlebitis and thrombi formation. Thrombophlebitis morphology is distinctly different in viable and ischemic bowel, changing from the classic lymphocytic to necrotizing lesions respectively.

Adult↗
PubMedDate not supplied

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.

Causality↗
PubMed2004

[Phlebitis in children].

UNLABELLED: The authors' objectives are to determine the occurrence of phlebitis in patients hospitalized in the General Pediatrics Unit and to define the possible factors associated to its development. The authors carried out a prospective study in the "Sant Joan de Deu" Hospital in Barcelona during the month of July and from the 15th of September until the 15th of October in 2002. A one variant and two variant analysis using the chi squared method as the basis for estimating which associations took place. There were 153 patients admitted having 201 peripheral veins canalized; occurrence of phlebitis was 8.4%; a venous cord (53%) was the most frequent clinical sign. In cases of phlebitis, the back of a patient's hands (64.7%) was the main spot to make an insertion using a 22G "Vasocán" catheter (70.6%). Phlebitis appeared 2 days after insertion; the high number of antibiotics administered increased the risk of phlebitis (p>0.05). CONCLUSION: Phlebitis is a frequent problem in pediatrics patients having endo-venous treatment, susceptible to prevention by means of the implementation of control measures and a program of continuous vigilance.

Catheterization, Peripheral↗
PubMed1996

Prospective study of the aetiology of infusion phlebitis and line failure during peripheral parenteral nutrition.

Four techniques of administering peripheral parenteral nutrition (PPN) were examined prospectively to investigate the role of mechanical trauma in the development of infusion phlebitis. Patients in group 1 (n = 15) were fed via a standard 18-G Teflon cannula which was removed on completion of the infusion and was rotated to the contralateral arm every day. Group 2 patients (n = 15) had a similar catheter sited in each forearm simultaneously, with rotation of the side of infusion each day. Patients in group 3 (n = 17) had a 15-cm Silastic rubber catheter inserted into a forearm vein and a standard cannula sited in the contralateral forearm, with alternation of infusion each day. Those in group 4 (n = 13) had a fine-bore 23-G silicone catheter sited in one arm only. Patients in groups 1, 2 and 3 were fed over 12-h cycles and those in group 4 for a 24-h continuous cycle. A total of 408 patient-days of PPN were given. Mean duration of PPN in groups 1-4 was 7.5, 9, 5.5 and 5 days respectively. Infusion phlebitis was not recorded in patients who had a daily change of cannula (group 1), but occurred in four patients in group 2, eight in group 3 and eight in group 4. Phlebitis scores were 0, 9, 15 and 12 for groups 1-4 respectively. Severe phlebitis and line occlusion occurred more frequently in patients with a 15-cm catheter (group 3) and in those fed continuously over 24 h (group 4). These results suggest that mechanical trauma is an important factor in the aetiology of infusion phlebitis. This can be minimized by reducing the time for which the vein wall is exposed to nutrient infusion and by reducing the amount of prosthetic material within the vein.

Adult↗
PubMed2003

Prediction of precipitation-induced phlebitis: a statistical validation of an in vitro model.

To avoid phlebitis, new intravenous (IV) parenterals are often screened by injection into animals. This method is not only expensive and time consuming, it is also detrimental to the animals. An alternate method, focusing on precipitation as the cause, uses an in vitro dynamic injection model that requires less money and time and reduces the need for live models. Validation of the dynamic injection apparatus, for predicting mechanical phlebitis, is established. Twenty-one currently marketed IV products were injected into isotonic Sorenson's phosphate buffer flowing at 5 mL/min. The resulting opacities, produced by precipitation, are measured in an ultraviolet flow cell. These opacity data, coupled with literature reports on phlebitis occurrence, were used to generate a logistic regression that indicates the probability of phlebitis given an opacity value measured by the apparatus. Regression results are supported by a receiver operator characteristic curve that establishes the most ideal cut-off opacity value. This opacity value provides the highest combined sensitivity (statistical power) and specificity while minimizing false-positive and false-negative results. Both analyses show that an opacity value of 0.003 best delineates phlebitic and nonphlebitic products. Measures of sensitivity (0.83), specificity (0.93), positive predictive value (0.93), and negative predictive value (0.78) indicate the model's predictive accuracy and reliability. These results support the use of the dynamic model in place of animals for preliminary phlebitis testing of new IV injectables.

Chemical Precipitation↗
PubMed1995

Effect of pH on injection phlebitis.

Formulation pH has been reported to be responsible for the incidence of phlebitis. In this study, the effect of pH on injection phlebitis is investigated. Buffers of varying pHs were examined for their ability to produce phlebitis in rabbits. Thermal measurements as well as visual evaluations were used for phlebitis quantitation. The results show that formulation pH between 3.0 and 11.0 does not contribute to the incidence of phlebitis when administered as an iv bolus injection.

Animals↗
PubMed1999

Topical heparin for the treatment of acute superficial phlebitis secondary to indwelling intravenous catheter. A double-blind, randomized, placebo-controlled trial.

OBJECTIVE: To assess the clinical efficacy of a topical gel containing 1000 IU x g(-1) of heparin, applied three times daily for a maximal period of 7 days to patients with acute superficial phlebitis secondary to indwelling intravenous catheter. METHODS: A Double-blind, randomized, placebo-controlled study was conducted in one of the internal medicine wards of a tertiary General Hospital in Barcelona, Spain. Inpatients of both genders over 18 years of age that developed superficial phlebitis and gave informed consent were included in the study. The sample size estimation was 132 patients. Sixty-six patients were allocated to each group. There were five protocol deviations and 24 withdrawals in the intervention group, and one protocol deviation and 25 withdrawals in the control group. Consequently, 37 patients in the intervention group and 40 in the control group completed the trial. The main outcome measure was the disappearance of the symptoms and signs of superficial phlebitis. Clinical course, investigator's global impression and adverse events were also recorded. RESULTS: According to the intention-to-treat analysis, after treatment for 7 days superficial phlebitis healed in 27 of the 61 patients (44.3%) who received topical heparin, and in 17 of the 65 patients (26.1%) receiving placebo, giving a relative risk [95% confidence interval (CI)] of 1.69 (1.03-2.78). This indicates that six patients (95% CI, 3-72) have to be treated in order to induce one additional healing. The clinical course and the overall clinical impression were similar in both groups. One patient treated with topical heparin developed mild urticaria. CONCLUSION: Topical heparin is safe and effective for the treatment of superficial phlebitis secondary to indwelling intravenous catheter.

Administration, Topical↗
PubMed1979

Septic phlebitis: a neglected disease.

A review of 100 patients with peripheral septic phlebitis revealed that 54 per cent of the cases were due to intravenous catheters and 46 per cent were secondary to drug abuse. Eighty per cent of the involved veins were in the arm or neck. Pain was the most common symptom (83 per cent), with erythema and edema the most common physical signs (63 per cent). Eighty per cent of the causative organisms were gram-positive bacteria, usually Staphylococcus aureus (41 per cent) or Group A streptococcus (20 per cent). Complications were more common if septic phlebitis was due to intravenous therapy than drug abuse. No deaths were directly attributed to septic phlebitis. However, hospital stay after development of septic phlebitis was 14 days with a 56 per cent complication rate. The initial treatment of septic phlebitis should include prompt removal of the intravenous device, antibiotics, heat, and elevation. Because serious complications occur in a significant number of patients, operative excision of the involved vein should be performed if clinical deterioration occurs or if septicemia persists after 24 hours despite conservative therapy.

Arm↗
PubMed1997

Nodular granulomatous phlebitis of the skin: a fourth type of tuberculid.

We present five cases of granulomatous phlebitis of the skin and compare them with a case of miliary tuberculosis with granulomatous phlebitis. All five patients were hypersensitive to purified protein derivative, but without active tuberculosis. Although anti-tuberculous drugs were effective, no tubercle bacilli were isolated from the skin. Clinically, subcutaneous nodules were felt along the course of the leg vein. Histologically, epithelioid cell granulomas with Langhans' giant cells were observed within the walls of the cutaneous veins. In a later stage, granulomatous panniculitis was often associated. Using the polymerase chain reaction method. Mycobacterium tuberculosis DNA was detected in four of the five cases of granulomatous phlebitis of the skin. Granulomatous phlebitis of the skin seems to represent a relatively early phase of delayed-type hypersensitivity reactions to Mycobacterium tuberculosis and may represent a distinct entity different from other types of tuberculid-a new tuberculid. Nevertheless, before making the diagnosis, the possibility of true tuberculosis must always be excluded. Nodular granulomatous phlebitis of the skin would be an appropriate name for the newly described condition.

Aged↗
PubMed2001

Arcuate and interlobular phlebitis in renal allografts.

Intimal arteritis in the renal allograft has a well-documented adverse effect on graft outcome. In contrast, venulitis is currently considered an innocuous finding, based largely on observations of thin-walled intermediary venules. Arcuate and interlobular veins have not been studied specifically. These veins have well-developed muscular walls, and inflammation at this level (phlebitis) could significantly alter renal hemodynamics. We studied the clinicopathologic correlates of arcuate and interlobular phlebitis in 31 renal allograft biopsy specimens. Phlebitis was seen in conjunction with borderline changes suggestive of acute cellular rejection (13 cases), or acute rejection Banff grade 1A (7 cases), Banff grade 1B (6 cases), Banff grade 2A (4 cases), and Banff grade 2B (1 case). Clinical follow-up (average 323 +/- 460 days) showed no adverse effects of phlebitis as judged by temporal changes in serum creatinine and the grade of chronic allograft nephropathy in follow-up biopsies. Thus it appears that arcuate and interlobular phlebitis in allograft biopsy specimens does not add prognostic information beyond that provided by conventional Banff criteria. However, this lesion frequently coexists with changes suggestive or diagnostic of acute cellular rejection, and intimal arteritis may be seen concurrently in up to 16% of cases.

Female↗
PubMed1985

Effect of filtering amphotericin B infusions on the incidence and severity of phlebitis and selected adverse reactions.

This study evaluated the effectiveness of filtering amphotericin B (ampho B) on the incidence and severity of drug-related complications. Fifteen males receiving ampho B via peripheral vein infusion participated in this randomized, double-blind study. Each patient had his dose of ampho B diluted in 500 ml of dextrose 5% in water, to which hydrocortisone 25 mg was admixed and infused over four to six hours. Eight patients had their ampho B infusions filtered through a 1 micron filter after preparation, while seven patients did not have their ampho B infusions filtered. Patients were evaluated daily for phlebitis and selected adverse effects. The two groups were comparable with regard to diagnosis, concomitant drugs, cannula type and size, vein selection, and frequency of iv site change. Four patients in each group developed phlebitis. Statistical testing using the Mann-Whitney U test revealed no difference between groups with regard to patient age, dose of ampho B, frequency and severity of phlebitis, time to onset of initial phlebitis, and frequency of adverse effects (fever, chills, headache, nausea, vomiting, and anorexia). Filtration of ampho B infusions using a 1 micron filter does not appear to decrease the incidence or severity of phlebitis and associated adverse effects.

Adult↗
PubMed2000

Transdermal nitroglycerin for the prevention of intravenous infusion failure due to phlebitis and extravasation.

OBJECTIVE: To evaluate the clinical use of transdermal nitroglycerin for the prevention of intravenous infusion failures due to phlebitis or extravasation. DATA SOURCES: Clinical literature was accessed through a MEDLINE search (1966-May 2000). Key search terms included nitroglycerin, transdermal, phlebitis, extravasation, intravenous, and infusion. DATA SYNTHESIS: Common and serious consequences of intravenous therapy include the occurrence of postinfusion phlebitis and failure to maintain intravenous therapy due to intravenous fluid extravasation. Transdermal application of nitroglycerin has been evaluated as a treatment and preventive method for intravenous infusion failures related to phlebitis or extravasation. An evaluation of studies focusing on transdermal nitroglycerin in the prevention of infusion failures due to phlebitis or extravasation was conducted. CONCLUSIONS: Use of transdermal nitroglycerin as a prophylactic measure for intravenous infusion failures is a therapeutic option for patients requiring long-term intravenous therapy (i.e., > 50 h).

Administration, Cutaneous↗
PubMedDate not supplied

[General surgeon's approach to deep phlebitis of the leg].

The therapeutic problems of the general surgeon, faced with a case of deep phlebitis of the lower limbs, differ according to whether it is diagnosed before or after surgery. If possible, pre-surgical phlebitis should be treated before the operation. Heparinotherapy remains the basic treatment. But there are numerous arguments against, or for the modification of, its use : old age, haemorrhagic lesions, haemorrhagic risks during surgery, or simply great operational urgency. In all these cases, an elastic bandage is invaluable. Treatment of post-operative phlebitis is also based on the heparins, combined if necessary with antibiotics and corticoids, but these products can result in iatrogenic complications (ulcers, haemorrhage). It is often difficult to choose between embolic and haemorrhagic risks ; it is always easy to apply an elastic bandage which suffices in most cases to remove the inflammatory signs of the phlebitis. This problem is not so frequent since systematic prevention has made post-operative phlebitis more rare. The use of anticoagulants in vascular surgery seems to the authors to be not so much an effective therapeutic method as a method to be feaved close surveillance of coagulation is indispensable during treatment.

Aged↗
PubMed1988

Postinfusion phlebitis after intravenous push versus intravenous piggyback administration of antimicrobial agents.

The incidence and severity of phlebitis associated with the i.v. push method versus the i.v. piggyback method of administration of antimicrobial agents were evaluated. All patients admitted to two nursing units of an 886-bed, tertiary-care hospital from March through June 1987 who received intravenous cephalosporins or extended-spectrum penicillins were considered for inclusion in the study. The method of administration, either i.v. push or i.v. piggyback, was randomly assigned. Each patient's catheter site was evaluated every 24 hours according to standardized definitions of phlebitis and patency. Information on each patient and venipuncture site also was collected. A total of 319 catheter sites were studied in 155 patients. There was no significant difference in the incidence or severity of postinfusion phlebitis between the i.v. push and the i.v. piggyback groups (41% versus 47%). When studying only those catheter sites discontinued because of phlebitis, the time until development of phlebitis averaged 45 +/- 20.5 hours in the i.v. push group, compared with only 36.2 +/- 17.6 hours in the i.v. piggyback group; this difference was significant. The fact that the catheter sites lasted significantly longer in the i.v. push group, combined with elimination of the cost of syringe infusion pumps or i.v. tubing and minibags, suggests that use of the i.v. push method may result in substantial cost savings. Other advantages associated with the i.v. push method include time savings for nursing personnel and patients and greater ease in scheduling doses of multiple antimicrobial agents.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗