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PubMedDate not supplied

[Iatrogenic phlebitis of the upper limb and thoracic outlet syndrome].

Classically, the primary forms of phlebitis of the upper limb due to venous compression in the thoracic outlet have been radically contrasted with the secondary phlebitis, always iatrogenic, occurring after peripheral venipuncture. However, this distinction is perhaps not as clear as all that. In this paper, the authors report 3 cases of iatrogenic phlebitis of the upper limb. In all 3 cases, phlebography demonstrated venous compression at the thoracic outlet. Consequently, the development of phlebitis in the upper limb after a nervous puncture should always suggest the possibility of a thoracic outlet syndrome and is an indication for phlebography. Conversely, a corollary to the diagnosis of thoracic outlet syndrome should be the formal contraindication of intravenous infusion on the affected side. The treatment of these iatrogenic forms of phlebitis involves the use of anticoagulants followed by surgical resection of the 1st rib to decompress the collateral venous circulation.

Adolescent↗
PubMed1979

Final inline filtration: a means of decreasing the incidence of infusion phlebitis.

Infusion phlebitis is the most common complication of intravenous therapy. Six methods of reducing the incidence of infusion phlebitis including inline final filtration, buffers, heparin, hydrocortisone, heparin-hydrocortisone combinations, and frequent set changes were tested in a two part randomized prospective double-blind study of 266 surgical patients. Patients who received filtered fluids had a significantly decreased incidence of infusion phlebitis as compared with that of controls (P = 0.0000001). Of the other methods tested, only the heparin-hydrocortisone combinations achieved any significant decrease in phlebitis (P less than 0.5). Therefore, inline filtration is a highly effective means of decreasing the incidence of infusion phlebitis and should be considered as a routine part of intravenous therapy.

Buffers↗
PubMedDate not supplied

[Ambulatory phlebitis. Clinical and therapeutic aspects. Significance of the "retention-ambulation" treatment].

Phlebitis developing in the case of an active, non-bedridden patient demands early clinical diagnosis, with the object of getting a rapidly effective treatment under way as quickly as possible. Retention using a fixed non-elastic dressing, applied when there is the slightest suspicion of phlebitis, constitutes both prevention and cure, and enables the patient to continue all activity, to stand up, and to walk, all of which are vital to favorable development. Complementary treatments following the indications of the symptomatology are the administration of anti-inflammatory drugs, in sufficient doses, intra-arterial injections of Novocaine, and eventually, but not systematically, the prescription of anti-coagulants. Developments should be closely followed afterwards, and the therapeutic pattern eventually completed. The treatment by "retention-ambulation" of phlebitis of the lower members is important at all stages of phlebitis illness, and in particular in the case of bedridden patients treated with the aim of enabling them to get up and walk, and in the case of patients recovering from phlebitis, facilitating the reabsorption of the oedema and in face of phlebitic sequelae to prevent complications.

Ambulatory Care↗
PubMed1995

Infusion-related phlebitis.

The incidence rate and risk factors of infusion-related phlebitis was studied in 1993. Thirty-five hospitals were enrolled. Data were collected from 6,256 infusion sites. Male and female patients were almost equal. Forearms were the commonest site of infusion, followed by hand and arm respectively. In 34.1 per cent the infusion was interrupted by complications of which 6.2 per cent was phlebitis. It was mild in most cases. Increased incidence rates of infusion related phlebitis were associated with: the use of plastic cannulas, dextrose containing solutions, administration at the sites other than hand and concomitant administration of antimicrobials. The incidence rate of phlebitis rose sharply after 24 hours of infusion. It is concluded that in addition to proper insertion and good nursing care, the avoidance of the above risk factors will lead to a lower incidence of infusion-associated phlebitis.

Adolescent↗
PubMedDate not supplied

[Phlebitis of infectious etiology].

Various infections are sometimes at the origin of phlebitis. Because of the different therapeutic consequences, this etiology should be considered whether it is a case of deep phlebitis of a limb, migratory recurrent phlebitis, or the type of phlebitis called "iron wire". The principal diseases that may lead to phlebitis are : tuberculosis, typhoid fever, rickettsiosis, and streptococcal, staphylococcal, and pneumococcal infections. Certain viruses may have a role but so far there is no formal proof. Focal pathology of dental or tonsillar origin involves in some cases an aseptic venous lesion. Bacterial or mycotic suppurative thrombophlebitis related to an intravenous catheter is the price paid for the use, often unnecessarily, of this method of perfusion.

Bacterial Infections↗
PubMed1998

[Prospective 3-month study of intravascular catheter complications in HIV-infected patients: relation between phlebitis and infection].

BACKGROUND: The aim of this study was to evaluate the etiology of phlebitis (chemical or infectious) and the prevalence of infections related to intravascular catheters (IRIC) in patients with HIV infection admitted to a 22-bed Infectious Disease Unit with a high rate of HIV infection. MATERIAL AND METHODS: A 3-month prospective study from November 1, 1994 to January 31, 1995 was carried out following a formula for data collection of all the intravenous catheters used during that time period. Cultures of the catheters withdrawn on Wednesdays and those with signs of phlebitis were performed. RESULTS: One hundred fifty-two intravenous catheters in 71 patients with HIV infection with a mean age of 37 years (range: 21-73) and mean hospital stay of 10.2 days were reported. During the study period 42 phlebitis were produced, of which 37 catheters (7 central and 30 peripheral) were processed. Of the 37 phlebitis processed, 29 (78.9%) were considered to be of physiochemical origin. Of the 21 catheters withdrawn Wednesday, 18 were processed, 8 with phlogotic signs, 2 with IRCI, equivalent to 1.9 IRCI/100 days of catheterization. During the study period no local or severe systemic infections related to the catheter were reported. Staphylococcus epidermidis was the organism involved in all the cases of IRCI. CONCLUSIONS: Despite the high number of immunosuppressed patients in related to HIV infection, a greater incidence of IRCI was not found in these patients. The most frequent cause of phlebitis by catheter was of chemical origin.

Adult↗
PubMed1989

Incidence of phlebitis in peripheral parenteral nutrition: effect of the different nutrient solutions.

To determine the influence of peripheral parenteral nutrition (PPN) on the incidence of phlebitis and the effect of simultaneous infusion of lipid emulsion, 68 surgical patients were assigned randomly to 3 nutrition groups: (1) amino-acid 4% solution and dextrose 8% (AA + DX) + Intralipid (IL) 10% in the ratio 1.5:1 (2) AA + DX and IL 20% in the ratio 3:1 (3) AA + DX alone. Group 4 (control group) consisted of 25 patients receiving maintenance solutions and iso-osmotic drugs. No filters were used. The cannulae were studied for 72 hours and the cannula sites were evaluated daily for phlebitis. Mean age of patients was 52.3 +/- 17.7 years, with a similar sex ratio in the 4 groups. One hundred and twenty-five cannulae were studied. At 72 h, the following cumulated phlebitis rates were recorded: 22% in Group 1 (712 mOsm/L), 48% in Group 2 (802.5 mOsm/L), 44% in Group 3 (920 mOsm/L) and 26% in Group 4 (260-314 mOsm/L). The phlebitis incidence was similar in groups 1 and 4 (control) throughout the study. Both Groups 2 and 3 had higher phlebitis rates on days 2 and 3 (II: p < 0.05, III: p < 0.01). It is concluded that PPN with simultaneous IL 10% in the ratio 1.5:1 is no more phlebogenic than the usual maintenance solutions during the first 72 h. This is probably due to the lower osmolality and lower DX and K concentrations of the solution with IL 10%. Intralipid 20% does not have the same protective venous effect. The lower complication rate, the limited need for nursing, and lower costs compared to central parenteral nutrition, make PPN a safe nutrition technique for up to 10 days in patients needing no volume restriction.

Journal Article↗
PubMed1991

Peripheral parenteral nutrition: effect of a standardized compounded mixture on infusion phlebitis.

The incidence and severity of infusion phlebitis was evaluated prospectively in 142 surgical patients who received peripheral parenteral nutrition (PPN) for a total of 700 days. In a first study phase 83 patients were given PPN for a total of 424 days. All nutrient solutions were delivered over a 12-h period from a 3-litre bag and the infusion sites rotated daily. These methods resulted in an incidence of phlebitis of 18 per cent, 75 per cent of the patients being fed successfully by PPN until resumption of oral nutrition. In an attempt to assess the importance of the method of delivering nutrient solutions, the next 59 patients were randomized to receive PPN as a compounded mixture or by a conventional technique with simultaneous infusion from separate bottles. Infusion phlebitis was significantly more frequent (P less than 0.001) in patients infused with separate bottles. There was no difference between the groups with regard to duration of nutrition or the need to establish central venous access. We conclude that PPN is a safe and cost-effective means of providing total parenteral nutrition in most surgical patients. The use of compounded mixtures significantly reduces the incidence of phlebitis without increasing total costs.

Aged↗
PubMed2001

Prevention of vinorelbine phlebitis with cimetidine. A two-step design study.

One hundred eighteen patients with various malignancies received a total of 847 vinorelbine (VNR) infusions, during 25 of which episodes of vinorelbine phlebitis occurred (1 in each of the 25 patients concerned). Venous irritation was graded with reference to the scale devised by Rittenberg et al. To prevent these 25 patients against further venous toxicity, we pretreated them with cimetidine 200 mg i.v. prior to VNR administration in subsequent cycles of chemotherapy. In most (19, or 76%) complete prevention of recurrent phlebitis was observed, while partial prevention was observed in 5 patients (20%). Treatment was unsuccessful in 1 patient. In 127 VNR infusions given after cimetidine prophylaxis only 7 (6%) episodes of phlebitis occurred. These data show that i.v. administration of cimetidine prior to vinorelbine infusion can successfully prevent recurrence of phlebitis in patients who have shown venous irritation upon prior VNR treatment, at a rate of 94%.

Adult↗
PubMed2004

Phlebitis rate and time kinetics of short peripheral intravenous catheters.

BACKGROUND: An observational prospective cohort study was carried out on complication rates and time kinetics of phlebitis caused by short peripheral intravenous catheters (PIVCs) in inpatients on 15 hospital wards in four hospitals in Cologne, Germany. PATIENTS AND METHODS: We observed 1,582 patients with 2,495 PIVCs daily using standardized questionnaires. Phlebitis was defined using modified Centers for Disease Control and Prevention (CDC) criteria. RESULTS: Average phlebitis rates were 27 per 100 patients and 104 per 1,000 catheter days. Median duration of PIVC was 2 days (25 percentile = 2 days; 75 percentile 3 days). Time kinetics (Kaplan-Meier) were linear. CONCLUSION: Linear time kinetics of PIVC phlebitis do not support CDC recommendations for an elective PIVC change after 72 hours, provided daily monitoring of the insertion site occurs.

Adult↗
PubMed1977

Retinal phlebitis in the Irvine-Gass syndrome.

We reviewed the pathology records from January 1965 through July 1975 for aphakic eyes. After exclusion of unsuitable cases, ten eyes (nine patients) with cystoid macular edema and 142 eyes without cystoid macular edema were studied. Clinical ophthalmic records were available for five of the ten eyes with the Irvine-Gass syndrome. Histologic sections were examined, revealing a significant correlation between the Irvine-Gass syndrome and retinal phlebitis, which has not been reported previously, as well as cyclitis and vitritis. Anterior segment operative complications tended to be more prevalent in eyes with the Irvine-Gass syndrome than in those without the Irvine-Gass syndrome, although the assocation was not statistically significant (P less than .1). Retinal trypsin digestion showed the phlebitis to be distributed posteriorly within primary and secondary retinal veins, frequently occurring near points of bifurcation. The changes in permeability seen in the Irvine-Gass syndrome may be due to this retinal phlebitis and to a generalized inflammation-induced increase in capillary permeability. The case of the phlebitis is not known.

Adult↗
PubMed2002

Peripheral Teflon catheters: factors determining incidence of phlebitis and duration of cannulation.

BACKGROUND: Catheter-related phlebitis is a frequent problem in the clinical setting. Risk factors for catheter-related phlebitis were assessed at a single tertiary-care institution where no routine change policy for peripheral intravenous catheters is in place. METHODS: In a nonrandomized, observational trial, peripheral intravenous Teflon catheters were inserted in patients with a diagnosis of leukemia, lymphoma, solid tumor, acquired immunodeficiency syndrome, other serious infection, or autoimmune disorder. Underlying disease, age, white blood cell count at the time of insertion, physician placing the catheter, catheter bore, duration of cannulation, reason for removal of the catheter, and visual inspection of the insertion site were recorded. RESULTS: Four hundred twelve catheters were inserted in 175 patients. The number of catheterizations per episode varied between 1 and 7. Three hundred sixty-four (88.3%) catheter placements were evaluable. The mean duration of cannulation was 4.2 days. The overall incidence of phlebitis was 12.9%. Catheters in leukopenic patients showed a longer duration of cannulation compared with catheters in nonleukopenic patients, but no difference regarding the phlebitis rate. CONCLUSION: Findings in this study partly contrast with data reported in the literature. In particular, leukopenia, female gender, prolonged duration of cannulation, antibiotics, and choice of insertion site could not be shown to be risk factors.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Dicloxacillin and erythromycin at high concentrations increase ICAM-1 expression by endothelial cells: a possible factor in the pathogenesis of infusion phlebitis.

OBJECTIVES: Antimicrobial agents are important risk factors for infusion phlebitis, but the risk varies between different antibiotics. Erythromycin and dicloxacillin are known to induce phlebitis frequently, as well as to exert toxic effects on cultured endothelial cells. The pathogenesis of infusion phlebitis is unclear, but chemical toxicity is thought to lead to inflammation and subsequent thrombosis. In the present study, endothelial cells were exposed to antibiotics at the range of concentrations used for intravenous administration, followed by analysis of pro-inflammatory and pro-coagulant surface molecules. METHODS: Primary human umbilical vein endothelial cells (HUVEC) and the endothelial hybrid cell line EaHy926 were exposed to dicloxacillin, erythromycin, benzylpenicillin and cefuroxime (all at 6250 mg/L) for 60 min, followed by washing. After 5 or 24 h additional incubation, cells were analysed for E-selectin (CD62E), tissue factor (TF) or intercellular adhesion molecule 1 (ICAM-1, CD54) density by flow cytometry. RESULTS: Despite constitutive expression of ICAM-1 (34%) in HUVEC, 6250 mg/L of dicloxacillin or erythromycin significantly increased the number of cells with ICAM-1 expression by 37% and 30%, respectively. In contrast, cefuroxime and benzylpenicillin did not up-regulate ICAM-1 above background levels. A similar pattern was seen with the endothelial cell line EaHy926. The E-selectin and TF density were not affected by the antibiotics examined. CONCLUSIONS: The results of this study support the theory that endothelial cells that are affected by high concentrations of antibiotics may initiate an inflammatory response through expression of ICAM-1. This is a novel finding in the pathogenesis of infusion phlebitis.

Anti-Bacterial Agents↗
PubMedDate not supplied

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.

Administration, Cutaneous↗
PubMed2004

Use of heparin to lower the incidence of phlebitis induced by anti-neoplastic agents used in ovarian cancer.

AIM: To investigate whether heparin infusion with the administration of anti-neoplastic agents in ovarian cancer can reduce the occurrence of phlebitis as a complication of chemotherapy. METHODS: The subjects were 20 patients with ovarian cancer who developed phlebitis following their first course of anti-cancer chemotherapy. In the subsequent chemotherapy course, 10 patients received heparin infusion of 5000 U, starting 3 h before the administration of anti-neoplastic agents and continuing concomitantly with the agents for 12 h. The other 10 patients (control) were treated with anti-neoplastic agents alone. RESULTS: Only one (10%) of 10 patients who had received heparin developed phlebitis, while eight patients (80%) in the control group did (P=0.005). In the heparin group, there were no toxic effects of heparin observed. The prothrombin time, activated partial thromboplastin time, fibrinogen, and platelet count did not differ before and after the completion of chemotherapy. CONCLUSION: Concurrent infusion of heparin and anti-neoplastic agents in ovarian cancer is a safe and effective method of preventing phlebitis induced by chemotherapy.

Anticoagulants↗
PubMed1980

Phlebitis induced by parenteral treatment with flucloxacillin and cloxacillin: a double-blind study.

Two studies were performed on a total of 54 patients with staphylococcal infections. Study I compares with phlebitogenic properties of flucloxacillin after intravenous infusions when either saline or sterile water was used as a solvent. No difference was observed between the two solvents, and the frequency of phlebitis for the total material without respect to solvents was 5% after 1 day of treatment and 13% after 2 days. Study II was a double-blind comparison of phlebitis caused by intravenous infusions of either flucloxacillin or cloxacillin. The frequencies of phlebitis were found to be 18 and 13%, respectively. After 2 days of treatment the frequency of phlebitis increased dramatically for both drugs. All infusions were given through a plastic cannula of 5-cm length and 1.2-mm diameter.

Adolescent↗
PubMed2002

Efficacy of minocycline and EDTA lock solution in preventing catheter-related bacteremia, septic phlebitis, and endocarditis in rabbits.

To determine the efficacy of antibiotic catheter lock solution in preventing catheter-related infections, silicone catheters were tunneled and inserted into the jugular veins of 18 rabbits. The catheters were challenged with an intraluminal injection of 10(5) CFU of slime-producing Staphylococcus epidermidis in 0.1 ml of water. The catheters were maintained on heparin (100 IU/ml) flush for the first 3 days. On day 3, quantitative blood samples for culture were obtained from the catheters and ear veins, which documented catheter-related bacteremia, and the rabbits were randomized to have their catheters flushed as follows: five animals were continued on heparin (100 IU/ml), five animals received vancomycin (3 mg/ml) with heparin (100 IU/ml), and eight animals received 3 mg of minocycline per ml with 30 mg of EDTA per ml (M-EDTA). All animals were killed at day 7. Blood, catheters, jugular veins, and heart valves were cultured quantitatively. Animals maintained on heparin developed catheter-related colonization, bacteremia, septic phlebitis, and endocarditis. Vancomycin-heparin partially prevented catheter colonization, bacteremia, and phlebitis (P = 0.2). M-EDTA completely prevented catheter colonization, catheter-related bacteremia, and phlebitis in all of the animals (P < 0.01). Tricuspid endocarditis was equally prevented by vancomycin-heparin and M-EDTA (P < or = 0.06). In conclusion, the M-EDTA catheter flush solution was highly efficacious in preventing catheter-related colonization, bacteremia, septic phlebitis, and endocarditis in rabbits.

Animals↗
PubMed1994

Peripheral intravenous line survival and phlebitis prevention in patients receiving intravenous antibiotics: heparin/hydrocortisone versus in-line filters.

OBJECTIVE: To compare the use of in-line filtration with the addition of heparin/hydrocortisone (hep/hc) to the infusate for both phlebitis prevention and intravenous (i.v.) line survival in peripheral i.v. catheters. This study was specific for a patient group receiving prolonged courses of i.v. antibiotics. Analysis of the two endpoints for conventional short i.v. catheters (short lines) versus long (30 cm) i.v. catheters (long lines) was also performed. METHODS: Patients with cystic fibrosis receiving intermittent i.v. antibiotics were randomly allocated to receive their drugs either through an in-line filter using a drug-free infusate or with no filter and an infusate containing heparin 500 units and hydrocortisone 10 mg/L. Infusion sites were assessed daily. RESULTS: Both the hep/hc and filter groups were similar in terms of phlebitis incidence and i.v. line survival when analyzed separately for both short and long lines. Long lines displayed markedly prolonged survival times and reduced phlebitis compared with short lines. CONCLUSIONS: The effectiveness of i.v. filters in excluding the large particle load introduced by i.v. antibiotics and hence in reducing the subsequent phlebitis makes them a useful alternative to the use of hep/hc. The use of filters in this patient group may offer advantages in terms of ease of use and a possible decrease in hep/hc-related problems. Long lines offer practical advantages over short lines for patients requiring longer term i.v. access.

Anti-Bacterial Agents↗