Antecubital Fossa Research Articles

Modified simple decompression in the treatment of cubital tunnel syndrome: avoiding ulnar nerve subluxation.

In this study, we propose a modification to the simple decompression technique that contains the ulnar nerve in the cubital fossa, thus preventing subluxation during forearm flexion movements. Five consecutive patients with leprosy-associated cubital tunnel syndrome underwent surgery with the modified technique between July 2011 and October 2012. The most common symptoms were neuropathic pain and sensory changes (both 60%). On the McGowan scale, three patients maintained their preoperative score and two patients improved by two points, while on the Louisiana State University Health Sciences Center scale, two patients maintained the same scores, two improved by two points, and one improved by one point. Four patients were able to discontinue corticosteroid use. The mean follow-up time was 25.6 months (range 2-48 months). There were no recurrences or subluxations in the long-term. This alternative technique resulted in excellent functional results, as well as successful withdrawal from corticosteroids. Furthermore, it resulted in no ulnar nerve subluxations.

Abstract P14: A Novel Forelimb Orthotopic Allotransplantation Model in Mouse

PURPOSE: In translational research related to Vascularized composite allotransplantation (VCA), mouse models provide a profoundly relevant means to successfully studying of crucial aspects related to the immunobiology of graft rejection and acceptance, neuronal reinnervation of sensory and motor function and associated cortical reintegration of lost extremity function. The model developed here is designed to address this critical void to allow for mouse orthotopic forelimb transplantation, a tool to studying both aspects of functional recovery and immunobiology related to VCA in a genetically versatile mouse model system. METHODS: Male Balb/c donors and C57BL/6 recipients (8–10 weeks) mice were used to perform syngeneic and allogeneic orthotopic forelimb transplantation. Co-stimulation blockaded (CTLA4-Ig & MR-1) was used for immunosuppression. A circumferential skin incision was made at the shoulder. The pectoralis major muscle insertion was released at the humerus and reflected. The vascular pedicle was dissected from the axilla to the cubital fossa and transected at the level of the proximal axillary artery. Median and ulnar nerves were identified and transected proximal to the cubital fossa. The radial nerve was identified and transected dorsally at the intersection of medial and distal third of the humerus. Both flexor and extensor muscle groups were cauterized and transected at mid humerus level. In the recipient animal shoulder mobility was preserved and vessels and nerves were transected proximal to the cubital fossa. The graft was secured by muscle approximation with 6-0 Polysorb and by using a 26G spinal needle as an intramedullary rod for osteosynthesis. A non-suture cuff technique was employed to anastomose donor axillary vessels with recipient brachial (mid-arm) vessels. Tension free primary end-to-end neurorrhaphy was performed in median, ulnar and radial nerves using 11-0 microsuture. RESULTS: Long term animal and graft survival in syngeneic transplant combinations demonstrated the feasibility of orthotopic mouse forelimb transplantation with only limited behavioral disabilities (>60 days; N=3).The non-suture cuff technique allows for successful supermicrovascular anastomosis of the donor axillary vessel with the recipient brachial vessel. The feasibility of radial, median and ulnar nerve coaptation provides the basis for studying functional recovery as well as cortical reintegration of upper extremity function after VCA. Long term allograft survival (>4 months; N=3) underpins the applicability of orthotopic forelimb transplantation for studying the immunobiology of functional extremity reconstruction using VCA. CONCLUSION: The described orthotopic forelimb transplantation model in the mouse is designed to add an additional research model for VCA by providing the option of using the entire range of genetically engineered mice for research related to transplant immunology, neuroregeneration, and functional recovery after upper extremity transplantation.

Additional Muscle Slip of Bicipital Aponeurosis and its Anomalous Relationship with the Median Cubital Vein.

The cubital region of the arm is a common site for recording blood pressure, taking blood for analysis and administering intravenous therapy and blood transfusions. During the routine dissection of a 70-year-old male cadaver at the Kasturba Medical College, Manipal, Karnataka, India, in 2015, it was observed that the aponeurotic insertion of the biceps brachii muscle divided into two slips. The medial slip fused normally with the deep fascia of the forearm, while flexor carpi radialis muscle fibres originated from the lateral slip. There was also a single vein in the forearm, the cephalic vein, which bifurcated to form the median cubital vein and the cephalic vein proper. The median cubital vein, further reinforced by the radial vein, passed deep to the two slips of the bicipital aponeurosis and then continued as the basilic vein. During venepuncture, medical practitioners should be aware of potential cubital fossa variations which could lead to nerve entrapment syndromes.

Relationship of the Median and Radial Nerves at the Elbow: Application to Avoiding Injury During Venipuncture or Other Invasive Procedures of the Cubital Fossa.

IntroductionThe median and radial nerves are two important neural structures found in the cubital fossa. The trajectory and landmarks used to identify their location are important when procedures are done in this area.Methods and materialsTen fresh-frozen cadavers were dissected (20 upper limbs) and measurements were taken from the medial epicondyle to the median and radial nerves as well as to the lateral epicondyle of each limb.ResultsThe distance between the medial epicondyle and the median nerve was found to be three centimeters with a range of 2.1 to four centimeters and the distance from the medial epicondyle to the radial nerve had a mean distance of 5.5 cm and a range of 3.8 to seven centimeters.DiscussionDamage to the median or radial nerves can lead to major complications including loss of extension, flexion, and sensation in the forearm and hand. Other studies have tried to identify the course of these nerves in order to prevent their injury during procedures.ConclusionAfter identifying the medial epicondyle, using the results we obtained, physicians may have a better understanding of where the median and radial nerves lie within the cubital fossa when performing procedures in this area.

Radial Nerve Injury after Venipuncture.

Venipuncture is the most commonly performed invasive procedure in hospitals daily.[1] Nerves in the antecubital fossa classically lie on a plane just beneath and in close proximity to the veins, making them susceptible to injury during phlebotomy.[1] Cadaveric studies have demonstrated a great deal of variability in the nerves of the antecubital fossa in relationship to veins, suggesting that even a nontraumatic, straightforward venipuncture can directly damage a cutaneous nerve.[2] Despite this, there remains a relative paucity in the literature reporting cases of peripheral nerve injury secondary to venipuncture. Of the few reported cases, an even smaller percentage of these have been validated with electrodiagnostic evidence of injury. The majority of these studies report injury to the lateral antebrachial cutaneous nerve. To the best of our knowledge, there has been only one reported case in current literature of radial nerve injury.

The effects of different exercise training modalities on plasma proenkephalin Peptide F in women

Due to the important interactions of proenkephalin fragments (e.g., proenkephalin [107–140] Peptide F) to enhance activation of immune cells and potentially combat pain associated with exercise-induced muscle tissue damage, we examined the differential plasma responses of Peptide F to different exercise training programs. Participants were tested pre-training (T1), and after 8 weeks (T2) of training. Fifty-nine healthy women were matched and then randomly assigned to one of four groups: heavy resistance strength training (STR, n=18), high intensity endurance training (END, n=14), combined strength and endurance training (CMB, n=17), or control (CON, n=10). Blood was collected using a cannula inserted into a superficial vein in the antecubital fossa with samples collected at rest and immediately after an acute bout of 6 X 10 RM in a squat resistance exercise before training and after training. Prior to any training, no significant differences were observed for any of the groups before or after acute exercise. With training, significant (P≤0.95) elevations were observed with acute exercise in each of the exercise training groups and this effect was significantly greater in the CMB group. These data indicate that in untrained women exercise training will not change resting of plasma Peptide F concentrations unless both forms of exercise are performed but will result in significant increases in the immediate post-exercise responses. Such findings appear to indicate adrenal medullary adaptations opioid production significantly altered with exercise training.

Radiology Implanted Forearm Ports: A Review of the Literature

BackgroundInsertion of totally implanted venous access devices; that is, port systems, in the forearm is an option for long-term venous access. To better understand the radiology literature reported for this anatomic location, we performed a search for, and an analysis of, previous publications related to forearm implantation of these devices by interventional radiology department personnel. Materials and MethodsA review of the literature was performed for articles describing radiology implantation of forearm ports. Articles published between 1990 and 2015 were reviewed. ResultsEleven articles were found that met the review criteria. None were randomized studies and only 1 was a prospective study. All of the other studies were retrospective reviews of a variety of different port devices. An analysis of these articles was performed. ConclusionsForearm port implantation had high technical success rates (range, 98%-100%; mean, 99.7%). A wide variety of complications were encountered, none of which exceeded the Society of Interventional Radiology threshold levels for complications associated with port insertion. A subset of the studies were upper arm venipunctures with the port catheter and housing subsequently implanted in the forearm distal to the antecubital fossa.

Relation of the Cubital Veins Used for Intravenous Access in Reference to Anatomical Landmarks of the Cubital Fossa

Background and Objectives A peripheral intravenous access is commonly required in patients presenting to emergency room in order to collect blood specimens and to provide a route for intravenous medication and fluid administration. However, this procedure is occasionally associated with certain challenges. The present study has been conducted to explore the anatomic characteristics of cubital veins located in the cubital fossa through assessment of their relative location to certain anatomic landmarks. Materials and Methods Patterns of superficial veins of the cubital fossa were studied in 80 male and female students from a health sciences school. Results Several variations of the cubital veins were found. The mean distance between the outer and inner MCV to the reference central point was 1.33 ± 0.95 cm (range: 0-4.5) and 1.33 ± 0.96 cm (range: 0-3.54), respectively. Conclusion A thorough knowledge on the regional venous anatomy of the cubital fossa will aid in providing more efficient intravenous access routes. Keywords: Angle, Cubital Vein, Cubital Fossa, Distance, Intravenous Access

Does Extracellular DNA Production Vary in Staphylococcal Biofilms Isolated From Infected Implants versus Controls?

BackgroundProsthetic implant infections caused by Staphylococcus aureus and epidermidis are major challenges for early diagnosis and treatment owing to biofilm formation on the implant surface. Extracellular DNA (eDNA) is actively excreted from bacterial cells in biofilms, contributing to biofilm stability, and may offer promise in the detection or treatment of such infections.Questions/purposes(1) Does DNA structure change during biofilm formation? (2) Are there time-dependent differences in eDNA production during biofilm formation? (3) Is there differential eDNA production between clinical and control Staphylococcal isolates? (4) Is eDNA production correlated to biofilm thickness?MethodsWe investigated eDNA presence during biofilm formation in 60 clinical and 30 control isolates of S aureus and S epidermidis. The clinical isolates were isolated from patients with infections of orthopaedic prostheses and implants: 30 from infected hip prostheses and 30 from infected knee prostheses. The control isolates were taken from healthy volunteers who had not been exposed to antibiotics and a hospital environment during the previous 3 and 12 months, respectively. Control S epidermidis was isolated from the skin of the antecubital fossa, and control S aureus was isolated from the nares. For the biofilm experiments the following methods were used to detect eDNA: (1) fluorescent staining with 4′,6-diamidino-2-phenylindole (DAPI), (2) eDNA extraction using a commercial kit, and (3) confocal laser scanning microscopy for 24-hour biofilm observation using propidium iodide and concanavalin-A staining; TOTO®-1 and SYTO® 60 staining were used for observation and quantification of eDNA after 6 and 24 hours of biofilm formation. Additionally antibiotic resistance was described.ResultseDNA production as observed by confocal laser scanning microscopy was greater in clinical isolates than controls (clinical isolates mean ± SD: 1.84% ± 1.31%; control mean ± SD: 1.17% ± 1.37%; p < 0.005) after 6 hours of biofilm formation. After 24 hours, the amount of eDNA was greater in biofilms of S epidermidis than in biofilms of S aureus (S aureus mean ± SD: 1.35% ± 2.0%; S epidermidis mean ± SD: 6.42% ± 10.6%; p < 0.05). Clinical isolates of S aureus and S epidermidis produced more eDNA than control isolates at 6 hours of biofilm formation. The extraction method also showed that clinical isolates produced substantially greater amounts of eDNA than controls.ConclusionsS aureus and S epidermidis exhibit a differential production of DNA with time. Clinical isolates associated with implant infections produce greater amounts of eDNA than controls. Future research might focus on the diagnostic value of eDNA as a surrogate laboratory marker for biofilm formation in implant infections.Clinical relevanceeDNA should be considered as a potential future diagnostic tool or even a possible target to modify biofilms for successful treatment of biofilm-associated infections.

High origin of radial artery from the axillary artery: Case report

The axillary artery is the main artery supplying the shoulder region and is clinically important. In the present case we report an arterial variation of the left upper extremity of a 65 year-old female cadaver. The radial artery arose from the axillary artery 2.5 cm below the anterior humeral circumflex artery and above the teres major muscle. It first coursed along the medial aspect of the arm, then it passed laterally between the biceps brachii and the brachialis muscle. Reaching the upper part of the elbow, it coursed medial to the brachioradialis muscle. It did not give off any branches in either the arm or in the forearm regions. It contributed to the formation of the superficial palmar arch in the palm of the hand. Further, the brachial artery entered the cubital fossa and divided into ulnar and common interosseous arteries. The right upper extremity had a normal arterial branching pattern.Being aware of the variations of the axillary artery may help to prevent diagnostic errors and avoid complications during the surgery of the region.

Preliminary Study for Designing a Novel Vein-Visualizing Device.

Venipuncture is an important health diagnosis process. Although venipuncture is one of the most commonly performed procedures in medical environments, locating the veins of infants, obese, anemic, or colored patients is still an arduous task even for skilled practitioners. To solve this problem, several devices using infrared light have recently become commercially available. However, such devices for venipuncture share a common drawback, especially when visualizing deep veins or veins of a thick part of the body like the cubital fossa. This paper proposes a new vein-visualizing device applying a new penetration method using near-infrared (NIR) light. The light module is attached directly on to the declared area of the skin. Then, NIR beam is rayed from two sides of the light module to the vein with a specific angle. This gives a penetration effect. In addition, through an image processing procedure, the vein structure is enhanced to show it more accurately. Through a phantom study, the most effective penetration angle of the NIR module is decided. Additionally, the feasibility of the device is verified through experiments in vivo. The prototype allows us to visualize the vein patterns of thicker body parts, such as arms.

Acute monoplegia secondary to herpes zoster infection: a case report

Brachial plexopathy with motor involvement secondary to herpes zoster infection is very rare. Also known as shingles, herpes zoster occurs as a result of reactivation of varicella zoster virus in the dorsal root ganglia. We present a 69-year-old male patient with right upper extremity monoplegia secondary to herpes zoster infection. Physical examination showed scars from rash on his right antecubital fossa. Electroneuromyography showed a low amplitude motor response of the right median nerve, while having no sensation response at digits 1 and 3. Right ulnar and radial nerve sensation responses were lower in amplitude compared to the left side. Herpes zoster should be considered in the differential diagnosis of acute monoparesis. It is very important in avoiding unnecessary tests and treatments.

Safety of the Peripheral Administration of Vasopressor Agents.

Vasopressors are an integral component of the management of septic shock and are traditionally given via a central venous catheter (CVC) due to the risk of tissue injury and necrosis if extravasated. However, the need for a CVC for the management of septic shock has been questioned, and the risk of extravasation and incidence of severe injury when vasopressors are given via a peripheral venous line (PVL) remains poorly defined. We performed a retrospective chart review of 202 patients who received vasopressors through a PVL. The objective was to describe the vasopressors administered peripherally, PVL size and location, the incidence of extravasation events, and the management of extravasation events. The primary vasopressors used were norepinephrine and phenylephrine. The most common PVL sites used were the forearm and antecubital fossa. The incidence of extravasation was 4%. All of the events were managed conservatively; none required an antidote or surgical management. Vasopressors were restarted at another peripheral site in 88% of the events. The incidence of extravasation was similar to prior studies. The use of a PVL for administration of vasopressors can be considered in patients with a contraindication to a CVC.

Estimation and Comparison of Erythrocyte and Hemoglobin Levels in Subjects with Healthy Periodontium and Chronic Periodontitis

Objective: To compare and evaluate the relationship between anemia and periodontitis by estimation of peripheral blood between healthy patients and chronic periodontitis patients. Material and Methods: Of the total of 230 outpatients approached to participate in the study, 100 eligible patients were selected as per the selection criteria. After written consent, these patients were divided into two groups according to the clinical parameters as healthy and disease (chronic periodontitis) groups. Under aseptic conditions, venous blood samples were obtained by vein-puncture in the ante-cubital fossa without excessive venous stasis and the mean value of erythrocytes (EC), hemoglobin concentration (HGB), mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) were measured. Paired t-test was employed to find the significance of study parameters on continuous scale within the group analysis and unpaired t-test (two tailed, dependent) was used to find the significance of study parameters on continuous scale in the inter group analysis. Results: Generally, the healthy group reported higher levels of EC, HGB, MCV and MCH than the periodontitis group. The mean hemoglobin level was significantly higher (p-value<0.05) in healthy patients (12.66 ±1.41 gm/dl) whereas a slightly lower level of 11.32±1.85 gm/dl was observed in patients with chronic periodontitis. Similarly, the range of erythrocyte count of healthy patients was significantly higher (3.69-5.29 million/µl) than chronic periodontitis patients (3.33-5.97 million/µl). Whilst MCV was higher in healthy patients but non-significant, higher mean MCH of 27.75 ± 3.25 pg/cell was reported in healthy patients compared to mean of 25.73 ± 3.22 pg/cell in patients with chronic periodontitis. Conclusion: Significant hematological differences in EC, HGB, MCV and MCH between healthy periodontium and chronic periodontitis subjects were seen indicating mild anemia.

Blood Lead Levels among Automobile Mechanics in a Megacity, Lagos, Nigeria

Blood Lead Levels among Automobile Mechanics in a Megacity, Lagos, Nigeria M. Adejumo, Y. V. Olaiya, M. K. C. Sridhar Abstract This study assessed blood lead and Packed Cell Volume (PCV) levels among automobile mechanics in Agidingbi, Ikeja Local Government Area of Lagos. A cross-sectional study was conducted among 37 consented automobile mechanics at a mechanic village in the study setting. Interviews were conducted using a semi-structured questionnaire while blood samples were collected through antecubital fossa. Respondents’ mean age was 29 ± 11 years, 64.9% were single while 37.8% were operating as a master of the facility. Some 48.6% occasionally experienced headaches while 35.1% and 29.7% experienced tiredness and abdominal pain, respectively. Most (97.3%) have not heard about lead poisoning, 91.9% did not wear any personal protective equipment (PPE) and 89.2% did not wear apron during practice. The mean blood lead level and PCV% were 4.4±2and 38.7±3.8 respectively. PCV and years of professional practice significantly reflected in blood lead level (R2=0.679, p<0.001) while years of professional experience independently predicted blood lead level (R2adjusted=0.656, p<0.001) when adjusted for age and level of operation. Although, the blood lead level was relatively low to warrant public health concerns, but the use of PPE was poor. Regular use of PPE is encouraged to prevent exposure to lead among automobile mechanics. Full Text: PDF DOI: 10.15640/ijhs.v5n2a3

Sensory Distribution of the Lateral Cutaneous Nerve of Forearm After Ultrasound-Guided Block: Potential Implications for Thumb-Base Surgery.

Surgery of the wrist and hand commonly involves regional anesthesia of the median nerve and superficial radial nerve within the forearm. In this sonographic study, the contribution of the lateral cutaneous nerve of forearm (LCNF) to thumb cutaneous sensation was studied. Patients scheduled for thumb suspension arthroplasty (n = 35) were examined by ultrasound, with LCNF, median nerve, and superficial radial nerve identified. A single nerve was then injected with local anesthetic, and the area of cutaneous sensory loss mapped at 15 minutes. The remaining 2 nerves were then blocked for progression to theater. In 15 patients, the LCNF was blocked first at the antecubital fossa, where it was located posterior to the cephalic vein 9.1 (1.6) mm distal to the interepicondylar line. Bifurcation occurred further distally, 18 (2.6) mm from the interepicondylar line. In 14 of 15 cases, LCNF sensory distribution extended to the thumb base, 8.3 (7.8) mm distal to the radiocarpal joint. This study has demonstrated the LCNF to innervate the thumb base, indicating neural blockade of this nerve may be required for surgery of the basal thumb joint.

Basilic vein transposition: A viable alternative for multiple failed arteriovenous fistulas - A single center experience.

Primary use of the autogenous arteriovenous access is recommended by the National Kidney Foundation-Dialysis Outcomes Quality Initiative guidelines. In spite of troublesome comorbidities associated with basilic vein transposition (BVT), it is still the most preferred technique when autologous veins are not suitable to construct radio-cephalic fistula (RCF) and brachiocephalic fistula (BCF), arteriovenous fistula (AVF). The present study highlights our experience with BVT, with small incision technique, over a period of two years with excellent outcome. This retrospective study included all the patients who underwent BVT at our tertiary care center between March 2013 and March 2015. It was performed in patients with failed previous RCF or BCF or who had small caliber or thrombosed cephalic veins. The patients with minimum 3 mm basilic vein diameter on Doppler were only included in the study. A 3-cm horizontal incision was made in antecubital fossa to expose brachial artery and basilic vein. Multiple longitudinal separate second skin incisions (2-3 cm) were made to explore proximal part of basilic vein. Side branches of the vein were isolated and ligated. The divided basilic vein in antecubital fossa was brought over fascia through newly created subcutaneous tunnel followed by end-to-side anastomosis. A total of 18 (12 males and 6 females) underwent BVT in the two years period. The mean fistula maturation time was 42 ± 10 days. Maturation rate was 100%, and the postoperative flow rate was 290 ± 22 (mL/min). No bleeding, thrombosis, failure, pseudo aneurysm, or rupture occurred in our patients. Arm edema occurred in ix (33%) patients, infection in three (17%), and lymphorrhea in five (28%). The mean follow-up was six months. BVT is an alternative method with excellent initial maturation and functional patency rates requiring less extensive skin incision and surgical dissection. It is the most durable hemodialysis access procedure for those patients having multiple forearm AVF surgeries.

Kimura's Disease: Uncommon Cause of Proptosis

Purpose: To describe a case of inferior orbital mass with generalized lymphadenopathy and histopathological examination proven Kimura’s disease. Methodology: Case report Findings: A 17 year-old Malay man with no previous illness. Presented with two months history of progressive proptosis of the right eye (RE). Upon presentation vision was 6/7.5 RE and left eye (LE) 6/6. Ocular examination revealed RE proptosis with restricted extraocular muscle movement and optic disc swelling. Systemic examination noted multiple lymphadenopathy over cubital fossa and inguinal region. Blood investigation showed peripheral eosinophilia. CT brain and orbit revealed RE inferior orbital mass compressing the optic nerve. Subsequently RE orbital mass incisional biopsy and inguinal node excisional biopsy was done. The later showed typical features of Kimura’s disease with diffuse eosinophils infiltration within the germinal centres of the lymphoid nodule. He was started on tapering dose of oral corticosteroids and responded well evidenced by reducing RE proptosis. Conclusion: This case demonstrates that proptosis with lymphadenopathy does not always imply lymphoma but may have a benign pathogenesis such as Orbital Kimura’s disease. Therefore it should be considered in the differential diagnosis of orbital lesions occurring in adults. Accurate diagnosis in biopsies is also crucial to avoid unnecessary radical surgery.

Brachio-Cubital Fasciotomy for Resistant Stenosis of Arterio-Venous Fistula

Purpose: Radio-cephalic arterio-venous fistula can become dysfunctional due to venous outflow stenosis along its course. When the median cubital and the upper arm cephalic vein are small or obliterated, all the forearm cephalic vein blood flow can go through the perforating deep median vein into the brachial vena comitans. These deeply located veins, when dilated, become compressed by the overlying antecubital fascia and bicipital aponeurosis. These ensuing stenoses are usually resistant to endovascular balloon dilatation angioplasty or recur rapidly afterwards. Brachio-cubital fasciotomy was utilized to help relieve the compression and salvage the access. Methods: For the confirmed resistant stenoses of the AVF, open fasciotomy was performed along the medial aspect of the antecubital fossa. Endovascular angioplasty of the stenotic lesions was accomplished in conjunction with vascular skeletonization while the balloon was inflated inside the AVF. Results: Nineteen patients recognized to have resistant stenoses of their AVF underwent brachio-cubital fasciotomy. Through the fasciotomy, stenoses were resolved and intra-access pressure reduced to satisfactory levels in all patients. Three patients required resection of the constricted segment and reanastomosis of the mobilized fistula in addition to the fasciotomy. At the follow-up observation of minimum 9 months, all but one of the rescued stenotic lesions stayed patent and required no further intervention. Conclusions: Radio-cephalic arterio-venous fistula can become dysfunctional due to the development of outflow stenosis from compression by overlying fascia and this stenosis is usually resistant to the dilatation angioplasty. Brachio-cubital fasciotomy resolves these stenoses successfully and allows complete angioplasty with vascular skeletonization and open revision if required.

Relationship between peripheral insertion site and catheter-related phlebitis in adult hospitalized patients: a systematic review.

To explore the relationship between the anatomical site of peripheral venous catheterization and risk of catheter-related phlebitis. Peripheral venous catheterization is frequently associated with phlebitis. Recent guidelines, recommend the use of an upper-extremity site for catheter insertion but no univocal consensus exists on the anatomical site with lower risk of phlebitis. Systematic review. We searched Medline (PubMed) and CINAHL (EBSCOhost) databases until the end of January 2017. We also reviewed the reference lists of retrieved articles and gray literature was excluded. Searches were limited to articles published in English with no restriction imposed to date of publication. The primary outcome was the incidence of phlebitis associated with anatomical site of peripheral catheterization. We included randomized controlled trials and observational studies on adult patients who required a peripheral catheter for the administration of medi- cation, intermittent or continuous fluid infusion. Antecubital fossa veins are associated with lower phlebitis rates, while hands veins are the most risky sites to develop phlebitis. There is no consensus regarding vein in forearm. Choosing the right anatomical site to insert a peripheral venous catheter is important to decrease phlebitis rate. Further studies should compare indwelling time in different anatomical sites with phlebitis rate. A more standardized approach in defining and assessing phlebitis among studies is recommended.