Phlebitis Rate Research Articles

544 The VIP QIP - Reducing the Rate of Inpatient Phlebitis

544 The VIP QIP - Reducing the Rate of Inpatient Phlebitis

The effect of different flushing and locking techniques on catheter occlusion rates in central venous catheters: protocol for a multicentre, randomized controlled, parallel-group, open-label, superiority clinical trial

BackgroundMaintaining venous access is of great clinical importance. Running a slow continuous infusion to keep the vein open (KVO) is often used in peripheral intravenous catheters (PIVCs). Previous studies have compared the effects of intermittent flushing and continuous infusion via peripherally inserted central catheters (PICCs). In this study, we applied KVO to central venous catheters (CVCs) and compared the occlusion rate of this technique with that of the intermittent flushing technique.MethodThis is a randomized controlled trial of 14 hospitals in China. A total of 250 patients will be recruited in this study, and they will be randomized at a 1:1 ratio. After study inclusion, patients who will undergo CVC insertion will receive intermittent flushing with prefilled saline syringes (control group) or KVO infusion with elastic pumps (test group). All the catheters will be checked for patency by scoping Catheter Injection and Aspiration (CINAS) Classification on Days 3 and 7. The primary outcome is the rate of catheter occlusion in 7 days. Patients will be followed up until 9 days after CVC insertion, catheter occlusion, or catheter removal. The secondary outcomes are the rate of catheter occlusion in 3 days, nurse satisfaction, cost-effectiveness, adverse event rate, catheter-related bloodstream infection rate, catheter-related thrombosis rate, extravasation rate, phlebitis rate, and catheter migration.DiscussionWe expect that the trial will generate findings that can provide an evidence-based basis for the improvement and optimization of clinical catheter flushing techniques.Trial registrationChinese Clinical Trial Registry, ChiCTR2200064007. Registered on 23 September 2022. https://www.chictr.org.cn/showproj.html?proj=177311.

Impact of an interventional bundle on complications associated with peripheral venous catheters in elderly patients.

Elderly patients admitted to geriatrics departments often require peripheral venous catheters (PVC), which should be inserted and maintained following a series of preventive recommendations. Our objective was to evaluate the impact of a training bundle comprising measures aimed at reducing complications associated with the use of PVC in elderly patients admitted to a tertiary teaching hospital. We performed a prospective study of patients who received a PVC within 24h of admission to a geriatrics department. After a 10-month pre-interventional period, we implemented an educational and interventional bundle over a 9-month period. Follow-up was until catheter withdrawal. We analyzed and compared clinical and microbiological data between both study periods. A total of 344 patients (475 PVC) were included (pre-intervention period, 204 patients (285 PVC); post-intervention period, 140 patients (190 PVC)). No statistically significant differences in demographic characteristics were observed between the study periods. The colonization and phlebitis rates per 1000 admissions in both periods were, respectively, 36.7 vs. 24.3 (p = 0.198) and 81.5 vs. 65.1 (p = 0.457). The main reason for catheter withdrawal was obstruction/malfunctioning (33.3%). Obstruction rate was higher for those inserted in the hand than for those inserted at other sites (55.7% vs. 44.3%, p = 0.045). We found no statistically significant differences regarding phlebitis and catheter tip colonization rates. It is necessary to carry out randomized studies assessing the most cost-effective measure to reduce complications associated with PVC.

Physicochemical Characteristics of Antimicrobials and Practical Recommendations for Intravenous Administration: A Systematic Review.

Most antimicrobial drugs need an intravenous (IV) administration to achieve maximum efficacy against target pathogens. IV administration is related to complications, such as tissue infiltration and thrombo-phlebitis. This systematic review aims to provide practical recommendations about diluent, pH, osmolarity, dosage, infusion rate, vesicant properties, and phlebitis rate of the most commonly used antimicrobial drugs evaluated in randomized controlled studies (RCT) till 31 March 2023. The authors searched for available IV antimicrobial drugs in RCT in PUBMED EMBASE®, EBSCO® CINAHL®, and the Cochrane Controlled Clinical trials. Drugs' chemical features were searched online, in drug data sheets, and in scientific papers, establishing that the drugs with a pH of <5 or >9, osmolarity >600 mOsm/L, high incidence of phlebitis reported in the literature, and vesicant drugs need the adoption of utmost caution during administration. We evaluated 931 papers; 232 studies were included. A total of 82 antimicrobials were identified. Regarding antibiotics, 37 reach the "caution" criterion, as well as seven antivirals, 10 antifungals, and three antiprotozoals. In this subgroup of antimicrobials, the correct vascular access device (VAD) selection is essential to avoid complications due to the administration through a peripheral vein. Knowing the physicochemical characteristics of antimicrobials is crucial to improve the patient's safety significantly, thus avoiding administration errors and local side effects.

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

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

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

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

Amiodarone-induced phlebitis: Incidence and adherence to a clinical practice guideline.

Intravenous amiodarone is an irritant of peripheral blood vessels with phlebitis as an adverse effect. The aims were to determine the incidence of intravenous amiodarone-induced phlebitis, to describe adherence to a clinical practice guideline, and to determine how characteristics were distributed between those with and without phlebitis. A prospective observational study was conducted. Adult patients treated with amiodarone through a peripheral intravenous catheter (PIVC) or a central venous catheter (CVC) were included. PIVC characteristics were measured using the PIVC mini questionnaire. Patients with ≥2 signs of phlebitis were categorised as having phlebitis. Adherence to the clinical practice guideline was registered on a standard abstract sheet. Data were collected from the amiodarone start-up to two days after the amiodarone was discontinued. In total, 124 patients with amiodarone infusions were observed, of which 69% were administered via a PIVC. The phlebitis rate was 44%. Fifty-three per cent developed amiodarone-induced phlebitis during the infusion phase, while 47% presented phlebitis during the post-infusion phase. The three most observed signs or symptoms of phlebitis were redness (87%), pain (81%) and swelling (71%). The most commonly used PIVC site was the elbow, and 35% of the PIVCs were large (18 gauge), which was the last preferred site and size according to the clinical practice guideline. A large proportion of the patients developed amiodarone-induced phlebitis. The adherence to the clinical practice guideline was not optimal according to the PIVC recommendations. Prevention of amiodarone-induced phlebitis should have high priority to reduce patient harm.

Comparison The Use Transparent Dressing With Conventional Fixation on Phlebitis Rates In Rumkitban 05.08.03 Sidoarjo

Phlebitis is a major problem faced throughout the world and this incidence continues to increase. Phlebitis that occurs mechanically occurs when the type of fixation of the sterile gauze plaster is not strong enough or is not sticky enough, causing a change in the position of the catheter or friction in the internal area of the blood vessel which results in inflammation. Efforts to prevent the occurrence of phlebitis can be done by using a transparent dressing which can minimize bacteria entering through the attached vein, thereby reducing the occurrence of phlebitis. The aim of this research is to analyze the comparison of the use of Transparent Dressing with gauze on Phlebitis rates in RUMKITBAN 05.08.03 Sidoarjo. The design of this study is a comparative study, knowing the use of transparent dressings with conventional dressings. The number of samples taken using consecutive sampling was 73 patients. data collection method using an observation sheet instrument, the independent variables are Transparent dressing and conventional fixation, while the dependent variable is Phlebitis. In this study, researchers used SPSS software to carry out the Chi square test for research data analysis. Based on the results of the research and data analysis that has been carried out, it can be It was concluded that the results of research conducted on 73 respondents showed that there was a difference or influence between the use of Transparent Dressing and conventional dressing on Phlebitis rates at RUMKITBAN 05.08.03 Sidoarjo. From the research results, the author believes that the use of transparent dressings can prevent the entry of microorganisms that will enter intravenously because transparent dressings have no circulation at all.

Electroconvulsive Therapy Anesthetic Choice and Clinical Outcomes.

Etomidate and methohexital are the 2 commonly used anesthetics for electroconvulsive therapy (ECT) in the United States. The objective of this study was to examine how anesthetic choice between etomidate and methohexital is associated with real-world clinical outcomes. This naturalistic retrospective cohort study examined longitudinal electronic health records for 495 adult patients who received 2 or more ECT treatments from 2010 to 2019 in Kaiser Permanente North California, a large integrated health care system. Study outcomes included 12-month posttreatment depression remission as measured by the 9-item Patient Health Questionnaire, psychiatric and all-cause emergency department visits, and psychiatric and all-cause hospitalizations. Anesthetic choice was not significantly related to depression severity, emergency department visits, or psychiatric hospitalizations at 12 months after completing ECT. In exploratory analyses, we found that etomidate compared with methohexital was associated with higher rates of patient discomfort adverse effects-postictal agitation, phlebitis, and myoclonus (2.4% vs 0.4%; P < 0.001). We present the first large comparison of etomidate and methohexital as anesthetics for ECT and their associations with real-world outcomes. Our study showed no significant difference on depression remission, emergency department visits, or hospitalizations 12-months posttreatment. Thus, clinicians should focus on other patient or treatment characteristics when deciding on anesthetics for ECT. Further investigation is needed to confirm our exploratory findings that etomidate use was correlated with a higher rate of patient discomfort adverse effects relative to methohexital.

Complications of peripheral intravenous catheters and risk factors for infiltration and phlebitis in children

ABSTRACT Aim: This study aimed to identify the types of complications of peripheral intravenous catheters (PIVCs) in hospitalised children and possible risk factors for the development of extravasation, infiltration and phlebitis. Method: The study was conducted in the largest children’s hospital in a region of Turkey, with a bed capacity of 354 and 1400 employees, which provides care only to paediatric patients aged from newborn to 18 years old. In this 5-month prospective study, the complications of PIVCs in hospitalised children and risk factors leading to the development of extravasation, infiltration and phlebitis were recorded. During morning and afternoon daily visits, the researcher examined catheter sites for complications and indications for removal. Results: The study covered 244 patients aged from 1 month to 17 years, 575 PIVCs and 1600 catheter days. The rates of infiltration and phlebitis observed in children with PIVCs were 8.7 % and 15.8% respectively. Logistic regression revealed that using 22- and 24-gauge catheters, hospitalisation in the surgery ward and continuous infusion were significant independent risk factors for the development of infiltration (P&amp;lt;0.001). Direct logistic regression revealed that age in months, hospitalisation in a surgery ward and placement of the catheter in the veins of the antecubital fossa were significant independent risk factors for the development of phlebitis (P&amp;lt;0.001). Conclusion: Catheter size, hospitalisation in the surgery ward and continuous infusion contributed to the development of infiltration. Age, hospitalisation in the surgery ward and catheter placement in the antecubital vein contributed to the development of phlebitis.

Complications of peripheral intravenous catheters and risk factors for infiltration and phlebitis in children.

This study aimed to identify the types of complications of peripheral intravenous catheters (PIVCs) in hospitalised children and possible risk factors for the development of extravasation, infiltration and phlebitis. The study was conducted in the largest children's hospital in a region of Turkey, with a bed capacity of 354 and 1400 employees, which provides care only to paediatric patients aged from newborn to 18 years old. In this 5-month prospective study, the complications of PIVCs in hospitalised children and risk factors leading to the development of extravasation, infiltration and phlebitis were recorded. During morning and afternoon daily visits, the researcher examined catheter sites for complications and indications for removal. The study covered 244 patients aged from 1 month to 17 years, 575 PIVCs and 1600 catheter days. The rates of infiltration and phlebitis observed in children with PIVCs were 8.7 % and 15.8% respectively. Logistic regression revealed that using 22- and 24-gauge catheters, hospitalisation in the surgery ward and continuous infusion were significant independent risk factors for the development of infiltration (P<0.001). Direct logistic regression revealed that age in months, hospitalisation in a surgery ward and placement of the catheter in the veins of the antecubital fossa were significant independent risk factors for the development of phlebitis (P<0.001). Catheter size, hospitalisation in the surgery ward and continuous infusion contributed to the development of infiltration. Age, hospitalisation in the surgery ward and catheter placement in the antecubital vein contributed to the development of phlebitis.

Real-world short-term VenaSeal ablation outcomes for symptomatic saphenous incompetence.

Chronic venous insufficiency is a common vascular condition with significant resultant patient morbidity. There has been a shift towards minimally invasive treatment modalities with VenaSeal endovenous ablation among the more recent treatment modalities introduced. Long-term outcome data for this treatment modality is not widely available yet. We aim to report 6-week patient outcomes over a 5-year period from a high-volume tertiary vascular centre. This is a retrospective, single-centre study reporting short-term outcomes following VenaSeal endovenous ablation for symptomatic saphenous incompetence. Patients were followed-up at 6-weeks post-procedurally by telemedicine or in-person clinic appointment without routine venous ultrasound assessment. We report outcomes for 235 patients during this study period. All patients tolerated the procedure under local anaesthesia. Average age was 60.5years (29-82years) with slight male predominance (55.7%). The majority were New Zealand European (63.8%). Mean body mass index was 28.5 (22.2-41.4). We report a 21% rate of self-limiting phlebitis and 33 minor complication events. These include 15 cases of residual varicose veins, 9 saphenous nerve neuropraxia, 6 cases of puncture-site cellulitis and 3 deep vein thromboses. Patient demographics and primary surgeon did not have a statistically significant outcome on development of complications. We report that VenaSeal endovenous ablation is a safe and effective method of treatment for symptomatic truncal saphenous vein incompetence. We report safely managing post-operative phlebitis conservatively and find a mixture of clinical and phone clinic follow-up sufficient without requirement for objective duplex ultrasound following the procedure to ensure objective saphenous vein closure.

Clinical efficacy and safety of two concentrations of intravenous nicardipine hydrochloride for nicardipine-related phlebitis in patients with preeclampsia.

To evaluate the effect of two concentrations of intravenous administration of nicardipine hydrochloride on nicardipine-related phlebitis in patients with preeclampsia. A total of 100 preeclampsia patients were administered with nicardipine hydrochloride and divided into the low-concentration (LC) and high-concentration (HC) groups. The incidence and severity of phlebitis, time from treatment to onset of phlebitis, skin temperature, visual analogue scale (VAS) score, induration, and systemic adverse reactions were compared between two groups. The incidence rate of phlebitis in the LC group was 20% (10/50), significantly lower than 42% (21/50) in the HC group (P< 0.05). Ridit Analysis showed that the severity of phlebitis in the LC group was remarkably lower than that in the HC group (P< 0.05). In the LC group, the time from intravenous administration to onset of phlebitis was longer, the average skin temperature was higher, the VAS score was lower, and the indurated area was smaller than those in the HC group (all P< 0.05). Intravenous infusion of nicardipine hydrochloride with constant and low concentration reduces the incidence rate of phlebitis, prolongs the time from treatment to onset of phlebitis, alleviates the severity of phlebitis and pain, maintains skin temperature, and minimizes induration in preeclampsia patients without systemic adverse reactions.

Effect of the Phlebitis Assessment Scale on the Incidence of Phlebitis Rate on Peripheral Infusion: A Systematic Review

Background: Phlebitis is a common complication of peripheral intravenous cannulation. To assess phlebitis, carried out by using a phlebitis assessment scale. There're many scales of phlebitis assessment, however there’s no uniformity in their use, causes the incidence rate of phlebitis is increasing to reach. Purpose: To identify the effect of phlebitis assessment scale used in clinical settings. Design: We conducted a systematic review from 3 world online libraries (Pubmed, Science direct, Ebsco) until June 2020. The research used was in English, type of research randomized controlled trials, prospective cohort, and cross-sectional. Occur 267 articles found based on keywords. After exclusion resistance, 9 articles including the criteria inclusion and analyzed using the phlebitis assessment scale of the research. Conclusion: Phlebitis scale assessments found in the selected studies have diversity, on types and applications, has an impact on difference in incidence rate and output assessment. Two studies used definition in determining phlebitis (22.2%). 1 of a study used a scale based on a rating system (11.1%). Other studies used the severity level of 6 studies (66.7%). The scale of the phlebitis assessment contributed to the differences in the incidence of phlebitis in surveillance, causes assessment of phlebitis scale not standardized with expected output.

Reduction in the incidence of infusion-related phlebitis in a pediatric critical care unit of Eastern India: A quality improvement initiative

BackgroundPhlebitis is one of the most common complications of the peripheral venous catheter (PVC) and adversely impacts future venous access, and bacterial phlebitis may lead to bloodstream infection. The objective of the study was to reduce the to reduce the incidence of infusion-related phlebitis in children admitted to the pediatric critical care unit. MethodsThis Quality Initiative was implemented in the pediatric critical care unit of a tertiary care hospital between November 2019 and April 2020. Five interventions were identified (hand hygiene, use of transparent dressing, use of extension lines with PVCs, use of hard cardboard splints for joint immobilization, use of heparinized flush after medication administration) and were introduced sequentially. Over the next five weeks, a new intervention was introduced weekly while continuing the previous ones, if found to be working well as per improvement parameter, the phlebitis rate. From the sixth week onwards, all five interventions were applied together as a bundle. ResultsTotal seven hundred eighteen PVCs were sited in 284 (Male: female 1.58:1) patients during study period and a total of 56 incidences of phlebitis were observed. Mean baseline phlebitis rate was 48.5%. In the next 5 weeks when interventions were implemented as planned, phlebitis rate was 35.7% (n = 10), 16.6% (n = 03), 21.6% (n = 8), 10% (n = 05), and 13.3% (n = 2) respectively. Implementation of all five interventions together as a bundle led to reduction in phlebitis rate below 5 % consistently over the next 18 weeks (n = 8). ConclusionA consistent reduction in PVC-related phlebitis can be achieved by the implementation of evidence-based interventions for the prevention of phlebitis, as a bundle.

Impact of interventions on the incidence of thrombophlebitis in peripheral venous cannulation in a tertiary care teaching hospital

Background: In hospitalized patients the use of intravenous devices like cannula are indispensable. Nearly about 80% of hospitalized patients require peripheral venous cannulation, as a part of therapy. Thrombophlebitis is one of the prevalent complications of peripheral venous cannulation.Method: The present study was aimed to find the incidence of thrombophlebitis after peripheral venous cannulations in the patients admitted in a tertiary care teaching hospital. Impact of regular trainings and interventions on the incidence and grades of thrombophlebitis was also studied. The study was conducted for period of 1 year.Result: The total of 28850 cannulations carried out on 11686 patients was observed. Phlebitis was diagnosed in 1821 peripheral venous cannulations, giving the incidence of 6.3%. As per Visual Infusion Phlebitis (VIP) score, 1527 (83.86%) were grade 1 phlebitis, 274 (15.04%) were with grade 2 phlebitis and 20 (1.10 %) were grade 3 phlebitis. Regular surveillance, training and timely interventions were carried out during this period and the effect of these interventions was noted in the monthly phlebitis rate. Phlebitis rate reduced from 9.89% in January to 3.99% in the month of December. There was also reduction in grade 2 thrombophlebitis (from 21.05% in January to 6.09% in December). In the last 4 months of study period grade 3 phlebitis was not reported.Conclusions: A significant reduction in the incidence of phlebitis associated with peripheral intravenous cannulations may be achieved by regular surveillance, training and timely interventions.

The Risk Factors of Phlebitis in The Installation of Intravent Catalysts

Background: A hospital is a health service facility that allows nosocomial infections, namely phlebitis. Phlebitis is a complication of intravenous catheter placement that is characterized by redness, pain, swelling, and fever. The high rate of phlebitis in various countries is due to the risk factors that predispose to the incidence of phlebitis due to intravenous catheter placement.Objective: This study aims to determine the risk factors for phlebitis in intravenous catheter placement.Methodology: This study uses an observational analytic method with a cohort design. The study was conducted on 27 February - 14 March 2020 with 22 samples taken using purposive accidental sampling in the inward and RST surgery Dr. Soedjono Magelang. The instrument used was an observation sheet designed by researchers that had been tested by experts and a standard operational checklist for infusion. Data analysis uses a chi-square test and multiple logistic regression.Results: The incidence of phlebitis was 7 respondents (31.8%) and the associated risk factors were the type of infusion fluid (RR = 4.37 CI 95% 1.09-17.58; p-value 0.020). While the factors of age, sex, nutritional status, chronic diseases, types of injection drugs, insertion location, duration of installation, nurse skills, installation techniques, and catheter size were not related to the incidence of phlebitis (p-value 0.05).Conclusion: Although several factors are not related to the incidence of phlebitis, these factors can be a support for the incidence of phlebitis.

Reducing the incidence of phlebitis in medical adult inpatients with peripheral venous catheter care bundle: a best practice implementation project.

One major complication of the insertion of a peripheral venous catheter (PVC) is phlebitis, often resulting in delay of treatment, increased healthcare costs and prolonged hospitalization. The current study sought to evaluate the effectiveness of a standardized PVC care bundle in increasing the compliance of PVC care and assessment and reduce the occurrences of phlebitis rates. A pre and postimplementation audit approach was used in this study and adopted the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice program. This study was carried out in three phases over a 10-month period, from March 2017 to December 2017 across three medical wards in a hospital in Singapore with a sample size of 90 patients. The study involved educating nurses on phlebitis assessment, implementing a PVC care bundle and monitoring compliance. An audit tool comprising four criteria from the Joanna Briggs Institute Practical Application of Clinical Evidence System was developed. One-month and 3-month postimplementation findings revealed significant improvement in Criteria 1, 3 and 4 (P < 0.001) but no significant improvement in Criterion 2 (P > 0.05). Six-month postimplementation findings showed significant improvement in all four criteria (P < 0.05). An interesting finding was that the number of reported occurrences of phlebitis increased after implementing the PVC care bundle. The increase in phlebitis rates could be attributed to the care bundle facilitating prompt and early identification of phlebitis. Despite the initial increase in occurrences 1 month post implementation, the general effectiveness of the care bundle in reducing occurrences of phlebitis was seen 6 months post implementation. The effectiveness of the care bundle to reduce phlebitis rates may be even more evident across a longer implementation period. The current study showed that the implementation of a standardized PVC care bundle can significantly enhance the assessment and identification process of phlebitis and can aid in reducing the incidence of phlebitis. The nurses' compliance in practicing the PVC care bundle was determined by the post and preimplementation audits, thus, the audit approach was beneficial in translating evidence into practice.

Tissue adhesives for peripheral intravenous catheter securement: A prospective randomized controlled pilot trial.

In some patients securing the peripheral intravenous cannula (PIVC) with a standard adhesive dressing can be difficult because of sweat or other body fluids. The aim of our study was to evaluate the use of tissue adhesives alone as a means to secure PIVCs inserted in the emergency department. We performed a prospective interventional pilot study from November 2019 to May 2020 in a medical emergency department of an urban tertiary hospital. Patients were randomized to two groups: tissue adhesives (TA) or adhesive dressing (AD) group. After randomization we followed them until day 4. There were no significant differences between TA and AD groups in the rate of unplanned removal of PIVCs in the first 72h (57.1% vs. 45.8%, p=0.29), the rate of unplanned removal of PIVCs in the ED (0% vs. 2.1%, p=1.00), the rate of unplanned removal of PIVC in the first 24h (42.8% vs. 35.4%, p=0.52), as well as in the rate of phlebitis (7.1% vs. 14.6%, p=0.34) and the rate of any blood-stream infection (0% vs. 0%, p=1.00). We did not observe any significant differences when PIVCs inserted in the emergency department were secured with tissue adhesives alone, compared to standard adhesive dressings. We observed a high rate of unplanned removal of PIVCs, necessitating further research to determine more reliable ways of securing PIVCs.

Occurrence and incidence rate of peripheral intravascular catheter-related phlebitis and complications in critically ill patients: a prospective cohort study (AMOR-VENUS study)

BackgroundThe lack of precise information on the epidemiology of peripheral intravascular catheter (PIVC)-related phlebitis and complications in critically ill patients results in the absence of appropriate preventive measures. Therefore, we aimed to describe the epidemiology of the use of PIVCs and the incidence/occurrence of phlebitis and complications in the intensive care unit (ICU).MethodsThis prospective multicenter cohort study was conducted in 23 ICUs in Japan. All consecutive patients aged ≥ 18 years admitted to the ICU were enrolled. PIVCs inserted prior to ICU admission and those newly inserted after ICU admission were included in the analysis. Characteristics of the ICU, patients, and PIVCs were recorded. The primary and secondary outcomes were the occurrence and incidence rate of PIVC-related phlebitis and complications (catheter-related blood stream infection [CRBSI] and catheter failure) during the ICU stay.ResultsWe included 2741 patients and 7118 PIVCs, of which 48.2% were inserted in the ICU. PIVC-related phlebitis occurred in 7.5% (95% confidence interval [CI] 6.9–8.2%) of catheters (3.3 cases / 100 catheter-days) and 12.9% (95% CI 11.7–14.2%) of patients (6.3 cases / 100 catheter-days). Most PIVCs were removed immediately after diagnosis of phlebitis (71.9%). Grade 1 was the most common phlebitis (72.6%), while grade 4 was the least common (1.5%). The incidence rate of CRBSI was 0.8% (95% CI 0.4–1.2%). In cases of catheter failure, the proportion and incidence rate per 100 intravenous catheter-days of catheter failure were 21% (95% CI 20.0-21.9%) and 9.1 (95% CI 8.7–10.0), respectively.ConclusionPIVC-related phlebitis and complications were common in critically ill patients. The results suggest the importance of preventing PIVC-related complications, even in critically ill patients.Trial registrationUMIN-CTR, the Japanese clinical trial registry (registration number: UMIN000028019, July 1, 2017).