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Journal of Evaluation in Clinical... Apr 2014Phlebitis is a common and painful complication of peripheral intravenous cannulation. The aim of this review was to identify the measures used in infusion phlebitis... (Review)
Review
RATIONALE, AIMS AND OBJECTIVES
Phlebitis is a common and painful complication of peripheral intravenous cannulation. The aim of this review was to identify the measures used in infusion phlebitis assessment and evaluate evidence regarding their reliability, validity, responsiveness and feasibility.
METHOD
We conducted a systematic literature review of the Cochrane library, Ovid MEDLINE and EBSCO CINAHL until September 2013. All English-language studies (randomized controlled trials, prospective cohort and cross-sectional) that used an infusion phlebitis scale were retrieved and analysed to determine which symptoms were included in each scale and how these were measured. We evaluated studies that reported testing the psychometric properties of phlebitis assessment scales using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines.
RESULTS
Infusion phlebitis was the primary outcome measure in 233 studies. Fifty-three (23%) of these provided no actual definition of phlebitis. Of the 180 studies that reported measuring phlebitis incidence and/or severity, 101 (56%) used a scale and 79 (44%) used a definition alone. We identified 71 different phlebitis assessment scales. Three scales had undergone some psychometric analyses, but no scale had been rigorously tested.
CONCLUSION
Many phlebitis scales exist, but none has been thoroughly validated for use in clinical practice. A lack of consensus on phlebitis measures has likely contributed to disparities in reported phlebitis incidence, precluding meaningful comparison of phlebitis rates.
Topics: Catheterization, Peripheral; Cross-Sectional Studies; Humans; Incidence; Phlebitis; Psychometrics; Reproducibility of Results
PubMed: 24401116
DOI: 10.1111/jep.12107 -
Professioni Infermieristiche 2017To explore the relationship between the anatomical site of peripheral venous catheterization and risk of catheter-related phlebitis. (Review)
Review
AIM
To explore the relationship between the anatomical site of peripheral venous catheterization and risk of catheter-related phlebitis.
BACKGROUND
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.
DESIGN
Systematic review.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
Topics: Adult; Catheterization, Peripheral; Hospitalization; Humans; Phlebitis
PubMed: 28485909
DOI: 10.7429/pi.2017.701051 -
Critical Care Nurse Feb 2019Intravenous amiodarone is the gold-standard treatment for arrhythmias, but phlebitis is a common adverse effect.
BACKGROUND
Intravenous amiodarone is the gold-standard treatment for arrhythmias, but phlebitis is a common adverse effect.
OBJECTIVES
To determine the incidence and contributing factors of amiodarone-induced phlebitis and examine phlebitis severity.
METHODS
A systematic review was conducted of articles published before February 2016 in the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, MEDLINE, Embase, Web of Science, and gray databases (Bielefeld, Lenus, EUGrey, RIAN, and DART). All studies in which amiodarone-induced phlebitis was a primary or secondary outcome were included. Meta-analysis was not appropriate because of study heterogeneity. Studies of the same contributing factors were analyzed together.
RESULTS
In the 20 included studies, phlebitis incidence ranged from 0% to 85%. Increasing the infusion concentration from 1.2 mg/mL to 1.8 mg/mL increased the phlebitis rate ( < .001). Total amiodarone doses greater than 1 g resulted in higher phlebitis rates than did doses less than 0.45 mg ( < .001). Most infusion durations and rates were not correlated with phlebitis incidence. However, phlebitis incidence was lower with bolus administration than with longer infusions ( = .002). The use of in-line filters and nursing guidelines significantly reduced phlebitis rates ( < .001) and phlebitis severity. The most common phlebitis severity grades, in descending order, were 0, 1, 2, 3, and 4.
CONCLUSIONS
Understanding factors that increase the risk of amiodarone-induced phlebitis can guide better practice. In-line filters and nursing guidelines should always be implemented when administering intravenous amiodarone. Increased surveillance is required when higher dosages and concentrations are used.
Topics: Amiodarone; Anti-Arrhythmia Agents; Humans; Incidence; Infusions, Intravenous; Phlebitis; Severity of Illness Index
PubMed: 30710042
DOI: 10.4037/ccn2019381 -
The American Journal of the Medical... Aug 2023Three percent hypertonic saline (3% HTS) is used to treat several critical conditions such as severe and symptomatic hyponatremia and increased intracranial pressure. It... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Three percent hypertonic saline (3% HTS) is used to treat several critical conditions such as severe and symptomatic hyponatremia and increased intracranial pressure. It has been traditionally administered through a central venous catheter (CVC). The avoidance of peripheral intravenous infusion of 3% HTS stems theoretically from the concern about the ability of the peripheral veins to tolerate hyperosmolar infusions. The aim of this systematic review and meta-analysis is to assess the rate of complications associated with the infusion of 3% HTS using peripheral intravenous access.
METHODS
We conducted a systematic review and meta-analysis to assess the rate of complications related to the peripheral infusion of 3% HTS. We searched several databases for available studies that met the criteria until February 24th, 2022. We included ten studies conducted across three countries examining the incidence of infiltration, phlebitis, venous thrombosis, erythema, and edema. The overall event rate was calculated and transformed using the Freeman-Tukey arcsine method and pooled using the DerSimonian and Laird random-effects model. I was used to evaluate heterogeneity. Selected items from Newcastle-Ottawa Scale were used to assess the risk of bias in each included study.
RESULTS
A total of 1200 patients were reported to have received peripheral infusion of 3% HTS. The analysis showed that peripherally administered 3% HTS has a low rate of complications. The overall incidence of each of the complications was as follows: infiltration 3.3%, (95% C.I. = 1.8-5.1%), phlebitis 6.2% (95% C.I. = 1.1-14.3%), erythema 2.3% (95% C.I. = 0.3-5.4%), edema 1.8% (95% C.I. = 0.0-6.2%), and venous thrombosis 1% (95% C.I. = 0.0-4.8%). There was one incident of venous thrombosis preceded by infiltration resulting from peripheral infusion of 3% HTS.
CONCLUSIONS
Peripheral administration of 3% HTS is considered a safe and possibly preferred option as it carries a low risk of complications and is a less invasive procedure compared to CVC.
Topics: Humans; Infusions, Intravenous; Saline Solution, Hypertonic; Phlebitis; Edema; Erythema
PubMed: 37192695
DOI: 10.1016/j.amjms.2023.04.025 -
Antibiotics (Basel, Switzerland) Aug 2023Most antimicrobial drugs need an intravenous (IV) administration to achieve maximum efficacy against target pathogens. IV administration is related to complications,... (Review)
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.
PubMed: 37627758
DOI: 10.3390/antibiotics12081338 -
Frontiers in Bioengineering and... 2019The purpose of this systematic review and meta-analysis is to assess the clinical effectiveness and safety of the medical hydrogel dressings used in skin wounds and...
The purpose of this systematic review and meta-analysis is to assess the clinical effectiveness and safety of the medical hydrogel dressings used in skin wounds and therefore to weight the evidence for their clinical application. PubMed/Medline (1980-2019), Cochrane Library (1980-2019), ClinicalTrials.gov, Cochrane CENTRAL, Chinese Journal Full-text Database (CNKI, 1994-2019), and China Biomedy Medicine disc (CBM, 1978-2019), Chinese Scientific Journal Database (VIP, 1989-2019), and Wanfang Database (WFDATA, 1980-2019) were searched to identify relevant clinical trials and studies. Forty-three studies that assessed hydrogel vs. non-hydrogel dressings were identified. Compared to the latter, hydrogel dressings associated with a significantly shortened healing time of degree II burn (superficial and deep) wounds, diabetic foot ulcers, traumatic skin injuries, radioactive skin injuries, dog bites, and body surface ulcers. In addition, hydrogel dressing obviously increased the cure rate of diabetic foot ulcers, surgical wounds, dog bites, and body surface ulcers. Moreover, hydrogel dressing significantly relieved pain in degree II burn (superficial and deep) wounds, traumatic skin injuries, and laser treatment-induced wounds. However, no significant differences obtained between hydrogel and non-hydrogel dressings in the healing time of surgical wounds, the cure rate of inpatients' pressure ulcers, and phlebitis ulcers. This comprehensive systematic review and meta-analysis of the available evidence reveals that the application of hydrogel dressings advances the healing of various wound types and effectively alleviates the pain with no severe adverse reactions. These results strongly indicate that hydrogel products are effective and safe in wound management.
PubMed: 31824935
DOI: 10.3389/fbioe.2019.00342 -
The Journal of Cardiovascular Surgery Apr 2008Radiofrequency obliteration (RFO), endovenous laser therapy (EVLT) and foam sclerotherapy (FS) are potential treatments for varicose veins. A systematic review was... (Meta-Analysis)
Meta-Analysis Review
AIM
Radiofrequency obliteration (RFO), endovenous laser therapy (EVLT) and foam sclerotherapy (FS) are potential treatments for varicose veins. A systematic review was undertaken to assess their safety and effectiveness and to compare these endoluminal therapeutic options with conventional ligation and vein stripping.
METHODS
An electronic health database search was performed on all studies published between 1970 and 2007 describing RFO, EVLT, and FS for treating varicose veins.
RESULTS
Twenty-nine EVLT studies, 32 RFO studies and 22 FS trials were included. RFO was associated with the worst short and long-term safety and efficacy results compared to EVLT and FS regarding ''complete occlusion at the end of follow-up'', ''phlebitis'', ''deep vein thrombosis'', and ''paraesthesia''. EVLT had the best results concerning the long-term effectiveness parameters for ''occlusion at the end of follow-up'' and ''recanalization, recurrence or development of new veins'', compared to RFO and FS. Foam sclerotherapy of varicose veins is associated with a higher recurrence rate in patients with saphenofemoral incompetence compared to the rates after EVLT or RFO treatment.
CONCLUSION
EVLT, RFO, and FS seem to be safe and effective modalities with good short and mid-term
RESULTS
Acquisition of comparative long-term and very long-term data on clinical efficacy (particularly with regard to the formation of recurrent varicose veins), safety, quality of life outcomes and costs is needed by large high-quality prospective randomized trials of endovenous techniques versus each other and versus surgery before considering endovenous techniques as the standard treatment.
Topics: Catheter Ablation; Humans; Laser Therapy; Sclerotherapy; Treatment Outcome; Varicose Veins
PubMed: 18431342
DOI: No ID Found -
The Journal of Vascular Access 2015To determine postinsertion complication rate for peripherally inserted central catheters (PICCs), in particular the difference between silicone and polyurethane lines in... (Review)
Review
PURPOSE
To determine postinsertion complication rate for peripherally inserted central catheters (PICCs), in particular the difference between silicone and polyurethane lines in general population groups as well as oncology and non-oncology patient groups.
METHODS
A systematic review of prospective and retrospective studies in the English language between January 2000 and October 2013 focusing on postinsertion complication rates for PICCs in the adult population. Joanna Briggs Institute tools were used to extract data from the final 19 articles with information collated relating to catheter type, patient type, overall complication rate, rates of infection, occlusion, dislodgment, phlebitis, thrombus and rupture.
RESULTS
Overall, the PICCs complication rates ranged from 8 to 50%. Although both lines saw similar overall rates upon closer observation, the strengths and weaknesses of both lines are shown.Polyurethane PICC lines were found to provide lower rates of infection, dislodgment, thrombus and rupture complications.Mixed results were found with catheter line occlusions, overall averages showing polyurethane lines slightly higher rates than silicone. Oncology patients however saw opposite results.Phlebitis rates saw the largest division among the postinsertion complication rates, with 6.7% more phlebitis in the general patient group and 14.5% in the oncology group more for those with polyurethane PICC lines compared with the silicone.
CONCLUSIONS
Both silicone and polyurethane PICC lines exhibit nearly identical overall average postinsertion compilation rates; however, it is the type of complications experienced that differ. Overall, oncology patients can expect to experience higher levels of postinsertion complications.
Topics: Administration, Intravenous; Antineoplastic Agents; Catheter Obstruction; Catheter-Related Infections; Catheterization, Central Venous; Catheterization, Peripheral; Central Venous Catheters; Equipment Design; Equipment Failure; Humans; Medical Oncology; Patient Safety; Polyurethanes; Risk Assessment; Risk Factors; Silicones; Thrombosis; Treatment Outcome
PubMed: 25634150
DOI: 10.5301/jva.5000330 -
Journal of Clinical Nursing Apr 2023This systematic review and meta-analysis aimed to compare the incidence of PVC-related complications between catheterisation in the forearm and back of the hand in adult... (Meta-Analysis)
Meta-Analysis Review
AIMS AND OBJECTIVES
This systematic review and meta-analysis aimed to compare the incidence of PVC-related complications between catheterisation in the forearm and back of the hand in adult patients.
BACKGROUND
A peripheral intravenous catheter (PVC) is often inserted as part of care during patients' hospitalisation. The catheter is typically inserted in the forearm or at the back of the hand in usual practice. Studies have not yet reached a consensus on the optimal insertion site in any clinical setting.
DESIGN
We performed a systematic review and meta-analysis based on PRISMA guidelines.
METHODS
We searched the following electronic databases: PubMed, Cochrane Library, Embase, and CINAHL. Randomised controlled trials, cohort studies, case-control studies and cross-sectional studies from inception to July 2021 reporting the incidence of PVC-related complications at the forearm and back of the hand were included. Fixed-effects models and random-effects models were used to derive the pooled risk ratios.
RESULTS
Twenty-four studies involving 16562 PVCs met our inclusion criteria. The meta-analysis showed that compared with PVC placement in the back of the hand, placement in the forearm was associated with a higher incidence of total complications and infiltration/extravasation. However, the differences between the PVC indwelling sites were not significant (total complications: P = 0.43; phlebitis: P = 0.35; infiltration/extravasation: P = 0.51). Both incidence of total complications and infiltration/extravasation analyses showed high heterogeneity (total complications: I = 60%; infiltration/extravasation: I = 58%).
CONCLUSION
Available evidence suggests that there is no significant difference between PVC placement in the forearm and at the back of the hand in terms of the incidence of complications, thus making both approaches suitable.
RELEVANCE TO CLINICAL PRACTICE
For patients who need indwelling PVC, medical staff can choose the best indwelling site, and both forearm and back of the hand are suitable.
Topics: Humans; Adult; Cross-Sectional Studies; Catheters; Case-Control Studies; Consensus; Hospitalization
PubMed: 35229381
DOI: 10.1111/jocn.16241 -
Clinical Nutrition ESPEN Apr 2023Peripheral parenteral nutrition (PPN) refers to the delivery of artificial nutrition via a peripheral intravenous cannula. As a nutritional intervention it remains... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Peripheral parenteral nutrition (PPN) refers to the delivery of artificial nutrition via a peripheral intravenous cannula. As a nutritional intervention it remains under-utilised in peri-operative care. This is despite purported advantages which includes avoiding the risks associated with central venous lines and preventing potential delays to the initiation of nutrition support. This systematic review and meta-analysis will detail the available evidence for PPN use in surgery.
METHODS
A comprehensive search of the EMBASE and Medline databases was undertaken to identify randomised control trials (RCTs) involving PPN use in surgical patients published until July 30th 2022. Three domains of PPN use were reviewed including: PPN compared to crystalloid intravenous fluids on nutritional and clinical outcomes; PPN compared to Central PN (CPN) on nutritional outcomes and complications; and strategies to prevent thrombophlebitis associated with PPN.
RESULTS
The meta-analysis included 8 studies which included 698 patients. Use of PPN led to reduced post-operative weight loss (% body weight change) with a mean difference of -1.45% (95% CI -2.9 to -0.01, p = 0.05). There was no statistically significant difference in terms of length of stay, infectious/non-infectious complications, surgical site infections or phlebitis. 42 RCTs were included in the systematic review. 14 RCTs compared PPN to crystalloid infusion. There was significant heterogeneity in the trial populations, interventions and measured outcomes. Most trials found that PPN may improve nitrogen balance and positively impact nutritional markers. Quality of life and post-operative complications were either improved or no difference found in trials assessing these outcomes. Four RCTs showed that PPN is a safe and feasible alternative to CPN. 22 RCTs reported on measures that may impact on thrombophlebitis rates associated with PPN. These included lower osmolality of PPN solution, cyclical PPN delivery, use of a small gauge polyurethane cannula in an upper limb vein, addition of heparin/hydrocortisone to PPN solutions and placement of a GTN patch over infusion sites.
CONCLUSION
PPN is a safe and effective mode of delivery of peri-operative nutrition. It is a feasible short-term alternative to central-line delivered PN. There are a number of strategies to reduce thrombophlebitis associated with PPN use. Further high-quality RCTs are required to assess the use of PPN in contemporary surgical practice.
Topics: Humans; Parenteral Nutrition; Nutritional Support; Parenteral Nutrition Solutions; Thrombophlebitis; Nutritional Status
PubMed: 36963880
DOI: 10.1016/j.clnesp.2023.02.004