The incidence of phlebitis in a Medical Clinical Unit

Abstract

The objective of this study was to verify the incidence of phlebitis in a clinical medical unit. A prospective cohort study was conducted using nonparticipatory observations guided by a structured questionnaire, with 100 patients admitted to the clinical medical unit, in whom 234 peripheral venous accesses were used. Phlebitis was identified in 60% of patients and in 55.6% of the peripheral venous accesses, and most of them remained intact for more than 72 hours (53%). The presence of phlebitis per patient was associated with longer hospitalization on the clinical unit (p=0.002) and a greater number of accesses per patient (p<0.001). Length of retention of venous access for more than 72 hours was also associated with the presence of phlebitis (p<0.001). Phlebitis occurred in the majority of the patients and peripheral venous accesses analyzed. Therefore, it is necessary to intensify the training protocols for nursing staff in order to reduce the rates of phlebitis.

Complicações relacionadas ao uso do cateter venoso periférico: ensaio clínico randomizado

“…(4,(7)(8)(9)(10)(11)(12)(13) Concerning the catheter characteristics, studies appoint that caliber 20G is the most used, (10)(11)(12)(13)(14) location in upper left limb (3,10) and forearm region, (1,8,9,13) successful puncture upon the first attempt, (1,4) and dwelling time superior to 72 hours, (8)(9)(10)13,15) similar to the present findings. The use of antimicrobials in this research differed from studies that appoint frequent use.…”

“…(22) In line with the research findings, a study appointed grade I phlebitis as the most frequent in 94.4% of the catheters and grade III was the most severe. (13) Other studies appoint that grade I predominates in 77.66%, (22) 46.2% (10) and 41.6%, (8) followed by 22% grade II, (22) 40%, (10) and 37.5%. (8) Grade III, only found in the trial group, was appointed with 12%, (22) 16.7%, (8) 19.3%, (23) 18.3%, (10) 9.9% (15) and 7.2%.…”

“…(13) Other studies appoint that grade I predominates in 77.66%, (22) 46.2% (10) and 41.6%, (8) followed by 22% grade II, (22) 40%, (10) and 37.5%. (8) Grade III, only found in the trial group, was appointed with 12%, (22) 16.7%, (8) 19.3%, (23) 18.3%, (10) 9.9% (15) and 7.2%. (12) As opposed to the present data, in which no grade IV phlebitis was developed, these cases did occur in studies, with rates of 4.2%, (8) 2.2% (12) and 22.8%.…”

“…Independent analyses appoint significant relations for the development of phlebitis, including: lower limb puncture (p=0.015) and use of antimicrobials (p=0.009); (12) puncture site in cubital fossa was vulnerable to more severe phlebitis when compared to the forearm (p<0.05); (20) regions of flexion or great mo- bility contribute to traumatic phlebitis; (12) closed infusion systems reduce phlebitis rates by 29% (p=0.004); (4) age (between 60-100 years), smoking (p=0,030), hospitalization at clinical, geriatrics and cardiology wards, emergency admission, use of intravenous antimicrobial drugs, catheter inserted in the back of the hand, calibers 22 and 24 gauge and other catheter materials different from polyurethane; (13) diabetes (p=0.003), 18 gauge caliber (p=0.031), punctured in antecubital fossa region (p=0.001), dwelling time longer than 49 hours (p=0.0000), continuous infusion (p=0.039), use of antimicrobials (p=0.002); (21) hospitalization time longer than 18 days (p=0.002) and dwelling time longer than 72 hours (p=<0.001). (10) A study that related the catheter dwelling time with phlebitis identified its development in 28% of the catheters between fourth and fifth day of the dwelling time (p=0.03). (22) In line with the research findings, a study appointed grade I phlebitis as the most frequent in 94.4% of the catheters and grade III was the most severe.…”

Phlebitis predictors in cardiac patients undergoing peripheral intravenous therapy

“…Another cohort study conducted in southeastern Brazil, with 60 neurosurgical patients (152 PVC) found a percentage of 10.5% of phlebitis [11], similar to this study. Two other cohort studies in hospitalized adults found phlebitis rates of 25.8% in 76 patients with cardiorespiratory and renal disease (155 PVC) [12] and 60% in 100 patients with pulmonary disease and cardiac patients (234 PVC), respectively [13].…”