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

Abstract

Aims 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. Methods and Results 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. Conclusion 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.

Aligning peripheral intravenous catheter quality with nursing culture—A mixed method study

“…However, many experienced nurses in the study felt knowledgeable about the local PIVC guideline until they read it ahead of the interview and realized they were unaware of recent updates. The discrepancy between clinical practice and evidence-based guidelines has been identified in other studies (Berger et al, 2021;Brors et al, 2023). Nurses know the insertion procedure, but they lack awareness of updates; therefore, guideline knowledge and adherence should be assessed regularly (Saliba et al, 2018).…”

“…Several evidence‐based guidelines for PIVC quality and care are available (Capdevila et al., 2016; Gorski et al., 2021; Loveday et al., 2016), but adherence to these guidelines is often inadequate (Berger et al., 2021; Hovik et al., 2019; Raynak et al., 2020; Zingg et al., 2023). Nurses' substandard adherence to PIVC handling needs to be further explored, as inconsistencies between guidelines and local policy are common (Berger et al., 2021; Brors et al., 2023; Yilmaz et al., 2021). There is a known need to identify individual and institutional factors that play a role in influencing the quality of PIVC care (Blanco‐Mavillard et al., 2022).…”

High concentration Amiodarone continuous infusion induced Phlebitis: A Case Report

“…In accordance with definitions, phlebitis is an inflammation of the tunica intima of the vein that can produce discomfort, tenderness, oedema, and erythema. The skin is also hot to the touch and may have a palpable cord [10][11][12] . Numerous factors, including concentrations above 2 mg/mL, a higher amiodarone dose, peripheral lines, speed of administration, duration of amiodarone administration, lack of in-line filters, suboptimal aseptic technique during line insertion, lack of post-infusion line flushing, poor vein condition, older age, female sex, administration errors, drug stability, amiodarone pH, host factors, and concussion, are linked to blood vessel irritation [12][13] [3.46-4.35].…”