Phlebitis as a consequence of peripheral intravenous administration of cisatracurium besylate in critically ill patients

Abstract

This case report series describes 3 cases of cisatracurium besylate associated phlebitis after an infusion period of 14-20 hours. No similar cases have been reported in the literature. Association of phlebitis with another neuromuscular blocking agent, atracurium, has been described in the literature. The acidity of atracurium is thought to be the main cause. It is recommended that atracurium is administered only via central venous catheters when indicated to infuse over prolonged periods of time due to the acidity. Cisatracurium is a stereoisomer of atracurium and as such has the same molecular weight. Although cisatracurium also has a similar acidity as atracurium, a recommendation concerning infusion via a central venous catheter is lacking. We suggest prolonged administration of cisatracurium besylate only via centrally placed venous catheters or if not possible to careful monitor relevant peripheral intravenous sites to diminish the risks of phlebitis and associated complications or other cutaneous reactions.

Using “Knowing That” and “Knowing How” to Inform Learning of Peripheral Vein Cannulation in Nursing Education

“…Concern has been expressed about the risk of patient harm associated with the lack of PVC skills among registered nurses (Binner et al, 2011;Carr et al, 2016;Milutinović, Simin, & Zec, 2015;Missen, McKenna, Beauchamp, & Larkins, 2016;Zamanzadeh, Jasemi, Valizadeh, Keogh, & Taleghani, 2015). For example, vein inflammation, phlebitis, is a common complication of PVC (Carr et al, 2016;Hadaway, 2012;Meeder, van der Steen, Rozendaal, & van Zanten, 2016;Milutinović et al, 2015;Niël-Weise, Stijnen, & van den Broek, 2010), diagnosed by clinical symptoms such as pain and signs of local infection (Carr et al, 2016). Several factors have been associated with the development of phlebitis, such as mechanical factors caused by the use of inadequate equipment and lack of skill of the inserter (Milutinović et al, 2015), and infection factors caused by catheter contamination (Hadaway, 2012).…”

Conditions Affecting the Performance of Peripheral Vein Cannulation during Hospital Placement: A Case Study

“…Vein inflammation, phlebitis, is an example of a consequence caused by poor vein cannulation [ 10 – 13 ]. Phlebitis contributes to clinical symptoms such as pain and local infection signs [ 11 ]. A phlebitis caused by catheter related infections has a risk of progressing into a bloodstream infection [ 12 ], increasing inpatient days in hospital [ 14 ].…”