Use of Transdermal Glyceryl Trinitrate to Reduce Failure of Intravenous Infusion Due to Phlebitis and Extravasation

Wright, Alex; Hecker, J. F.; Lewis, G. B. H.

doi:10.1016/s0140-6736(85)92678-9

Cited by 46 publications

(13 citation statements)

References 16 publications

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“…The use of a topical GTN patch conferred no additional benefit, and used alone was less effective than low-dose heparin and hydrocortisone in preventing PVT. This result differs from the findings of studies that employed short cannulas, in which a topical GTN patch appeared to be effective in preventing PVT 13,22 One interpretation of this difference is that vasoconstriction may occur more readily around short cannulas. Alternatively, a short cannula may occlude the vein more easily than a fine-bore midline catheter, making venodilatation more important to maintain blood flow and prevent PVT.…”

Section: Discussioncontrasting

confidence: 83%

“…However, placement of GTN patches close to the vein, rather than directly over the vein itself, has been shown not to influence the local effects of GTN 22 . The basilic and cephalic veins are relatively constant in their anatomical position, and placement of the patches on the medial or lateral aspect of the upper arm, 15 cm from the catheter insertion site, is likely to provide a similar local GTN effect to that of other studies in which short cannulas have been used.…”

Section: Discussionmentioning

confidence: 97%

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Randomized clinical trials to determine the role of topical glyceryl trinitrate in peripheral intravenous nutrition

Dobbins

Catton

Tighe

et al. 2003

British Journal of Surgery

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Section: Discussioncontrasting

confidence: 83%

Section: Discussionmentioning

confidence: 97%

Randomized clinical trials to determine the role of topical glyceryl trinitrate in peripheral intravenous nutrition

Dobbins

Catton

Tighe

et al. 2003

British Journal of Surgery

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“…Peripheral venous thrombophlebitis was defined as the development at an infusion site of two or more of the following signs: pain, erythema, swelling, excessive warmth, or a palpable venous cord. 4 Phlebitis was recorded as mild (erythema less than 2 cm), moderate (erythema greater than 2 cm) or severe (erythema greater than 2 cm with pain).…”

Section: Study Protocolmentioning

confidence: 99%

Randomised clinical trial of elective re-siting of intravenous cannulae

Barker¹,

Anderson²,

MacFie³

2004

Ann R Coll Surg Engl

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Introduction: Peripheral venous thrombophlebitis (PVT) represents a considerable source of iatrogenic morbidity, occurring in about 20% of hospital in-patients. The aim of this prospective randomised study was to investigate the effect of elective change of intravenous cannulae on the incidence of PVT in hospital in-patients. Patients and Methods: General medical and surgical inpatients requiring intravenous therapy were randomised into control (n = 26) or study (n = 21) groups. Cannulae in the control group were only removed if the site became painful, the cannula dislodged, or there were signs of PVT. Cannulae in the study group were changed electively every 48 h. All patients were examined daily for signs of PVT. Results: Peripheral venous thrombophlebitis developed in 11/26 patients in the control group and 1/21 patients in the study group (P = 0.003). Elective change of cannulae did not significantly increase the total number of cannulae sited (41 cannulae in the control group versus 43 in the study group). Conclusions: Elective change of cannulae resulted in a significant reduction in the incidence of infusion phlebitis. The authors recommend that elective re-siting of intravenous cannulae becomes standard practice for all patients requiring intravenous therapy.

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“…However, it has received no attention in the medical literature. Techniques which reduce the incidence of infusion failure, such as local transcutaneous glyceryl trinitrate (Wright et al, 1985;Khawaja et al, 1988) or the addition of small amounts of heparin to solutions (Tanner et al, 1980;DeCock et al, 1984;Alpan et al, 1984) could be considered to conserve veins of oncology patients who are likely to require repeated intravenous therapy.…”

Section: Resultsmentioning

confidence: 99%

Survival of intravenous chemotherapy infusion sites

Hecker

1990

Br J Cancer

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Summary Factors associated with the failure of intravenous infusions due to phlebitis and extravasation were studied with 218 infusions delivering cytotoxic drugs. The survival rate of these infusions was not significantly different from that of 56 non-cytotoxic infusions in oncology patients. Although survival analysis indicated that cisplatin was associated with longer survival, this was probably an artifact caused by this drug usually being preceded by 24 h prehydration. Multivariate analysis indicated that etoposide was the only drug associated with decreased infusion survival and that bleomycin, cyclophosphamide, doxorubicin, ifosphamide, methotrexate, treosulphan and 5-fluorouracil had no significant effects. Also age of patient, infusion site and flow rate had no effects but survival was shorter in women. Follow-up When an infusion site could be located precisely at a subsequent visit (from notes and the patients memory), patency of the vein proximal to the infusion site was determined by inspection and palpation. ResultsOf 284 infusion sites studied, 78 (27.4%) failed with 32 extravasating, 41 becoming phlebitic and five extravasating with obvious phlebitic signs. Of the failed infusions, 46 (13 for extravasation and 32 for phlebitis) required resiting for treatment (usually less than 72 h) to continue. In addition, four, three, one and one infusions were resited because of 'blockage', dislodgement, clotting and leakage respectively but these were not classed as failed.Statistics for oncology patients such as age, sex, cannula site and average fluid rate are shown in Table I. None of these factors was significant by univariate analysis.Cytotoxic drugs were infused at 228 sites while the 56 other sites received only crystaloid fluids and sometimes antibiotics. There was no significant difference between cytotoxic and non-cytotoxic infusions (RRFs 1.02 and 0.99 respectively, X2=0.01) (Figure 1).The most common drug given was cisplatin with bleomycin, etoposide, methotrexate, treosulphan and 5-fluorouracil (5-FU) also being used frequently. Other drugs (mitozan, JM8 and vinblastine) were used only occasionally (three, two and one times respectively). Univariate analyses of survival of infusions with individual drugs (Table II) showed that only cisplatin was associated with a statistically significant difference (this was longer survival). Table III shows factors selected by the multifactorial analysis. Cisplatin was associated with longer survival while infusions in females and infusions with etoposide had shorter survival.Subsequent patency was determined for 39 sites. Of 34 which ended without failure, 28 were patent while six were

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Use of Transdermal Glyceryl Trinitrate to Reduce Failure of Intravenous Infusion Due to Phlebitis and Extravasation

Cited by 46 publications

References 16 publications

Randomized clinical trials to determine the role of topical glyceryl trinitrate in peripheral intravenous nutrition

Randomized clinical trials to determine the role of topical glyceryl trinitrate in peripheral intravenous nutrition

Randomised clinical trial of elective re-siting of intravenous cannulae

Survival of intravenous chemotherapy infusion sites

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