Phlebitis risk varies by peripheral venous catheter site and increases after 96 hours: a large multi‐centre prospective study

Abstract Background: Hodgkin Lymphoma (HL) is a neoplastic hematologic disease that requires treatment with standard chemo-radiotherapy and, in relapsed patients, intensification with hematopoietic s cell transplantation (HCT). Introduction: Insertion of a Peripheral Insertion Central Venous Catheter (PICC) instead of a Peripheral Venous Catheter (PVC) could simplify HL patients management and allow a safer therapy, according to their outpatient care. Methods: Since the 2007, a PICC team, consisting of an hematology physician and two dedicated nurses has carried out a prospective study to evaluate complication rate and usefulness of PICC device in the hematology clinical practice, particularly in HL patients. Inclusion criteria included all HL inpatient and outpatient who needed program of chemo-radiotherapy, support treatment and HSCT, regardless of white blood cells (WBC) and platelets (PLT) counts. All patients underwent a previous evaluation of arms vascular anatomy by ultrasonography. All implantation procedures were performed under ultrasound guide with radiographic control following insertion. Results: From March 2007 to January 2018, 228 attempts of PICC implantation were performed in 202 HD patients (104 male and 90 females). Median age was 35 years, range 16-85. Catheter insertion was successful in 220 cases (96.5 %) in 194 patients, whilst in 8 cases (3.5%) PICC insertion was not possible; 96 PICC were inserted in patients treated with a previous chemotherapy. Two hundred and seven PICC (94%) were used for chemo-radiotherapy courses, five (2.3%) for support treatment, 7 (3.2%) for autologous HSCT, 1 (0.5%) for allogenic HSCT. At the time of this analysis 7 out of 220 PICC (3.5%) are still in situ and in use, 180 (81.5%) were removed for end of therapy and 10 (4.5%) for accidental withdrawals. Only 23 PICC (10.5%) were removed because of catheter related complications: 2 (0.9%) for catheter rupture, 4 (1.8 %) for malfunctioning, 7 (3.2%) for occlusions, 4 (1.8%) for local infection, 6 (2.7%) for suspected PICC-related sepsis. Only 3 episode of confirmed PICC-related septicemia (1.4 %; 0.1/1000 days/PICC) were recorded and Staphylococcus was isolated. There were only 5 episodes (2.3% ; 0.14/1000 days/PICC) of symptomatic PICC-related thrombotic complications, without need of removal. Two cases (0.9%) of delayed abnormal dislocation were recorded, fixed with subsequent replacement with guide. PICC median life was 157 days (range 1-396) for a total of 34,764 days. The 365-day cumulative incidence of catheter removal for end of therapy (PICC life) was 95,5%±1.7%. No significant difference was found in patients underwent previous chemotherapy course (95.1±2.6 vs 95.8±2.1%, p=NS). Neither stage of disease WBC or PLT count had influenced on PICC life. Conclusions. These data encourage the use of PICC as standard of care in the management of HD patients because of easy insertion, safety of use, duration of life and low rate of complication. Disclosures Angelucci: Celgene: Honoraria, Other: Chair DMC; Novartis: Honoraria, Other: Chair Steering Comiittee TELESTO Protocol; Vertex Pharmaceuticals Incorporated (MA) and CRISPR CAS9 Therapeutics AG (CH): Other: Chair DMC; Jazz Pharmaceuticals Italy: Other: Local ( national) advisory board; Roche Italy: Other: Local (national) advisory board.

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A Curious Case of MRSA Bacteremia and Septic Pulmonary Embolism Secondary to Peripheral Venous Catheter

Case Reports in Critical Care ◽

10.1155/2021/5544505 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Joshua Twito ◽

Syeda Sahra ◽

Abdullah Jahangir ◽

Neville Mobarakai

Keyword(s):

Infective Endocarditis ◽

Upper Extremity ◽

Venous Catheter ◽

Pulmonary Emboli ◽

Site Assessment ◽

Case Presentation ◽

Peripheral Venous Catheter ◽

Septic Pulmonary Embolism ◽

Catheter Site ◽

Pathogen Entry

Background. Central venous catheters (CVCs) have been frequently associated with septic thrombophlebitis, bacteremia, and septic emboli. Right-sided infective endocarditis is seen concurrently in patients with septic pulmonary emboli. A case of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and septic pulmonary emboli secondary to infected peripheral venous catheter (PVC) is reported. Transesophageal echocardiogram (TEE) showed no evidence of infective endocarditis. Case Presentation. A 44-year-old female presented to E.R. with left upper extremity pain and swelling at the previously inserted peripheral 18-gauge intravenous catheter site. She also had chest pain, which worsened with inspiration. The patient was found to be in septic shock. Her clinical condition deteriorated acutely. Right upper extremity deep venous thrombosis (DVT) and pulmonary emboli were seen on imaging. Blood cultures grew MRSA. Transthoracic and transesophageal echocardiograms showed no vegetations. The patient responded well to appropriate antibiotics and anticoagulation. Conclusion. Peripherally inserted catheters are an important portal for pathogen entry and need periodic site assessment and frequent evaluation of their need for insertion. Septic pulmonary emboli can also be seen without any evidence of right-sided infective endocarditis.

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Intravenous access placement and fluid administration appropriateness in the emergency department

Emergency Care Journal ◽

10.4081/ecj.2021.9150 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Massimo Salvetti ◽

Anna Paini ◽

Efrem Colonetti ◽

Claudio Mutti ◽

Silvia Bonetti ◽

...

Keyword(s):

Emergency Department ◽

Prospective Study ◽

Cost Savings ◽

Venous Catheter ◽

Fluid Administration ◽

Blood Samples ◽

Intravenous Access ◽

Peripheral Venous Catheter ◽

Intravenous Fluid Administration ◽

A Prospective Study

The aim of this study is to assess practice and effectiveness of Peripheral Venous Catheter (PVC) insertion and intravenous fluid administration in the Emergency Department (ED). A prospective study was conducted at a single primary ED in Brescia, Italy. 455 participants were included in the analysis. PVC were placed in 88 % of patients, 18 gauge catheters were the most frequently used (63%). In 360 patients PVC placement required one attempt. In 99 % of patients PVCs were used at least once. Fluid administration was considered appropriate in 23 patients. Out of 402 PVC placements, 244 were not necessary (in 225 patients PVCs were used only for blood samples withdrawal, and in 16 patients they were used for blood samples withdrawal, and inappropriate fluid administration). We concluded that a large number of PVC placements in the ED was potentially avoidable, and, when PVCs were used for IV fluid administration, the indication was often inappropriate. Physicians should carefully assess the real need of PVC placement in patients admitted to the ED and critically assess some issues of everyday practice, like PVC placement or IV fluids prescription, with evaluation of cost savings.

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Effectiveness of Heparin during Long-Term Tocolysis

ISRN Obstetrics and Gynecology ◽

10.1155/2013/650532 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4

Author(s):

Tetsunori Inagaki ◽

Shintaro Makino ◽

Takashi Yorifuji ◽

Motoi Sugimura ◽

Satoru Takeda

Keyword(s):

Side Effects ◽

Prospective Study ◽

Visual Analog Scale ◽

Uterine Contraction ◽

Venous Catheter ◽

Analog Scale ◽

Exchange Frequency ◽

Peripheral Venous Catheter ◽

Catheter Exchange

Objective. Drip infusion during long-term tocolysis causes mechanical and infectious vasculitis and increases the frequency of peripheral venous catheter exchange (PVC), thereby placing a burden on patients. Our study aim is to confirm whether heparin ameliorates pain due to vasculitis during long-term tocolysis and reduces the frequency of peripheral venous catheter exchange. Design. Prospective study. Setting and Sample. All the patients requiring admission because of the presence of uterine contraction or progressive cervical dilatation from August 2009 to June 2011 at Juntendo University in Japan. Methods. Heparin was used for patients at the time the total number of peripheral venous catheter exchanges exceeded 5 in two weeks, and we evaluated whether heparin reduced the frequency of peripheral venous catheter exchange and improved the visual analog scale (VAS) for patients. The main outcome measures frequency of PVC exchange and VAS. Results. This study demonstrated that heparin reduced the frequency of peripheral venous catheter exchange () and VAS (). No side effects were noted. Conclusion. Heparin could satisfy patients during long-term tocolysis in terms of ameliorating pain due to vasculitis and reducing the PVC exchange frequency.

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Prevention and Treatment of Phlebitis Secondary to the Insertion of a Peripheral Venous Catheter: A Scoping Review from a Nursing Perspective

Healthcare ◽

10.3390/healthcare9050611 ◽

2021 ◽

Vol 9 (5) ◽

pp. 611

Author(s):

Aitana Guanche-Sicilia ◽

María Sánchez-Gómez ◽

María Castro-Peraza ◽

José Rodríguez-Gómez ◽

Juan Gómez-Salgado ◽

...

Keyword(s):

Venous Catheter ◽

Venous Access ◽

Medication Administration ◽

Volume Control ◽

Nursing Interventions ◽

Intravenous Therapy ◽

Treatment Protocols ◽

Peripheral Venous Catheter ◽

Treatment And Prevention ◽

Prevention And Treatment

The objective of this work was to identify available evidence on nursing interventions for the prevention and treatment of phlebitis secondary to the insertion of a peripheral venous catheter. For this, a scoping systematic review was carried out following the guidelines in the PRISMA declaration of documents published between January 2015 and December 2020. The search took place between December 2020 and January 2021. Scielo, Pubmed, Medline, Scopus, WOS, CINHAL, LILACS, and Dialnet databases were consulted, and CASPe, AGREE, and HICPAC tools were used for the critical reading. A total of 52 studies were included to analyze nursing interventions for treatment and prevention. Nursing interventions to prevent phlebitis and ensure a proper catheter use included those related to the maintenance of intravenous therapy, asepsis, and choosing the dressing. With regard to the nursing interventions to treat phlebitis, these were focused on vigilance and caring and also on the use of medical treatment protocols. For the prevention of phlebitis, the highest rated evidence regarding asepsis include the topical use of >0.5% chlorhexidine preparation with 70% alcohol or 2% aqueous chlorhexidine, a proper hygienic hand washing, and the use clean gloves to handle connections and devices. Actions that promote the efficacy and safety of intravenous therapy include maintenance of venous access, infusion volume control, verification of signs of phlebitis during saline solution and medication administration, and constant monitoring. It is recommended to remove any catheter that is not essential. Once discharged from hospital, it will be necessary to warn the patient about signs of phlebitis after PVC removal.

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Risk factors for peripheral venous catheter failure: A prospective cohort study of 5345 patients

The Journal of Vascular Access ◽

10.1177/11297298211015035 ◽

2021 ◽

pp. 112972982110150

Author(s):

Ya-mei Chen ◽

Xiao-wen Fan ◽

Ming-hong Liu ◽

Jie Wang ◽

Yi-qun Yang ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Cohort Study ◽

Goodness Of Fit ◽

Insertion Site ◽

Healthcare Providers ◽

Venous Catheter ◽

Goodness Of Fit Test ◽

Peripheral Venous Catheter ◽

Independent Risk Factors

Purpose: The objective of this study was to determine the independent risk factors associated with peripheral venous catheter (PVC) failure and develop a model that can predict PVC failure. Methods: This prospective, multicenter cohort study was carried out in nine tertiary hospitals in Suzhou, China between December 2017 and February 2018. Adult patients undergoing first-time insertion of a PVC were observed from catheter insertion to removal. Logistic regression was used to identify the independent risk factors predicting PVC failure. Results: This study included 5345 patients. The PVC failure rate was 54.05% ( n = 2889/5345), and the most common causes of PVC failure were phlebitis (16.3%) and infiltration/extravasation (13.8%). On multivariate analysis, age (45–59 years: OR, 1.295; 95% CI, 1.074–1.561; 60–74 years: OR, 1.375; 95% CI, 1.143–1.654; ⩾75 years: OR, 1.676; 95% CI, 1.355–2.073); department (surgery OR, 1.229; 95% CI, 1.062–1.423; emergency internal/surgical ward OR, 1.451; 95% CI, 1.082–1.945); history of venous puncture in the last week (OR, 1.298, 95% CI 1.130–1.491); insertion site, number of puncture attempts, irritant fluid infusion, daily infusion time, daily infusion volume, and type of sealing liquid were independent predictors of PVC failure. Receiver operating characteristic curve analysis indicated that a logistic regression model constructed using these variables had moderate accuracy for the prediction of PVC failure (area under the curve, 0.781). The Hosmer-Lemeshow goodness of fit test demonstrated that the model was correctly specified (χ2 = 2.514, p = 0.961). Conclusion: This study should raise awareness among healthcare providers of the risk factors for PVC failure. We recommend that healthcare providers use vascular access device selection tools to select a clinically appropriate device and for the timely detection of complications, and have a list of drugs classified as irritants or vesicants so they can monitor patients receiving fluid infusions containing these drugs more frequently.

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Care of Peripheral Venous Catheter Sites: Advantages of Transparent Film Dressings Over Tape and Gauze

Journal of the Association for Vascular Access ◽

10.1016/j.java.2014.09.001 ◽

2014 ◽

Vol 19 (4) ◽

pp. 256-261 ◽

Cited By ~ 19

Author(s):

Stéphanie F. Bernatchez

Keyword(s):

Bloodstream Infections ◽

Venous Catheter ◽

The United States ◽

Central Venous ◽

Term Care ◽

Peripheral Venous Catheter ◽

Care Facilities ◽

Review Current ◽

Peripheral Venous Line

AbstractPeripheral intravenous (PIV) catheters are the most commonly used catheters in hospitals, with up to 70% of patients requiring a peripheral venous line during their hospital stay. This represents 200 million PIV catheters used per year in acute-care hospitals in the United States alone. These medical devices are also used in other health care settings, such as long-term care facilities and nursing homes, and common indications include the administration of medications, nutrients, and fluids. These catheters require proper maintenance and care to avoid complications such as phlebitis, infiltration, occlusion, local infection, and bloodstream infection. Recently it has been suggested that PIV catheter use may lead to a higher rate of complications than previously thought. This is important because some studies have claimed that the rate of bloodstream infections due to PIV catheters is actually comparable to the rates observed with central venous catheters, rather than much lower as previously thought. Moreover, catheter-related infections are now seen as largely preventable. Our goal was to review the current literature and provide an overview of the various approaches used to manage PIV catheter sites as well as review current recommendations.

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Efficacy of Adding 2% (w/v) Chlorhexidine Gluconate to 70% (v/v) Isopropyl Alcohol for Skin Disinfection Prior to Peripheral Venous Cannulation

Infection Control and Hospital Epidemiology ◽

10.1086/590664 ◽

2008 ◽

Vol 29 (10) ◽

pp. 963-965 ◽

Cited By ~ 30

Author(s):

Heather Small ◽

Debra Adams ◽

Anna L. Casey ◽

Cynthia T. Crosby ◽

Peter A. Lambert ◽

...

Keyword(s):

Clinical Trial ◽

Isopropyl Alcohol ◽

Venous Catheter ◽

Chlorhexidine Gluconate ◽

Venous Cannulation ◽

Catheter Colonization ◽

Peripheral Venous Catheter ◽

Skin Disinfection

We undertook a clinical trial to compare the efficacy of 2% (w/v) chlorhexidine gluconate in 70% (v/v) isopropyl alcohol with the efficacy of 70% (v/v) isopropyl alcohol alone for skin disinfection to prevent peripheral venous catheter colonization and contamination. We found that the addition of 2% chlorhexidine gluconate reduced the number of peripheral venous catheters that were colonized or contaminated.

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