A prospective sonographic evaluation of peripheral intravenous catheter associated thrombophlebitis

2021 ◽  
pp. 112972982110090
Author(s):  
Nicholas Mielke ◽  
Steven Johnson ◽  
Patrick Karabon ◽  
Amit Bahl
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Assessment Tools ◽  
Vein Wall ◽  
True Incidence ◽  
Related Risk ◽  
Peripheral Intravenous Catheter ◽  
Catheter Tip ◽  
Catheter Size ◽  
Observational Cohort

Objective: Thrombophlebitis associated with peripheral intravenous catheters (PIVCs) is a poorly described complication in the literature. Given limited accuracy of current assessment tools and poor documentation in the medical record, the true incidence and relevance of this complication is misrepresented. We aimed to identify risk factors in the development of thrombophlebitis using an objective methodology coupling serial diagnostic ultrasound and clinical assessment. Methods: We conducted a single-site, prospective observational cohort study. Adult patients presenting to the emergency department that underwent traditionally placed PIVC insertion and were being hospitalized with an anticipated length of stay greater than 2 days were eligible participants. Using serial, daily ultrasound evaluations and clinical assessments via the phlebitis scale, we identified patients with asymptomatic and symptomatic thrombosis. The primary goal was to identify demographic, clinical, and IV related risk factors associated with thrombophlebitis. Univariate and multivariate analyses were employed to identify risk factors for thrombophlebitis. Results: A total of 62 PIVCs were included between July and August 2020. About 54 (87.10%) developed catheter-related thrombosis with 22 (40.74%) of the thrombosed catheters were characterized as symptomatic. Multivariate cox regression demonstrated that catheter diameter relative to vein diameter greater than one-third [AHR = 5.41 (1.91, 15.4) p = 0.0015] and angle of distal tip of catheter against vein wall ⩾5° [AHR = 4.39 (1.39, 13.8) p = 0.0116] were associated with increased likelihood of thrombophlebitis. Conclusions: Our study found that the increased proportion of catheter relative to vein size and steeper catheter tip angle increased the risk of thrombophlebitis. Catheter size relative to vein size is a modifiable factor that should be considered when inserting PIVCs. Additional larger prospective investigations using objective methodologies are needed to further characterize complications in PIVCs.

scholarly journals Frequency of Peripheral Intravenous Catheter Related Phlebitis and Related Risk Factors: A Prospective Study

2019 ◽  
Vol 20 (1) ◽  
pp. 29-33
Author(s):  
Umma Salma ◽  
Mohammad Abdus Sattar Sarker ◽  
Nahida Zafrin ◽  
Kazi Shamin Ahamed
Keyword(s):  
Risk Factors ◽  
Prospective Study ◽  
Clinical Practices ◽  
Related Complication ◽  
Related Risk ◽  
Peripheral Intravenous Catheter ◽  
Amoxicillin Clavulanic Acid ◽  
Grade 3 ◽  
Associated Risk Factors ◽  
A Prospective Study

Background: Peripheral Intravenous Catheterization (PIVC) related complication is a common and significant problem in clinical practices. The aim of the study was to see the pattern of complication developed by PIVC and to find out the associated risk factors. Materials & methods: A prospective study was conducted amongst 300 patients and 420 PIVCs were observed. Results: 76 (18.09%) patients developed phlebitis and among the phlebitis patients 55.26% were grade 2 and 22.37% grade 3. Hypertonic fluid infusion and some antibiotics were found as risk factors for phlebitis. Amongst the antibiotics flucloxacilin (60%), amikacin (50%), amoxicillin + clavulanic acid were most common antibiotics responsible for development of phlebitis. Conclusions: Catheterization site and use of antibiotics and potassium chloride with associated co-morbidities are predisposing factors for phlebitis. Better insertion technique may be sought to lower the incidence of PIVC related complications. J MEDICINE JUL 2019; 20 (1) : 29-33

Risk factors for catheter related thrombosis during outpatient parenteral antimicrobial therapy

2021 ◽  
pp. 112972982110093
Author(s):  
Paul R Ingram ◽  
Sinead Kilgarriff ◽  
Michael Grzelak ◽  
Gavin Jackson ◽  
Peter Carr ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antimicrobial Therapy ◽  
Retrospective Case ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Related Risk ◽  
Reduction Strategies ◽  
Tertiary Hospitals ◽  
Catheter Tip ◽  
Clinically Significant ◽  
Catheter Related Thrombosis

Background: Outpatient parenteral antimicrobial therapy (OPAT) delivery using peripherally inserted central catheters is associated with a risk of catheter related thrombosis (CRT). Individualised preventative interventions may reduce this occurrence, however patient selection is hampered by a lack of understanding of risk factors. We aimed to identify patient, infection or treatment related risk factors for CRT in the OPAT setting. Methods: Retrospective case control study (1:3 matching) within OPAT services at two tertiary hospitals within Australia. Results: Over a 2 year period, encompassing OPAT delivery to 1803 patients, there were 19 cases of CRT, giving a prevalence of 1.1% and incidence of 0.58/1000 catheter days. Amongst the cases of CRT, there were nine (47%) unplanned readmissions and two (11%) pulmonary emboli. Compared to controls, cases had a higher frequency of malposition of the catheter tip (4/19 (21%) vs 0/57 (0%), p = 0.003) and complicated catheter insertion (3/19 (16%) vs 1/57 (2%), p = 0.046). Conclusions: Although CRTs during OPAT are infrequent, they often have clinically significant sequelae. Identification of modifiable vascular access related predictors of CRT should assist with patient risk stratification and guide risk reduction strategies.

scholarly journals Risk Factors for Lead-Related Venous Obstruction: A Study of 2909 Candidates for Lead Extraction

2021 ◽  
Vol 10 (21) ◽  
pp. 5158
Author(s):  
Marek Czajkowski ◽  
Wojciech Jacheć ◽  
Anna Polewczyk ◽  
Jarosław Kosior ◽  
Dorota Nowosielecka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Inverse Correlation ◽  
High Volume ◽  
Male Gender ◽  
Lead Extraction ◽  
Venous Obstruction ◽  
Vein Wall ◽  
Permanent Atrial Fibrillation ◽  
Related Risk

Background: our knowledge of lead-related venous stenosis/occlusion (LRVSO) remains limited and there is still controversy regarding the risk factors for LRVSO. Venography is mandatory before transvenous lead extraction (TLE). Methods: we performed a retrospective analysis of venograms in 2909 patients (39.43% females, average age 66.90 years) who underwent TLE between 2008 and 2021 at high-volume centers. Results: the severity of LRVSO was likely to be dependent on the number of leads in the system (OR = 1.345; p = 0.003), the number of abandoned leads (OR = 1.965; p < 0.001), the presence of coronary sinus leads (OR = 1.184; p = 0.056), male gender (OR = 1.349; p = 0.003) and patient age at first CIED implantation (OR = 1.008; p = 0.021). The presence of permanent atrial fibrillation (OR = 0.666; p < 0.001) and right ventricular diastolic diameter (OR = 0.978; p = 0.006) showed an inverse correlation with the degree of LRVSO. The combined three-model multivariate analysis provided better prediction of LRSVO using the above-mentioned factors than the CHA2DS2-VASc score. Conclusions: the severity of LRVSO is probably dependent on the mechanical impact of the implanted/abandoned leads on the vein wall, therefore the study has demonstrated the central role of system-/procedure-related risk factors. The thrombotic mechanism may be less important, especially long after implantation, and for this reason the combined prediction model for LRVSO in this study was more effective than the CHA2DS2-VASc score.

scholarly journals Phlebitis associated with peripheral intravenous catheters and nursing carePeriferik intravenöz kateterle ilişkili flebit ve hemşirelik bakımı

2016 ◽  
Vol 13 (2) ◽  
pp. 2905 ◽  
Author(s):  
Dilek Sarı ◽  
İsmet Eşer ◽  
Ayşe Akbıyık
Keyword(s):  
Risk Factors ◽  
Intravenous Catheter ◽  
Duration Of Hospitalization ◽  
Peripheral Intravenous Catheter ◽  
Catheter Size ◽  
The Cost ◽  
Systemic Infections ◽  
Intravenous Catheters ◽  
Intravenous Medication ◽  
Tunica Intima

Phlebitis, defined as inflammation of the tunica intima, is most important of complications associated with peripheral intravenous catheters and, occurs between 0.1% and 63.3% of patients with peripheral intravenous catheter.  Phlebitis can be originated mechanical, chemical and, bacterial.  Whatever the reason, phlebitis extends the duration of hospitalization, raise the cost of treatment, causes bacteremia. There are reported to be effective some factors such as  type of catheter material, catheter size, dwell time of catheterisation, anatomical region used for catheterisation, health personnel’s ability to place the catheter, liquid flow rate, using infusion pumps, number of intravenous medication, on the development of mechanical phlebitis. Chemical phlebitis, developes due to characteristics such as pH and osmolarity of the drug and fluid infused which caused irritation of the endothelial layer through the cannula. Bacterial phlebitis, which is occured a bacterial infection of vein intima, can be a source of serious systemic infections including bacteremia. As a result, phlebitis is a complication of intravenous application, can be avoided as long as working in accordance with certain principles. The risk development of phlebitis can be minimized, in case of compliance with the standards during peripheral intravenous catheter insertion and throughout of catheterization. In this article was focused on phlebitis definition, epidemiology, risk factors and prevention of the development phlebitis for risk factors and patient care with phlebitis. ÖzetVenin tunika intima tabakasının enflamasyonu olarak tanımlanan flebit, periferik intravenöz kateterlerle ilişkili komplikasyonların en önemlisi olup, periferik intravenöz kateter takılan hastaların %0.1-%63.3’ünde görülmektedir. Flebit mekanik, kimyasal ve bakteriyel kaynaklı olabilir. Flebit nedeni ne olursa olsun hastaların yatış süresini uzatmakta, tedavi maliyetini yükseltmekte ve bakteriyemiye neden olmaktadır. Kateter materyalinin tipi, kateteterin boyutu, kateterin vende kalış süresi, kullanılan anatomik bölge, kateteri yerleştiren kişinin becerisi, sıvı akış hızı, infüzyon pompalarının kullanımı, verilen ilaçların sayısı gibi faktörlerin mekanik flebit oluşumunda etkili olduğu bildirilmektedir. Kimyasal flebit, kanül boyunca infüze edilen ilaç ve sıvıların pH’sı ve osmolaritesi gibi özelliklerinden dolayı venin endoteyal katmanını tahriş etmesi sonucunda gelişir. Ven intimasının bakteriyel enfeksiyonu sonucu gelişen bakteriyel flebit bakteriyemi gibi ciddi sistemik enfeksiyonların kaynağı olabilmektedir. Sonuç olarak, flebit belirli ilkelere uygun çalışıldığında intravenöz uygulamaların önlenebilir bir komplikasyonudur. Periferik intravenöz kateter takma ve izlem sırasında belirlenen standartlara uyulma hassasiyeti gösterildiği taktirde flebit gelişimi minimize edilebilir. Bu makalede, flebitin tanımı, epidemiyolojisi, risk faktörleri ve risk faktörlerine yönelik flebit gelişimini önleme önerileri ve flebit gelişen hastanın bakımı üzerinde odaklanılmıştır.

scholarly journals P1482MORTALITY RATE AND RELATED RISK FACTORS IN THE CHINA DIALYSIS OUTCOMES AND PRACTICE PATTERNS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Xinju Zhao ◽  
Qingyu Niu ◽  
Liangying Gan ◽  
Li Zuo
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Lung Disease ◽  
Practice Patterns ◽  
Cox Regression ◽  
White Blood Count ◽  
Maintenance Hemodialysis ◽  
Laboratory Values ◽  
Related Risk ◽  
Dialysis Outcomes

Abstract Background and Aims Mortality risk for maintenance hemodialysis (MHD) patients varies by country and ethnicity. Here, mortality rate and its related risk factors in Chinese HD patients from Dialysis Outcomes and Practice Patterns Study (DOPPS) were studied. Method Data from the China DOPPS phase 5 (2012-2015) were used. All included patients were followed to the end of the study. Patients’ demographics, primary cause of end stage renal disease (ESRD), comorbidities, abstracted dialysis prescription, laboratory values, date of death, and causes for death were analyzed. All-cause mortality (per 100 patient-years) was calculated. We examined clinical and laboratory differences between died and survived patients. Cox regression was used to explore risk factors of death, accounting for facility clustering and adjusted for case-mix (age, sex, vintage, and comorbid conditions), and laboratory values (albumin, hemoglobin, white blood count, sodium). Results There were 1427 MHD patients were enrolled. The mean age at dialysis initiation was 59.4±14.9 years (table 1). The median follow-up time was 1.9 years (IQR 1.1-2.1). There were total 205 deaths. The overall mortality rate was 8.8 per 100 patient-years. Death from cardiovascular disease (CVD) occurred in 50.2% of the patients. Compared with survived patients, patients with mortality were older (58.5 Vs. 70.0 y), more likely with diabetes, with lower pre-dialysis albumin level (Pre-ALB) or hemoglobin level (Pre-HGB), with lower pre or post dialysis diastolic blood pressure (DBP), with some comorbidities and less likely with fistula as their blood access (table 2). Cox regression revealed that risk factors for higher mortality were older age, lower Pre-ALB level, higher pre-dialysis DBP and with CHF, hepatitis, hypertension, and lung disease. Conclusion CVD constituted half of the death reasons for Chinese dialysis patients. Our analysis highlighted that there are some modifiable risk factors for patients’ survival. Attention should be paid to patients who were older, with lower Pre-ALB level, higher pre-dialysis DBP and with CHF, hepatitis, hypertension, and lung disease.

Role of pulse oximetric monitoring during gastrointestinal endoscopy. Prospective multicenter study of the Gastroenterological Working Group of the Veszprém Regional Committee of the Hungarian Academy of Sciences (VEAB)

2013 ◽  
Vol 154 (21) ◽  
pp. 825-833
Author(s):  
Zoltán Döbrönte ◽  
Mária Szenes ◽  
Beáta Gasztonyi ◽  
Lajos Csermely ◽  
Márta Kovács ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multicenter Study ◽  
Hungarian Academy ◽  
Prospective Multicenter Study ◽  
Standard Requirement ◽  
Long Duration ◽  
Related Risk ◽  
American Society ◽  
Academy Of Sciences ◽  
Endoscopic Investigation

Introduction: Recent guidelines recommend routine pulse oximetric monitoring during endoscopy, however, this has not been the common practice yet in the majority of the local endoscopic units. Aims: To draw attention to the importance of the routine use of pulse oximetric recording during endoscopy. Method: A prospective multicenter study was performed with the participation of 11 gastrointestinal endoscopic units. Data of pulse oximetric monitoring of 1249 endoscopic investigations were evaluated, of which 1183 were carried out with and 66 without sedation. Results: Oxygen saturation less than 90% was observed in 239 cases corresponding to 19.1% of all cases. It occurred most often during endoscopic retrograde cholangiopancreatography (31.2%) and proximal enteroscopy (20%). Procedure-related risk factors proved to be the long duration of the investigation, premedication with pethidine (31.3%), and combined sedoanalgesia with pethidine and midazolam (34.38%). The age over 60 years, obesity, consumption of hypnotics or sedatives, severe cardiopulmonary state, and risk factor scores III and IV of the American Society of Anestwere found as patient-related risk factors. Conclusion: To increase the safety of patients undergoing endoscopic investigation, pulse oximeter and oxygen supplementation should be the standard requirement in all of the endoscopic investigation rooms. Pulse oximetric monitoring is advised routinely during endoscopy with special regard to the risk factors of hypoxemia. Orv. Hetil., 2013, 154, 825–833.

500-P: Renal Function Decline and the Related Risk Factors in a Cohort of Beijing Community Diabetes Study

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 500-P
Author(s):  
MINGXIA YUAN ◽  
SHENYUAN YUAN ◽  
Keyword(s):  
Risk Factors ◽  
Renal Function ◽  
Renal Function Decline ◽  
Related Risk

Stress, anxiety, depression and burnout in frontline health care workers during COVID-19 pandemic: a brief systematic review and new data from Russia

2021 ◽  
Author(s):  
Ekaterina Mosolova ◽  
Dmitry Sosin ◽  
Sergey Mosolov
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Female Gender ◽  
Assessment Tools ◽  
Care Workers ◽  
Younger Age ◽  
Wide Range ◽  
Associated Risk Factors ◽  
Anxiety Depression ◽  
The Impact

During the COVID-19 pandemic, healthcare workers (HCWs) have been subject to increased workload while also exposed to many psychosocial stressors. In a systematic review we analyze the impact that the pandemic has had on HCWs mental state and associated risk factors. Most studies reported high levels of depression and anxiety among HCWs worldwide, however, due to a wide range of assessment tools, cut-off scores, and number of frontline participants in the studies, results were difficult to compare. Our study is based on two online surveys of 2195 HCWs from different regions of Russia during spring and autumn epidemic outbreaks revealed the rates of anxiety, stress, depression, emotional exhaustion and depersonalization and perceived stress as 32.3%, 31.1%, 45.5%, 74.2%, 37.7% ,67.8%, respectively. Moreover, 2.4% of HCWs reported suicidal thoughts. The most common risk factors include: female gender, nurse as an occupation, younger age, working for over 6 months, chronic diseases, smoking, high working demands, lack of personal protective equipment, low salary, lack of social support, isolation from families, the fear of relatives getting infected. These results demonstrate the need for urgent supportive programs for HCWs fighting COVID-19 that fall into higher risk factors groups.

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