Viêm tĩnh mạch tại vị trí lưu kim luồn tĩnh mạch ngoại biên và một số yếu tố liên quan tại Bệnh viện Đại học Y Hà Nội

Nghiên cứu tiến cứu được thực hiện nhằm (1) mô tả tỷ lệ viêm tĩnh mạch tại vị trí lưu kim luồn tĩnh mạch ngoại biên và (2) phân tích một số yếu tố liên quan trên người bệnh nội trú tại Bệnh viện Đại học Y Hà Nội. 900 người bệnh với 1519 kim luồn tĩnh mạch ngoại biên được theo dõi và đánh giá thông qua thang điểm Visual Infusion Phlebitis (VIP). Kết quả có 462 kim luồn tĩnh mạch ngoại biên xuất hiện viêm tĩnh mạch (30,4%), phổ biến nhất là viêm độ 1 (21,3%) và độ 2 (8,5%); số ít có viêm độ 3 (0,6%); không phát hiện viêm độ 4 hoặc độ 5. Tỷ suất viêm tĩnh mạch được xác định là 134/1000 ngày điều trị. Một số yếu tố liên quan đến sự gia tăng tỷ lệ viêm tĩnh mạch gồm: tuổi cao ( ≥ 60), có bệnh lý nền mạn tính, thể trạng béo hoặc gầy, tiền sử uống rượu, kim luồn tĩnh mạch ngoại biên được đặt tại khoa cấp cứu, vị trí đặt ở cánh tay; bên cơ thể liệt, cỡ kim lớn (18G), sử dụng thiết bị kết nối. Nguy cơ tương đối phát sinh viêm tĩnh mạch khi kim luồn tĩnh mạch ngoại biên đặt tại cánh tay cao gấp 1,7 lần so với khuỷu tay.

Routine Replacement versus Clinically Indicated Replacement of Peripheral Venous Catheters through Assessment of Incidences and Grades of Phlebitis in Patients with IV Cannula at a Tertiary Care Hospital, Mumbai

Background: The current study assesses the incidences and grades of phlebitis among patients with IV cannula to determine the association of grades of phlebitis. The purpose of the study was to study the feasibility of Routine replacement versus Clinically indicated replacement of peripheral venous catheters. The study observes the incidences of removing peripheral intravenous catheters when clinically indicated compared with removing and re‐siting the catheter routinely. Methods: An observational study was conducted in the tertiary care private hospital of Mumbai, India. The study was conducted over 5 weeks from May -June 2020. Purposive sampling was considered during the collection of data. The sample size of the study was 117 patients admitted having peripheral venous catheters. The standard visual infusion phlebitis (VIP) score was used as a tool for data collection. Descriptive analysis was done. Results: Out of 117 patients (VIP score 0 -56, Score 1- 49, Score -12 no cases with score 3, 4, and 5). Routine replacement of IV cannula after every 5 days is judiciously followed, 45 healthy lines were replaced at score 0; which is the major concern (Rs. 633/- the total cost of replacing 1 PVC line). Conclusion: Following the routine practice of IV cannula replacement based on VIP score to avoid phlebitis is equally good but simultaneously clinically indicated replacement of IV cannula is advisable to make it cost-effective and reduced number of a prick to the patients; this will help to improve patient satisfaction.

Reliability study of Visual Infusion Phlebitis Score Portuguese European version

Phlebitis is the most frequent complication associated with the use of Short Peripheral Catheters. The Visual Infusion Phlebitis Scale is a tool used to access the catheter insertions site and surrounding area, providing a score. The goal of this study was to translate and culturally adapt the VIP scale to European Portuguese in order to achieve a reliability score. Intra and inter-observer reliability studies were performed. The study was conducted at one Portuguese Hospital in a sample of 23 participants. The reliability score was assessed using Kendall's Tau = 0.925, Spearman's Rho = 0.926 and Cohen Kappa = 0.918.

Impact of interventions on the incidence of thrombophlebitis in peripheral venous cannulation in a tertiary care teaching hospital

Background: In hospitalized patients the use of intravenous devices like cannula are indispensable. Nearly about 80% of hospitalized patients require peripheral venous cannulation, as a part of therapy. Thrombophlebitis is one of the prevalent complications of peripheral venous cannulation.Method: The present study was aimed to find the incidence of thrombophlebitis after peripheral venous cannulations in the patients admitted in a tertiary care teaching hospital. Impact of regular trainings and interventions on the incidence and grades of thrombophlebitis was also studied. The study was conducted for period of 1 year.Result: The total of 28850 cannulations carried out on 11686 patients was observed. Phlebitis was diagnosed in 1821 peripheral venous cannulations, giving the incidence of 6.3%. As per Visual Infusion Phlebitis (VIP) score, 1527 (83.86%) were grade 1 phlebitis, 274 (15.04%) were with grade 2 phlebitis and 20 (1.10 %) were grade 3 phlebitis. Regular surveillance, training and timely interventions were carried out during this period and the effect of these interventions was noted in the monthly phlebitis rate. Phlebitis rate reduced from 9.89% in January to 3.99% in the month of December. There was also reduction in grade 2 thrombophlebitis (from 21.05% in January to 6.09% in December). In the last 4 months of study period grade 3 phlebitis was not reported.Conclusions: A significant reduction in the incidence of phlebitis associated with peripheral intravenous cannulations may be achieved by regular surveillance, training and timely interventions.

Patient Characteristics Related to Phlebitis in the East Coast of Peninsular Malaysia Hospital

The insertion of peripheral intravenous catheters (PIVCs) is common for treatment among hospitalized patients. However, this procedure usually fails before the end of therapy because of several complications, including phlebitis. Therefore, this study aimed to determine the incidence and associated factors of phlebitis among patients with PIVC. A prospective cohort study was conducted in one of the hospitals located in East Coast Malaysia. The presence of phlebitis was assessed using the visual infusion phlebitis score checklist. The patients were followed until PIVC removal. A total of 321 data were collected among patients who received a new PIVC in the medical, gynecology, and orthopedic wards. The incidence of phlebitis was 36.1% (n= 116), and 96.6% of which were grade II. Patients aged 60 years (51.5%), men (42.2%), no known phlebitis history (47.4%), and with chronic disease record (46.8%) were determined as the highest percentage with phlebitis. This study demonstrated that age, gender, and chronic diseases were risk factors of developing phlebitis. Abstrak Karakteristik Pasien yang Berhubungan dengan Flebitis di Rumah Sakit Pantai Timur Semenanjung Malayía. Di antara pasien yang dirawat di rumah sakit, penyisipan kateter intravena perifer (PIVC) umum untuk pengobatan. Namun, prosedur ini seringkali gagal sebelum terapi selesai karena beberapa komplikasi. Salah satu komplikasi yang terjadi adalah flebitis. Oleh karena itu, penelitian ini bertujuan untuk menentukan kejadian dan faktor-faktor terkait flebitis di antara pasien dengan PIVC. Sebuah studi kohort prospektif dilakukan di salah satu rumah sakit yang berlokasi di Pantai Timur Malaysia. Kejadian flebitis dinilai menggunakan daftar periksa skor Visual Infusion Phlebitis (VIP). Para pasien ditindaklanjuti sampai pengangkatan PIVC. Terdapat 321 data yang dikumpulkan di antara pasien yang menerima PIVC baru di bangsal medis, ginekologi, dan ortopedi. Insiden flebitis ditemukan 36,1% (n= 116), 96,6% di antaranya adalah grade II. Pasien berusia 60 tahun (51,5%), pria (42,2%), pasien tidak memiliki riwayat flebitis (47,4%) dan pasien dengan catatan penyakit kronis (46,8%) tercatat sebagai persentase tertinggi dengan flebitis. Studi ini menunjukkan bahwa usia, jenis kelamin, dan pasien dengan penyakit kronis kemungkinan besar mengalami flebitis. Kata Kunci: flebitis, kateter intravena peripheral, pasien dewasa

ANALISIS PENGARUH PENGGANTIAN RUTIN PENUSUKAN KATETER INTRAVENA DAN PENGGANTIAN SET INFUSE TERHADAP TERJADINYA PLEBITIS DI RS SINT CAROLUS JAKARTA

ABSTRAKPemasangan infus adalah prosedur umum pada pasien di rumah sakit dimana komplikasi yang umum terjadi adalah plebitis. Tujuan penelitian untuk menganalisa pengaruh penggantian rutin penusukan dan penggantian set infuse terhadap kejadian phlebitis. Metoda penelitian kuntitatif, desain Kohort, sample pasien dewasa diambil secara purposif sebanyak 247 sample, dilakukan pengamatan tusukan infuse sejak pemasangan sampai pencabutan. Data dikumpulkan menggunakan lebar observasi dan VIP score (Visual infusion phlebitis score). Hasil analisa mayoritas responden perempuan 140 (56.7%), rata-rata berusia 48.9 tahun, penyakit noninfeksi 151 (61.1%), nomor kateter iv 22: 193 (78.1%), lokasi penusukan di tangan 173 (70%), pemberian cairan isotonik 181 (73.3%), pemberian terapi bolus satu jenis 89 (36%), mendapat terapi drip 142 (57.5%), lama pemasangan 4 hari 63 (25.5%), tidak ada penggantian tusukan iv 169 (68.4%), set infuse drip diganti setiap pemberian 91 (36.8%) dan skala plebitis satu 12,6%. Analisa bivariateKendal’s tau C ada hubungan pemberian terapi iv bolus (p=0.03), lama pemasangan kateter iv (p=0.00) terhadap terjadinya plebitis (p<0.05). Uji Regresi logistik didapatkan variabel independen memberikan kontribusi kejadian plebitis sebesar 24.5%. Uji probabilitas disimpulkan responden yang tidak diganti tusukan infuse rutin dan set drip secara rutin berisiko plebitis sebesar 100%. Diskusi: Hasil penelitian ini menyimpulkan pentingnya penggantian kateter intravena perifer dan penggantian set infuse untuk pemberian terapi drip secara rutin untuk mencegah terjadinya plebitis. Kesimpulan: penelitian lebih lanjut menganalisa faktor risiko plebitis diluar faktor yang telah diteliti seperti faktor tetesan dan ketrampilan perawat dalam pemasangan infuse. Kata kunci :Penggantian Kateter Intravena, Set Infus, Plebitis ABSTRACTThe insertion of peripheral intravenous catheters is a common practice in hospitals, where Phlebitis is the main local complication. This study attempts to analyze relationship of routine replacement Intravenous catheter insertion and routine replacement Intravenous infusion set to phlebitis. A quantitative-cohort design was used in this study. Purposive sampling was utilized involving 247 adult patients. The observation was conducted from insertion until intravenous catheters was retracted and the data was assessed using observation tool and VIP score (Visual infusion phlebitis score). The results found that the majority respondents were female (56.7%), average age of 48.9 years old, diagnosed with noninfectious diseases (61.1%), utilized intravenous catheter number 22 (78.1%), hand insertion location (70%), received isotones fluid (73.3%) with single bolus therapy (36%), received drip infusion (57.5%), duration of intravenous catheter of 4 days (25.5%), no intravenous replacement (68.4%), infusion drip replaced after therapy (36.8%) and a phlebitis scale of 12.6%. Kendal’s tau C statistical analysis revealed that there issignificant relationship between phlebitis and intravenous therapy (p = 0.03), duration of intravenous catheter (p = 0.00). Logistic regression test showed that independent variable contributed 24.5% to phlebitis. The probability test concluded that respondents who were not replacing Intravenous catheter insertion and Intravenous infusion setregularly may develop phlebitis risk of 100%. It is implied the importance of replacement intravenous catheter and Intravenous infusion setroutinely to prevent phlebitis. For further research, it is suggested to analyze the risk factors of phlebitis such as nurse skills for intravenous catheter insertion.Keyword: replacement Intravenous catheter insertion, infusion set, Phlebitis

Patient Characteristics Related to Phlebitis in the East Coast of Peninsular Malaysia Hospital

The insertion of peripheral intravenous catheters (PIVCs) is common for treatment among hospitalized patients. However, this procedure usually fails before the end of therapy because of several complications, including phlebitis. Therefore, this study aimed to determine the incidence and associated factors of phlebitis among patients with PIVC. A prospective cohort study was conducted in one of the hospitals located in East Coast Malaysia. The presence of phlebitis was assessed using the visual infusion phlebitis score checklist. The patients were followed until PIVC removal. A total of 321 data were collected among patients who received a new PIVC in the medical, gynecology, and orthopedic wards. The incidence of phlebitis was 36.1% (n = 116), and 96.6% of which were grade II. Patients aged 60 years (51.5%), men (42.2%), no known phlebitis history (47.4%), and with chronic disease record (46.8%) were determined as the highest percentage with phlebitis. This study demonstrated that age, gender, and chronic diseases were risk factors of developing phlebitis. Abstrak Karakteristik Pasien yang Berhubungan dengan Flebitis di Rumah Sakit Pantai Timur Semenanjung Malayía. Di antara pasien yang dirawat di rumah sakit, penyisipan kateter intravena perifer (PIVC) umum untuk pengobatan. Namun, prosedur ini seringkali gagal sebelum terapi selesai karena beberapa komplikasi. Salah satu komplikasi yang terjadi adalah flebitis. Oleh karena itu, penelitian ini bertujuan untuk menentukan kejadian dan faktor-faktor terkait flebitis di antara pasien dengan PIVC. Sebuah studi kohort prospektif dilakukan di salah satu rumah sakit yang berlokasi di Pantai Timur Malaysia. Kejadian flebitis dinilai menggunakan daftar periksa skor Visual Infusion Phlebitis (VIP). Para pasien ditindaklanjuti sampai pengangkatan PIVC. Terdapat 321 data yang dikumpulkan di antara pasien yang menerima PIVC baru di bangsal medis, ginekologi, dan ortopedi. Insiden flebitis ditemukan 36,1% (n = 116), 96,6% di antaranya adalah grade II. Pasien berusia 60 tahun (51,5%), pria (42,2%), pasien tidak memiliki riwayat flebitis (47,4%) dan pasien dengan catatan penyakit kronis (46,8%) tercatat sebagai persentase tertinggi dengan flebitis. Studi ini menunjukkan bahwa usia, jenis kelamin, dan pasien dengan penyakit kronis kemungkinan besar mengalami flebitis.Kata Kunci: flebitis, kateter intravena peripheral, pasien dewasa.

Effectiveness of Glycerin Magnesium Sulphate Versus Heparin Benzyl Nicotinate Application Among Children with Phlebitis

Introduction: Phlebitis is the most common complication of intravenous infusion therapy. Incidence of phlebitis in children receiving intravenous therapy has been reported to be as high as 71.25%. The study was done to find out the effectiveness of glycerin magnesium sulphate versus heparin benzyl nicotinate application in children with phlebitis. Methods: A pre-post control group design was used. A total of 43 subjects were randomly assigned into two groups [22 in experimental (glycerin magnesium sulphate application) and 21 in control (heparin benzyl nicotinate application) group] by lottery method. Data was collected using Modified Visual Infusion Phlebitis (VIP) Score. Results: The comparison between VIP score was based on observations made before the interventions and at 12, 24, 36 and 48 hours after the intervention. Independent t tests showed significant difference in reduction of VIP score in experimental and control group after 12 hours and 24 hours of intervention. The study demonstrated that there is no statistically significant difference in reduction of VIP score among the subjects in experimental and control group at 12 hours (p = 0.219), 24 hours (p = 0.349), 36 hours (p = 0.695) and 48 hours (p = 0.424) after the intervention. Conclusion: The study concludes that both glycerin magnesium sulphate and heparin benzyl nicotinate can be used effectively among children with phlebitis. However, after 24 hours of phlebitis, an alternative intervention needs to be used.

Clinically indicated replacement of peripheral vascular catheters: is it safe for patients?

Replacing peripheral vascular catheters when clinically indicated rather than routinely has multiple benefits for patients and practitioners. Managing vascular catheters based on clinical indication provides early opportunities for intervention, or catheter removal or replacement. Where clinically indicated, peripheral vascular catheters can be used for a long time, and this is aided by decision-making tools such as the visual infusion phlebitis score and care bundles. Fewer cannulations result in less pain, better patient comfort and a lower risk of infection. For each cannulation avoided, about 20 minutes can be saved for other care activities. Replacing peripheral vascular catheters according to clinical indication can improve patient safety and optimise resource use.

Post-injection thrombophlebitis in patients undergoing peripheral IV catheterization in a tertiary care hospital: incidence and risk factors

<p class="abstract"><strong>Background:</strong> Intravenous catheters cause endothelial damage and trauma, which can predispose to venous thrombosis. Peripheral vein infusion thrombophlebitis occurs in 25- 35% of hospitalized patients with intravenous catheters and has both patient-related implications (e.g., sepsis) and economic consequences (e.g., extra nursing time). This study is designed to address this issue, by assessing the potential risk factors in those who have developed phlebitis, and deriving conclusions based on the same.</p><p class="abstract"><strong>Methods:</strong> A total of 830 patients were observed over a period of 2 months. All details of the patient were collected. Thrombophlebitis was graded using Visual Infusion Phlebitis Score. Each case was compared with a matching control. </p><p class="abstract"><strong>Results:</strong> 53 of 830 patients observed, developed thrombophlebitis giving an incidence of 6.4%. 92.5% had IV cannulation flushed after insertion. IV cannula had to be changed at least 2 times during the hospital stay. All had an average IV cannulation for 5 days. All had insertion of same size cannula (20G). Level 1 Phlebitis was identified in 64.15% patients, level 2 Phlebitis in 33.96% patients and Level 3 Phlebitis was seen 1.88% patients.</p><p class="abstract"><strong>Conclusions:</strong> Significant association was noted between the number of times the catheter was changed since admission and administration of Potassium chloride and Certain Medications such as Piperacillin through the cannula.</p>