Incidencia y factores de riesgo de flebitis asociadas a catéteres venosos periféricos

  1. Loreto Arias-Fernández
  2. Belén Suérez-Mier
  3. María del Carmen Martínez-Ortega
  4. Alberto Lana
Journal:
Enfermería clínica

ISSN: 1130-8621

Year of publication: 2017

Volume: 27

Issue: 2

Pages: 79-86

Type: Article

DOI: 10.1016/J.ENFCLI.2016.07.008 DIALNET GOOGLE SCHOLAR

More publications in: Enfermería clínica

Sustainable development goals

Abstract

Objective To determine the incidence and risk factors of phlebitis associated to the care of peripheral vascular catheters (PVC). Method Prospective cohort study at the Central University Hospital of Asturias (Spain). A total of 178PVC were observed daily until their extraction. The incidence of phlebitis was measured using the Visual Infusion Phlebitis Scale, that distinguishes between gradei (possible phlebitis) andii (phlebitis). The independent diagnoses of phlebitis made by staff nurses were also collected. Finally, data about the insertion and the care of the PVC was also obtained. The incidence of phlebitis and the validity of the diagnoses made by staff nurses were calculated and the risk factors of phlebitis were determined by means of logistic regression. Results 5.6% of the PVC presented phlebitis, 21.3% possible phlebitis and 11.2% had phlebitis according to nurses’ criteria. The staff nurses had a sensitivity of 100%, a specificity of 94% and a positive predictive value of 50% in the diagnosis of phlebitis. After adjusting for potential confounders, the use of an extension tube as an accessory of the PVC was an independent predictor of phlebitis (odds ratio: 4.8; P=.04), but a PVC size of 22/24 gauges was associated with lower phlebitis incidence (odds ratio: 0.2; P=.02). Conclusions Clinical phlebitis assessment is difficult because the agreement for phlebitis diagnosis is low. To minimize the incidence of phlebitis would be recommended to choose the smallest PVC size possible and to avoid using an extension tube as an accessory of the PVC.

Bibliographic References

  • 1 Alianza Mundial para la Seguridad del Paciente. La Investigación en Seguridad del Paciente [Internet]. París: Organización Mundial de la Salud; 2008 [consultado 28 Nov 2015]. Disponible en: http://www.who.int/patientsafety/information_centre/documents/ps_research_brochure_es.pdf.
  • 2 Ferrete-Morales, C., Vázquez-Pérez, M.A., Sánchez-Berna, M., Gilabert-Cerro, I., Corzo-Delgado, J.E., Pineda-Vergara, J.A., et al. Incidencia de flebitis secundaria por catéter venoso de acceso periférico e impacto de un protocolo de manejo. Enferm Clin. 20 (2010), 3–9.
  • 3 Pasalioglu, K.B., Kaya, H., Catheter indwell time and phlebitis development during peripheral intravenous catheter administration. Pak J Med Sci. 30 (2014), 725–730.
  • 4 Nassaji-Zavareh, M., Ghorbani, R., Peripheral intravenous catheter related phlebitis and related risk factors. Singapore Med J. 48 (2007), 733–736.
  • 5 Uslusoy, E., Mete, S., Predisposing factors to phlebitis in patients with peripheral intravenous catheters: A descriptive study. J Am Acad Nurs Pract. 20 (2008), 172–180.
  • 6 Washington, G.T., Barret, R., Peripheral phlebitis: A point-prevalence study. J Infus Nurs. 35 (2012), 252–258.
  • 7 Kaur, P., Thakur, R., Kaur, S., Bhalla, A., Assesment of risk factors of phlebitis amongst intravenous cannulated patients. Nursing and Midwifery Research Journal. 7 (2011), 106–114.
  • 8 Gallant, P., Schultz, A.A., Evaluation of a Visual Infusion Scale for determining appropriate discontinuation of peripheral intravenous catheters. J Infus Nurs. 29 (2006), 338–345.
  • 9 Hadaway, L., Short peripheral intravenous catheters and infections. J Infus Nurs. 35 (2012), 230–240.
  • 10 Lee, W.L., Chen, H.L., Tsai, T.Y., Lai, I.C., Chang, W.C., Huang, C.H., et al. Risk factors for peripheral intravenous catheter infection in hospitalized patients: A prospective study of 3165 patients. Am J Infect Control. 37 (2009), 683–686.
  • 11 Rickard, C.M., Webster, J., Wallis, M.C., Marsh, N., McGrail, M.R., French, V., et al. Routine versus clinically indicated replacement of peripheral intravenous catheters: A randomised controlled equivalence trial. Lancet. 380 (2012), 1066–1074.
  • 12 O'Grady NP, Alexander M, Burns A, Dellinger EP, Garland J, Heard SO, et al. Guidelines for the Prevention of Intravascular Catheter-Related Infections [Internet]. Atlanta: Centers for Disease Control and Prevention (CDC); 2011 [consultado 14 Oct 2015]. Disponible en: http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf.
  • 13 Webster, J., Osborne, S., Rickard, C.M., New, K., Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev., 8, 2015, CD007798.
  • 14 Loveday, H.P., Wilson, J.A., Pratt, R.J., Golsorkhi, M., Tingle, A., Bak, A., et al. epic3: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect. 86:Suppl 1 (2014), S1–S70.
  • 15 González E, Argüelles AR, Martínez B, Comisión de Cuidados de Enfermería. Protocolo para la inserción, mantenimiento y retirada del catéter venoso periférico [Internet]. Oviedo: Hospital Universitario Central de Asturias; 2013 [consultado 20 Jun 2016]. Disponible en: http://www.hca.es/huca/web/enfermeria/html/f_archivos/Cateter%20venoso%20periferico.pdf.
  • 16 Jackson, A., Infection control-a battle in vein: infusion phlebitis. Nurs Times. 94 (1998), 68–71.
  • 17 Martínez-Ortega C, Suárez Mier B, coordinadoras. Flebitis Zero: diagnóstico de la flebitis [Internet]. Oviedo: Hospital Universitario Central de Asturias; 2015 [consultado 20 Jun 2016]. Disponible en: http://flebitiszero.com/app/formacion/DiagnosticoFlebitis.html.
  • 18 Marsh, N., Mihala, G., Ray-Barruel, G., Webster, J., Wallis, M.C5, Rickard, C.M., Inter-rater agreement on PIVC-associated phlebitis signs, symptoms and scales. J Eval Clin Pract. 21 (2015), 893–899.
  • 19 Aranaz JM, Aibar C, Larizgoitia I, Gonseth J, Colomer C, Terol E et al. Estudio IBEAS. Prevalencia de efectos adversos en hospitales de Latinoamérica [Internet]. Madrid: Ministerio de Sanidad y Política Social. 2010 [consultado 3 May 2015]. Disponible en: http://www.seguridaddelpaciente.es/resources/contenidos/castellano/2009/INFORME_IBEAS.pdf.
  • 20 González López, J.L., Arribi Vilela, A., Fernández del Palacio, E., Olivares Corral, J., Benedicto Martí, C., Herrera Portal, P., Indwell times, complications and costs of open vs closed safety peripheral intravenous catheters: A randomized study. J Hosp Infect. 86 (2014), 117–126.
  • 21 Davies, J., Cotton, J., Wood, J., Burke, D., McMahon, M., Intravenous nutrition—peripheral or central administration?. Br J Surg 90:Suppl 1 (2003), 86–91.
  • 22 Grune, F., Schrappe, M., Basten, J., Wenchel, H.M., Tual, E., Stutzer, H., Phlebitis rate and time kinetics of short peripheral intravenous catheters. Infection. 32 (2004), 30–32.
  • 23 Infusion Nurses Society. Infusion nursing — Standards of practice. J Infus Nurs. 34:Suppl 1 (2011), 1–106.
  • 24 Hasselberg, D., Ivarsson, B., Andersson, R., Tingstedt, B., The handling of peripheral venous catheters—from non-compliance to evidence-based needs. J Clin Nurs. 19 (2010), 3358–3363.
  • 25 Wallis, M.C., McGrail, M., Webster, J., Marsh, N., Gowardman, J., Playford, E.G., et al. Risk factors for peripheral intravenous catheter failure: A multivariate analysis of data from a randomized controlled trial. Infect Control Hosp Epidemiol. 35 (2014), 63–68.
  • 26 Saini, R., Agnihotri, M., Gupta, A., Walia, I., Epidemiology of infiltration and phlebitis. Nurs Midwifery Res J. 7 (2011), 22–33.
  • 27 Tagalakis, V., Kahn, S.R., Libman, M., Blostein, M., The epidemiology of peripheral vein infusion thrombophlebitis: A critical review. Am J Med. 113 (2002), 146–151.
  • 28 Cicolini, G., Manzoli, L., Simonetti, V., Flacco, M.E., Comparcini, D., Capasso, L., et al. Phlebitis risk varies by peripheral venous catheter site and increases after 96 hours: A large multi-centre prospective study. J Adv Nurs. 70 (2014), 2539–2549.
  • 29 López Rodríguez, L., Seda Diestro, J., Garrido Díaz-Malaguilla, I.M., Llave de tres vías con alargadera en complicaciones asociadas a la vía intravenosa. Enferm Clin. 8 (1998), 104–109.
  • 30 Rivas, J.S., Artes, J.L., Arjona, F.J., Carmona, D., Soriano, F.J., Mejías, F.M., et al. Flebitis traumáticas. Cómo disminuir su incidencia. Rev Enferm. 27 (2004), 602–606.
  • 31 Núñez-Crespo, F.J., Efectos adversos hospitalarios en dispositivos venosos periféricos: estudio de validez diagnóstica [tesis]. 2014, Universidad Rey Juan Carlos, Madrid.
  • 32 Webster, J., McGrail, M., Marsh, N., Wallis, M., Ray-Barruel, G., Rickard, C.M., Post infusion phlebitis: Incidence and risk factors. Nurs Res Pract., 2015, 2015, 691934.
Data source: Dialnet