Estudio experimental aleatorizado para la evaluación de la efectividad del proyecto Flebitis Zero en Navarra
- M. Ferraz-Torres
- M.I. Corcuera Martínez
- E. Sancho Sena
- M. Aldonza-Torres
- S. Maali Centeno
- M.C. Martínez-Ortega
- M.B. Suárez-Mier
ISSN: 1137-6627
Ano de publicación: 2021
Volume: 44
Número: 3
Páxinas: 417-426
Tipo: Artigo
Outras publicacións en: Anales del sistema sanitario de Navarra
Resumo
Background. Phlebitis is one of the most frequent complications in peripheral venous catheters. The aim was to compare the frequency of phlebitis before and after the implementation of the Flebitis Zero project, in order to ascertain its effectiveness and what factors were associated with this complication. Methods. Randomized pre-post intervention (Flebitis Zero project) study performed in the Hospital Universitario de Navarra (Pamplona, Spain) between 2015 and 2019. The intervention consisted of training of professionals along with the implementation of measures in order to lower the incidence of complications associated with the peripheral venous catheters. The control group (CG) was selected prior the intervention and the Intervention Group (IG) in the subsequent five years. Results. The study included 656 patients, 96 (14.6%) in the CG and 569 in the IG. Lower frequency of complications (49.0 vs 37.1%; p<0.001), especially accidental PVC exit (18.8 vs 8.1%), and of phlebitis (13.5 vs 11.8%). The intervention and the use of fully reinforced dressings were associated to happening of phlebitis. The implantation of the Flebitis Zero project prevented the occurrence of phlebitis (OR= 0.78; IC95%: 0.42-0.86; p= 0.042). Conclusion. The implementation of the measures used in the Phlebitis Zero project was associated with a significant reduction of the complications linked to the use of the peripheral venous catheters; the frequency of phlebitis dropped, although nowhere near the recommended level.
Referencias bibliográficas
- Citas 1. GONZÁLES DE LA CUESTA D, LÓPEZ N, BARRADO M, ARAZO A, BARA G, RAMOS G et al. Protocolo de vías venosas periféricas en el hospital clínico universitario Lozano Blesa. Rev Cienc y Arte Enferm 2019; 4: 6-11.
- BRAGA M, PARREIRA P, DE SOUSA SALGUEIRO A, DOS SANTOS MENDES L, ARREGUY-SENA C, HENRIQUES M. Flebitis e infiltración: traumas vasculares asociados al catéter venoso periférico. Rev Latino-Am Enfermagem 2018. 26: e3002. https://doi.org/10.1590/1518-8345.2377.300
- LACOSTENA-PÉREZ ME, BUESA-ESCAR AM, GIL-ALÓS AM. Complications related to the insertion and maintenance of peripheral venous access central venous catheter. Enferm Intensiva 2019; 30: 116-126. https://doi.org/10.1016/j.enfi.2018.05.002
- XIE J, XU L, XU X, HUANG Y. Complications of peripherally inserted central catheters in advanced cancer patients undergoing combined radiotherapy and chemotherapy. J Clin Nurs 2017; 26: 4726-4733. https://doi.org/10.1111/jocn.13825
- ARIAS-FERNÁNDEZ L, SUÁREZ-MIER B, MARTÍNEZ-ORTEGA MC, LANA A. Incidencia y factores de riesgo de flebitis asociadas a catéteres venosos periféricos. Enferm Clin 2017; 27: 79-86. https://doi.org/10.1016/j.enfcli.2016.07.00810
- MERMEL LA. Short-term peripheral venous catheter-related bloodstream infections: a systematic review. Clinic Infect Dis 2017; 65: 1757-1762.
- ANSEL B, BOYCE M, EMBREE JL. Extending short peripheral catheter dwell time: a best practice discussion. J Infus Nurs 2017; 40: 143-146. https://doi.org/10.1097/NAN.0000000000000137.
- CHAN RJ, NORTHFIELD S, LARSEN E, MIHALA G, ULLMAN A, HANCOCK P et al. Central venous access device securement and dressing effectiveness for peripherally inserted central catheters in adult acute hospital patients (CASCADE): a pilot randomised controlled trial. Trials 2017. 4; 18: 458. https://doi.org/10.1186/s13063-017-2207-x
- SANTOLIM TQ, SANTOS LA, GIOVANI AM, DIAS VC. The strategic role of the nurse in the selection of IV devices. Br J Nurs 2012; 21: S28-S32.
- CLEMONS M, STOBER C, KEHOE A, BEDARD D, MACDONALD F, BRUNET MC et al. A randomized trial comparing vascular access strategies for patients receiving chemotherapy with trastuzumab for early-stage breast cancer. Sup Care Cancer 2020; 28: 4891-4899. https://doi.org/10.1007/s00520-020-05326-y
- YIN YX, GAO W, LI XY, LU W, DENG QH, ZHAO CY et al. Randomized multicenter study on long-term complications of peripherally inserted central catheters positioned by electrocardiographic technique. Phlebology 2020; 35: 614-622. https://doi.org/10.1177/0268355520921357
- SOUZA J, GRASSMANN C, MAY TA. Incidence of phlebitis associated with the use of peripheral IV catheter and following catheter removal. Rev. Latino-Am 2016; 24: 27-46. https://doi.org/10.1590/1518-8345.0604.2746
- ATAY S, SEN S, CUKURLU D. Phlebitis-related peripheral venous catheterization and the associated risk factors. Niger J Clin Pract 2018; 21: 827-831. https://doi.org/10.4103/njcp.njcp_337_17
- MAILHE M, AUBRY C, BROUQUI P, MICHELET P, RAOULT D, PAROLA P et al. Complications of peripheral venous catheters: the need to propose an alternative route of administration. Int J Antimicrob Agents 2020; 10: 58-75. https://doi.org/10.1016/j.ijantimicag.2020.105875
- COMPARCINI D, SIMONETTI V, BLOT S, TOMIETTO M, CICOLINI G. Relationship between peripheral insertion site and catheter-related phlebitis in adult hospitalized patients: a systematic review. Prof Inferm 2017; 70: 51-60. https://doi.org/10.7429/pi.2017.701051
- PALESE A, AMBROSI E, FABRIS F, GUARNIER A, BARELLI P, ZAMBIASI P et al, ESAMED Group. Nursing care as a predictor of phlebitis related to insertion of a peripheral venous cannula in emergency departments: findings from a prospective study. J Hosp Infect 2016; 92: 280-286. https://doi.org/10.1016/j.jhin.2015.10.021
- MILIANI K, TARAVELLA R, THILLARD D, CHAUVIN V, MARTIN E, EDOUARD S et al. Peripheral Venous Catheter-Related Adverse Events: Evaluation from a Multicentre Epidemiological Study in France (the CATHEVAL Project). PLoS ONE 2017; 12: e0168637. https://doi.org/10.1371/journal. pone.0168637
- PÉREZ-GRANDA MJ, BOUZA E, PINILLA B, CRUCES R, GONZÁLEZ A, MILLÁN J et al. Randomized clinical trial analyzing maintenance of peripheral venous catheters in an internal medicine unit: heparin vs. saline. PLoS One 2020; 15: 226-251. https://doi.org/10.1371/journal.pone.0226251
- O’GRADY NP, ALEXANDER M, DELLINGER EP, GERBERDING JL, HEARD SO, MAKI DG et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2011; 39: 31-34. https://doi.org/10.1016/j.ajic.2011.01.003
- LÓPEZ-BRIZ E, RUIZ GARCIA V, CABELLO JB, BORT-MARTÍ S, CARBONELL SANCHIS R, BURLS A. Heparin versus 0.9% sodium chloride locking for prevention of occlusion in central venous catheters in adults. Cochrane Datab Syst Rev 2018; 7: CD008462. https://doi.org/10.1002/14651858.CD008462.pub3
- CORLEY A, ULLMAN AJ, MIHALA G, RAY-BARRUEL G, ALEXANDROU E, RICKARD CM. Peripheral intravenous catheter dressing and securement practice is associated with site complications and suboptimal dressing integrity: A secondary analysis of 40,637 catheters. Int J Nurs Stud 2019; 100: 103409. https://doi.org/10.1016/j.ijnurstu.2019.103409
- URBANETTO JS, MUNIZ FOM, SILVA RM, FREITAS APC, OLIVEIRA APR, SANTOS JCR. Incidence of phlebitis and post-infusion phlebitis in hospitalised adults. Rev Gaucha Enferm 2017; 38: e58793. https://doi.org/10.1590/1983- 1447.2017.02.58793
- TOMÁS-VECINA S, MOZOTA-DUARTE J, MARCOS-ORTEGA M, RUIZ-NAVARRA M, BORILLO V, SAN JUAN-GAGO L et al. Estudio sobre la reducción de eventos adversos en pacientes y problemas de bioseguridad de los profesionales derivados de la aplicación de catéteres vasculares en urgencias. Emergencias 2016; 28: 89-96.
- ZHENG G, YANG L, CHEN H, CHU J, MEI L. For prevention and treatment of infusion phlebitis. Cochrane Database Syst Rev 2014; 6: CD009162. https://doi.org/10.1002/14651858.CD009162.pub2
- WEBSTER J, OSBORNE S, RICKARD CM, MARSH N. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev 2019; 1: CD007798. https://doi.org/10.1002/14651858.CD007798.pub5
- FERRETE-MORALES C, VÁZQUEZ-PÉREZ MA, SÁNCHEZ-BERNA M, GILABERT-CERRO I, CORZO-DELGADO JE, PINEDA-VERGARA JA et al. Incidencia de flebitis secundaria por catéter venoso de acceso periférico e impacto de un protocolo de manejo. Enferm Clin 2010; 20: 3-9. https://doi.org/10.1016/j.enfcli.2009.10.001