Phlebitis associated with peripheral intravenous catheters in adults admitted to hospital in the Western Brazilian Amazon

Enes, Sandra Maria Sampaio; Opitz, Simone Perufo; Faro, André Ricardo Maia da Costa de; Pedreira, Mavilde de Luz Gonçalves

doi:10.1590/S0080-623420160000200012

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ORIGINAL ARTICLE • REEUSPRev. esc. enferm. USP 50 (02) • Mar-Apr 2016 • https://doi.org/10.1590/S0080-623420160000200012 copy

Phlebitis associated with peripheral intravenous catheters in adults admitted to hospital in the Western Brazilian Amazon^* * Extracted from the dissertation "Complicações relacionadas ao uso de cateteres intravenosos periféricos em pacientes adultos internados em um hospital de ensino na Amazônia Ocidental Brasileira", Programa de Pós-graduação em Enfermagem, Universidade Federal de São Paulo, 2014.

Flebitis asociadas con catéteres intravenosos periféricos en adultos ingresados en hospital de la Amazonía Occidental Brasileña

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

OBJECTIVE

To identify the presence of phlebitis and the factors that influence the development of this complication in adult patients admitted to hospital in the western Brazilian Amazon.

METHOD

Exploratory study with a sample of 122 peripheral intravenous catheters inserted in 122 patients in a medical unit. Variables related to the patient and intravenous therapy were analyzed. For the analysis, we used chi-square tests of Pearson and Fisher exact test, with 5% significance level.

RESULTS

Complication was the main reason for catheter removal (67.2%), phlebitis was the most frequent complication (31.1%). The mean duration of intravenous therapy use was 8.81 days in continuous and intermittent infusion (61.5%), in 20G catheter (39.3%), inserted in the dorsal hand vein arc (36.9 %), with mean time of usage of 68.4 hours. The type of infusion (p=0.044) and the presence of chronic disease (p=0.005) and infection (p=0.007) affected the development of phlebitis.

CONCLUSION

There was a high frequency of phlebitis in the sample, being influenced by concomitant use of continuous and intermittent infusion of drugs and solutions, and more frequent in patients with chronic diseases and infection.

Descriptors
Phlebitis; Catheterization, Peripheral; Infusions, Intravenous; Inpatients; Nursing Care

Variables	N	%
Age (years)
Up to 50 years old	68	55.7
Over 50 years old	54	44.3
Median (Q1 - Q3)	47 (31-58)
Mean	46.1
Standard-deviation	17.6
Minimum - Maximum	18-89
Gender
Female	61	50.0
Male	61	50.0
Self-reported skin color
White	27	22.1
Brown	70	57.3
Black	18	14.9
Red	02	1.6
Yellow	05	4.1
Predisposing condition for complications
Yes	104	85.2
No	18	14.8
Type of predisposing condition (122)
Infection
Yes	32	26.2
No	90	73.8
Edema
Yes	12	9.9
No	110	90.1
Hypovolemia
Yes	01	0.8
No	121	99.2
Obesity
Yes	05	4.1
No	117	95.9
Chronic disease
Yes	74	60.7
No	48	39.3
Vascular disease
Yes	07	5.7
No	115	94.3
Other
Yes	10	8.2
No	112	91.8

Variables	N	%
Time of IVT use (days)
Up t 7 days	71	58.2
Over 7 days	51	41.8
Median (Q1-Q3)	7 (4-11.25)
Mean	8.81
Standard-deviation	6.89
Minimum-Maximum	0-32
IVT type of infusion
Continuous	03	2.5
Intermitent	44	36.0
Continuous and intermitent	75	61.5
IVT infusion method
Bolus	22	18.0
Gravitational	08	6.6
Infusion pump	01	0.8
Bolus and Gravitational	91	74.6
Type of fluid administered
Solution	03	2.5
Drugs	19	15.5
Solutions and drugs	100	82.0
Number of solutions
One solution	83	68.0
More than one solution	39	32.0
Number of drugs
Up to two drugs	23	18.9
More than two drugs	99	81.1
Current treatment of risk for complications
Yes	80	65.6
No	42	34.4
Type of current risk treatment = (80)
Prolonged intravenous therapy
Yes	34	42.5
No	46	57.5
Use of vesicant drugs
Yes	50	62.5
No	30	37.5
Drugs with extreme pH
Yes	50	62.5
No	30	37.5
Drugs with high osmolarity
Yes	15	18.7
No	65	81.3
High rate of infusion
Yes	26	32.5
No	54	67.5

Variables	N	%
Type of catheter
On needle	121	99.0
Needled	01	1.0
Caliber of the catheter
24 G	17	13.9
22 G	38	31.1
20 G	48	39.3
18 G	18	14.7
Other	01	1.0
Anatomical position
Hand	45	36.9
Forearm	65	53.3
Antecubital fossa	05	4.1
Arm	06	4.9
Others	01	0.8
Catheter insertion site
Dorsal venous arch of hand	45	36.9
Basilic vein	16	13.1
Cephalic vein	31	25.4
Median vein of forearm	18	14.7
Median vein of elbow	08	6.6
Others	04	3.3
Fixation of the catheter
Microporous tape	02	1.6
Adhesive tape	120	98.4
Professional performing PVP
Nurse	10	8.2
Nurse technician	112	91.8
Nursing care level
Grade 0	26	21.3
Grade 1	89	73.0
Grade 2	07	5.7
Length of time with the catheter (hours)
Up to 96 hours	98	80.3
Over 96 hours	24	19.7
Median (Q1-Q3)	57 (35-89.75)
Mean	68.4
Standard-deviation	46.28
Minimum-Maximum	11-283

Variables	Phlebitis
	Yes		No		Total		P
	N	%	N	%	N	%
Time of use of IVT							0.964^a a Chi-square test;
Up to 7 days	22	18.0	49	40.2	71	58.2
Over 7 days	16	13.1	35	28.7	51	41.8
Infusion type							0.044^b b Fisher's exact test.
Continuous	01	0.8	02	1.7	03	2.5
Intermitent	08	6.6	36	29.4	44	36.0
Continuous and intermitent	29	23.8	46	37.7	75	61.5
Infusion method							0.269^b b Fisher's exact test.
Infusion pump	01	8.0	0	-	01	0.8
Bolus	04	3.3	18	14.7	22	18.0
Gravitational	02	1.7	06	4.9	08	6.6
Bolus and gravitational	31	24.4	60	50.2	91	74.6
Fluid types							0.239^b b Fisher's exact test.
Solution	01	8.0	02	1.7	03	2.5
Drugs	03	2.5	16	13.0	19	15.5
Solution and drugs	34	27.9	66	54.1	100	82.0
Number of drugs							0.279^a
Up to two drugs	05	4.1	18	14.8	23	18.9
Over two drugs	33	27.1	66	54.0	99	81.1
Current treatment risk							0.392^a a Chi-square test;
Yes	27	22.1	53	43.5	80	65.6
No	11	9.0	31	25.4	42	34.4
Nursing level of care							0.054^b b Fisher's exact test.
Grade 0	04	3.3	22	18.0	26	21.3
Grade 1	31	25.4	58	47.6	89	73.0
Grade 2	03	2.4	04	3.3	07	5.7
Length of hospital stay							0.796^b b Fisher's exact test.
Up to 96 hours	30	24.5	68	55.7	98	80.3
Over 96 hours	08	6.6	16	13.1	24	19.7
Infection							0.007^a a Chi-square test;
Yes	16	13.1	16	13.2	32	26.2
No	22	18.0	68	55.7	90	73.8
Chronic disease							0.005^a a Chi-square test;
Yes	16	13.1	58	47.6	74	60.7
No	22	18.0	26	21.3	48	39.3

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Sandra Maria Sampaio Enes. Universidade Federal do Acre, Campus Universitário, BR-364, km 4, CEP 69920-900 - Rio Branco, AC, Brazil. sandraenes25@hotmail.com