A prospective sonographic evaluation of peripheral intravenous catheter associated thrombophlebitis

Abstract

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.

Effect of indwelling depth of peripheral intravenous catheters on thrombophlebitis

“…[6] Nicholas Mielke used ultrasound into diagnosis of thrombophlebitis and found the incidence rate of thrombophlebitis among 62 included patients was 87.10%. [17] Among the 339 patients in the present study, the incidence rate of thrombophlebitis is 14.5%, which is inconsistent with previous studies and is directly related to the normalized nursing and the optimized consumable quality of our hospital. Moreover, our nursing is timely and active; after use of high-concentration or irritant drugs, the indwelling needles and tubes are rinsed with normal saline; activities of the body at the intubation side are well guided to promote blood circulation.…”

Risk Factors for Coated Midline Catheter-Related Thrombosis

“…The development of thrombus in veins that have MCs in >40% of the lumen is a new, although expected, finding in this study, given previous literature on peripherally inserted central catheters and peripheral intravenous catheters demonstrating similar results 16–18. The authors feel that this finding represents the most clinically relevant risk factor uncovered in this analysis.…”

“…The development of thrombus in veins that have MCs in >40% of the lumen is a new, although expected, finding in this study, given previous literature on peripherally inserted central catheters and peripheral intravenous catheters demonstrating similar results. [16][17][18] The authors feel that this finding represents the most clinically relevant risk factor uncovered in this analysis. While MCs have begun to replace central access devices in many situations, vascular access clinicians must consider the patient's anatomy prior to the insertion of these devices.…”

Prevalence of peripheral intravenous catheters and policy adherence: A point prevalence in a tertiary care university hospital

“…Additionally, the duration of Staphylococcus aureus bloodstream infections due to an infected PIVC was significantly longer and associated with higher mortality (Mermel, 2017). Furthermore, a prospective sonographic evaluation of PIVC‐associated thrombophlebitis by Mielke et al (2021) reported 68.18% of symptomatic and 90.63% of asymptomatic thrombus cases occurred with PIVC inserted at the antecubital fossa. Where large vessels and large bore PIVCs are required for resuscitation or rapid fluid replacement, these should be repositioned once the patient is stabilised (Ray‐Barruel et al, 2019).…”