Evidence for elective replacement of peripheral intravenous catheter to prevent thrombophlebitis: a systematic review

Abstract

Limited scientific evidence suggests that elective replacement of peripheral intravenous catheters reduces the incidence and severity of thrombophlebitis.

Associação entre flebite e retirada de cateteres intravenosos periféricos

“…O tempo de permanência e o calibre do CIP, preditores da flebite apontados por inúmeros autores, 3,7,10,[13][14][15] não apresentaram impacto no presente estudo. Esse achado discordante pode ser devido a dois motivos: todos os CIPs usados eram de poliuretano -Vialon ® , e o tempo médio de permanência foi de 3,15 dias, ou seja, 72 h. O Vialon ® é um polímero elastomérico que possui baixa incidência trombogê-nica e é mais flexível, especialmente quando atinge a temperatura corporal, por isso permite maior tempo de canulação do acesso, apresentando menor risco de flebite.…”

“…4,8 No cenário brasileiro, os estudos conduzidos com pacientes hospitalizados em unidades clínicas e cirúrgicas mostraram incidência de 3% a 20,6%. [9][10][11][12] Os estudos relativos aos fatores associados ao desenvolvimento da flebite são, ainda, inconclusivos, porém apontam que o risco aumenta dependendo do tipo de material e calibre do CIP, 3,13 do tempo de permanência do CIP, 3,7,10,[13][14][15] do local da punção, 16 do uso de fármacos hipertônicos e pH ácido. 8,17 Considerando o panorama, que a flebite representa um importante indicador da qualidade assistencial de enfermagem, e que no contexto nacional os estudos sobre o tema são, ainda, incipientes, os objetivos do presente estudo foram: a) Verificar a incidência de flebite em pacientes com CIP; e b) Identificar as possíveis associações dessa complicação com as variáveis relativas aos CIPs e à terapia farmacológica em pacientes internados em uma Enfermaria Geral de Adultos (EGA).…”

Commentary on Hasselberg D, Ivarsson B, Andersson R & Tingstedt B (2010) The handling of peripheral venous catheters – from non‐compliance to evidence‐based needs. Journal of Clinical Nursing 19, 3358–3363

“…The study was designed to describe compliance, but not to investigate different times between replacing in situ PVCs, an undertaking that would require a clinical controlled trial to yield solid evidence. The authors refer to a review by Idvall and Gunningberg (2006) that suggested using more clinical trials rather than descriptive studies to find evidence. A recently published Cochrane Library review (Webster et al 2010) of clinically-indicated replacement vs. routine replacement of PVCs recommended that any future trial include at least 3000 subjects in each arm of a randomised controlled trial (RCT) to show true differences (e.g.…”

“…Several large descriptive studies present 'evidence' for different in situ times, but as the reviews of Idvall and Gunningberg (2006) and the Cochrane Library (Webster et al 2010) assert, solid evidence would require RCTs. Moreover, the present study does not provide a definition of thrombophlebitis, rendering comparisons with other similar studies difficult.…”

Management, clinical outcomes, and complications of acute cannula-related peripheral vein phlebitis of the upper extremity: A retrospective study

“…In addition, many of these studies have been primarily focused on preventive measures for phlebitis and have not identified the criteria for surgical intervention. [6][7][8][9][10] In the present retrospective study, we aimed to compare the clinical course and diagnostic findings, as well as the outcome of conservative versus surgical treatment, in patients diagnosed with upper extremity thrombophlebitis. Moreover, we propose treatment guidelines to reduce the high incidence of severe phlebitis and to simplify the choice of appropriate treatments.…”