Risk Factors of Nicardipine-Related Phlebitis in Acute Stroke Patients

Kawada, Kei; Ohta, Tsuyoshi; Tanaka, Koudai; Kadoguchi, Naoto; Yamamoto, Souichi; Morimoto, Masanori

doi:10.1016/j.jstrokecerebrovasdis.2016.06.028

Cited by 9 publications

(5 citation statements)

References 35 publications

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“…Some findings of this study pertaining to critically ill patients were similar to the findings of studies in a general hospital ward setting [10][11][12][19][20][21][22][23][24][25][26][27][28][29][30]. Previous studies related to general wards showed the increased risk of phlebitis with the administration of nicardipine and noradrenaline [12,[31][32][33]. In addition, the present study showed that PIVC insertion in the upper arm was significantly associated with lower phlebitis rates than that in the forearm, similar to a finding reported in previous studies in general wards [34].…”

Section: Discussionsupporting

confidence: 82%

“…A large number of drugs are administered to critically ill patients in the ICU; therefore, the frequency of PIVCrelated complications is expected to be high. Various studies have reported the effect of administered drugs on the development of phlebitis [32,33,39,45,46]. In the present study, the effects of 26 drugs on phlebitis selected from a database of more than 300 drugs were examined.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for peripheral intravascular catheter-related phlebitis in critically ill patients: analysis of 3429 catheters from 23 Japanese intensive care units

Yasuda

Rickard

Marsh

et al. 2022

Ann. Intensive Care

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Background Phlebitis is an important complication occurring in patients with peripheral intravascular catheters (PIVCs). The risk factors for phlebitis in the intensive care unit (ICU) was examined. Methods A secondary analysis of a prospective multicenter cohort study was conducted, involving 23 ICUs in Japan—the AMOR–VENUS study. Consecutive patients aged ≥ 18 years admitted to the ICU with newly inserted PIVCs after ICU admission were enrolled. Characteristics of the ICU, patients, PIVCs, and the drugs administered via PIVCs were recorded. A marginal Cox regression model was used to identify the risk factors associated with phlebitis. Results A total of 2741 consecutive patients from 23 ICUs were reviewed for eligibility, resulting in 1359 patients and 3429 PIVCs being included in the analysis population. The median dwell time was 46.2 h (95% confidence interval [CI], 21.3–82.9). Phlebitis occurred in 9.1% (95% CI, 8.2–10.1%) of catheters (3.5 cases/100 catheter days). The multivariate analysis revealed that the only factors that increased the risk of developing phlebitis were drugs administered intravenously. This study included 26 drugs, and 4 were associated with increased phlebitis: nicardipine (HR, 1.85; 95% CI, 1.29–2.66), noradrenaline (HR, 2.42; 95% CI, 1.40–4.20), amiodarone (HR, 3.67; 95% CI, 1.75–7.71) and levetiracetam (HR, 5.65; 95% CI, 2.80–11.4). Alternatively, factors significantly associated with a reduced risk of phlebitis were: standardized drug administration measures in the ICU (HR, 0.35; 95% CI, 0.17–0.76), 30≤ BMI (HR, 0.43; 95% CI, 0.20–0.95), catheter inserted by a doctor as nurse reference (HR, 0.55; 95% CI, 0.32–0.94), and upper arm insertion site as forearm reference (HR, 0.52; 95% CI, 0.32–0.85). The nitroglycerin was associated with a reduced phlebitis risk (HR, 0.22; 95% CI, 0.05–0.92). Conclusion Various factors are involved in the development of phlebitis caused by PIVCs in critically ill patients, including institutional, patient, catheter, and drug-induced factors, indicating the need for appropriate device selection or models of care in the ICU. Trial registration: UMIN-CTR, the Japanese clinical trial registry (registration number: UMIN000028019, July 1, 2017).

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Risk factors for peripheral intravascular catheter-related phlebitis in critically ill patients: analysis of 3429 catheters from 23 Japanese intensive care units

Yasuda

Rickard

Marsh

et al. 2022

Ann. Intensive Care

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“…4), 5) The most common factors that increased the incidence of phlebitis were drugs; 10) i t is important to examine the risk factors of drugs because the conditions that are likely to cause phlebitis differ among them. 13),16),17), 18) In our study, administration of nafamostat mesylate for ≥ 3 days in ICU or HCU may be an independent risk factor for phlebitis in patients treated with nafamostat mesylate. This result is supported by the findings in previous report of an increased risk of phlebitis with longer duration of drug administration.…”

Section: Discussionmentioning

confidence: 59%

Identification of Risk Factors for Phlebitis in Patients Treated with Nafamostat Mesylate

2023

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The proteolytic enzyme inhibitor nafamostat mesylate is widely used for the treatment of acute pancreatitis and disseminated intravascular coagulation. This drug may be a risk factor for phlebitis, but this risk has not been studied. Therefore, we aimed to investigate the frequency of phlebitis and its risk factors in patients treated with nafamostat mesylate in intensive care units (ICU) or high care units (HCU). During the study period, 83 patients met the inclusion criteria, and 22 of them (27%) experienced phlebitis. A multivariate logistic regression analysis was performed for severe acute pancreatitis, administration duration, and administration concentration of nafamostat mesylate in the ICU or HCU. As a result, the administration of nafamostat mesylate for ≥ 3 days in the ICU or HCU was an independent predictor of phlebitis caused by nafamostat mesylate (odds ratio, 10.3; 95% confidence interval, 1. 28-82.5; p=0.03). This study suggests that the number of days of nafamostat mesylate administration is associated with phlebitis in patients treated with the drug, and it may be necessary to pay attention to its administration for ≥ 3 days in the ICU or HCU.

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“…Many drugs are administered to critically ill patients admitted into the ICU. Various studies have reported on the effect of administered drugs (including nicardipine, noradrenaline, and amiodarone) on the incidence of phlebitis ( 20 – 24 ). The results of this study also showed that these drugs were associated with the occurrence of phlebitis.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for peripheral venous catheter-related phlebitis stratified by body mass index in critically ill patients: A post-hoc analysis of the AMOR-VENUS study

Kashiura

Yasuda²,

Oishi³

et al. 2022

Front. Med.

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IntroductionPhlebitis is an important complication in patients with peripheral intravascular catheters (PIVCs). Although an association between body mass index (BMI) and phlebitis has been suggested, the risk of phlebitis according to BMI has not been well elucidated. Therefore, in this study, we analyzed the risk of phlebitis according to BMI in patients in the intensive care unit (ICU).Materials and methodsThis study undertook a secondary analysis of the data from a prospective multicenter observational study assessing the epidemiology of phlebitis at 23 ICUs in Japan. Patients admitted into the ICU aged ≥18 years with a new PIVC inserted after ICU admission were consecutively enrolled and stratified into the following groups based on BMI: Underweight (BMI < 18.5 kg/m2), normal weight (18.5 ≤ BMI < 25.0 kg/m2), and overweight/obese (BMI ≥ 25.0 kg/m2). The primary outcome was phlebitis. The risk factors for phlebitis in each BMI-based group were investigated using a marginal Cox regression model. In addition, hazard ratios and 95% confidence intervals were calculated.ResultsA total of 1,357 patients and 3,425 PIVCs were included in the analysis. The mean BMI for all included patients was 22.8 (standard deviation 4.3) kg/m2. Among the eligible PIVCs, 455; 2,041; and 929 were categorized as underweight, normal weight, and overweight/obese, respectively. In the underweight group, catheter size ≥ 18 G and amiodarone administration were independently associated with the incidence of phlebitis. Drug administration standardization was associated with the reduction of phlebitis. In the normal weight group, elective surgery as a reason for ICU admission, and nicardipine, noradrenaline, and levetiracetam administration were independently associated with the incidence of phlebitis. Heparin administration was associated with the reduction of phlebitis. In the overweight/obese group, the Charlson comorbidity index, catheter size ≥ 18 G, and levetiracetam administration were independently associated with the incidence of phlebitis. Catheters made from PEU-Vialon (polyetherurethane without leachable additives) and tetrafluoroethylene were associated with the reduction of phlebitis.ConclusionWe investigated the risk factors for peripheral phlebitis according to BMI in ICU and observed different risk factors in groups stratified by BMI. For example, in underweight or overweight patients, large size PIVCs could be avoided. Focusing on the various risk factors for phlebitis according to patients’ BMIs may aid the prevention of phlebitis.

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Risk Factors of Nicardipine-Related Phlebitis in Acute Stroke Patients

Cited by 9 publications

References 35 publications

Risk factors for peripheral intravascular catheter-related phlebitis in critically ill patients: analysis of 3429 catheters from 23 Japanese intensive care units

Risk factors for peripheral intravascular catheter-related phlebitis in critically ill patients: analysis of 3429 catheters from 23 Japanese intensive care units

Identification of Risk Factors for Phlebitis in Patients Treated with Nafamostat Mesylate

Risk factors for peripheral venous catheter-related phlebitis stratified by body mass index in critically ill patients: A post-hoc analysis of the AMOR-VENUS study

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