Risk factors for peripheral intravenous catheter-related phlebitis in adult patients

Simões, Adriana Moreira Noronha; Vendramim, Patrícia; Pedreira, Mavilde Luz Gonçalves

doi:10.1590/1980-220X-REEUSP-2021-0398en

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 56 • 2022 • https://doi.org/10.1590/1980-220X-REEUSP-2021-0398en copy

Risk factors for peripheral intravenous catheter-related phlebitis in adult patients^* * Extracted from the dissertation: “Fatores de risco para o desenvolvimento de flebite relacionada ao uso de cateteres intravenosos periféricos em pacientes adultos”, presented at Universidade Federal de São Paulo, Escola Paulista de Enfermagem, 2021.

Factores de riesgo de flebitis relacionada al uso de catéteres intravenosos periféricos en pacientes adultos

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To identify risk factors for peripheral intravenous catheter-related phlebitis in adult patients.

Method:

This is a post hoc analysis of a randomized clinical trial, totaling 1,319 patients. Demographic and clinical variables related to therapy and phlebitis were investigated. For data analysis, frequencies, measures of central tendency and dispersion were calculated, and Pearson’s chi-square test and Fisher’s exact test were used, with logistic regression, ROC curve, and Odds Ratio calculation (95% confidence interval; 5% significance level) being implemented.

Results:

Of the 1,319 participants, 80 (6.1%) developed phlebitis. The following were associated with the occurrence of phlebitis: reduced mobility (p = 0.015), family history of deep vein thrombosis (p = 0.05), catheterization of veins on the back of the hand (p = 0.012), pain (p < 0.01), Amoxicillin-Potassium Clavulanate (p = 0.015), and Omeprazole Sodium (p = 0.029).

Conclusion:

Risk factors for phlebitis involved intrinsic and extrinsic factors to the patient, indicating preventive nursing interventions such as promoting patient mobility, not catheterizing veins in the dorsal arch of the hand, cautious infusion of risk drugs, and valuing pain complaints.

DESCRIPTORS
Phlebitis; Peripheral Catheterization; Adult; Nursing

Demographic and Clinical Characteristics	Phlebitis				Total		p
	Yes		No		Total		p
	N	%	N	%	N	%
Age (years)
Mean (±standard deviation)	59.79 (±20.48)
Age range							0.919^a
<30 years	6	7.5	109	8.7	115	8.7
≥30 years to <60 years	30	37.5	489	39.5	519	39.3
≥60 years to <80 years	28	35.0	391	31.6	419	31.8
≥80 years	16	20.0	250	20.2	266	20.2
Sex							0.338^a
Female	36	45.0	626	50.5	662	50.2
Male	44	55.0	613	49.5	657	49.8
Skin color (n = 1,312)							0.705^b
White	78	97.5	1,151	93.4	1229	93.7
Brown	1	1.25	32	2.6	33	2.5
Black	0	0.0	26	2.1	26	2.0
Yellow	1	1.25	23	1.9	24	1.8
BMI¹ (n = 1,295)							0.995^a
Mean (±standard deviation)	26.48 (±5.43)
Under weight	4	5.0	57	4.7	61	4.7
Eutrophy	30	37.5	469	38.6	499	38.5
Overweight	26	32.5	398	32.7	424	32.7
Obesity	20	25.0	291	24.0	311	24.1
Place of hospitalization							0.019^b
H1	77	96.2	1,089	87.9	1166	88.4
H2	3	3.8	150	12.1	153	11.6
Admission type (n = 1,316)							0.710^a
Clinical	11	13.7	189	15.3	200	15.2
Surgical	69	86.3	1,047	84.7	1116	84.8
Chronic diseases							0.018^a
No	37	46.3	413	33.3	450	34.1
Yes	43	53.7	826	66.7	869	65.9
VTE risk ²							0.071^a
No	14	17.5	330	26.6	344	26.1
Yes	66	82.5	909	73.4	975	73.9
Family history of VTE ²							0.171^b
No	79	98.7	1,237	99.8	1316	99.8
Yes	1	1.3	2	0.2	3	0.2
VTE ²							1.000^b
No	75	93.8	1,162	93.8	1237	93.8
Yes	5	6.2	77	6.2	82	6.2
Use of oral antiaggregant							0.559^a
No	69	86.3	1,038	83.8	1107	83.9
Yes	11	13.8	201	16.2	212	16.1
Use of oral anticoagulants							0.814^b
No	76	95.0	1.158	93.5	1234	93.6
Yes	4	5.0	81	6.5	85	6.4
Use of SC anticoagulant ³							0.292^b
No	49	61.3	684	55.2	733	55.6
Yes	31	38.8	555	44.8	586	44.4
Reduced mobility							0.011^a
No	48	60.0	906	73.1	954	72.3
Yes	32	40.0	333	26.9	365	27.7

PIC and IVT Characteristics	Phlebitis				Total		p
	Yes		No		Total		p
	N	%	N	%	N	%
Catheter type (n = 1,228)							0.201^a
Nexiva^®	53	73.6	722	62.5	775	58.8
Insyte^®	16	22.2	359	31.0	375	28.4
Intima^®	3	4.2	75	6.5	78	5.9
Catheter gauge (n = 1,263)							0.805^b
16 gauge	0	0.0	1	0.1	1	0.1
18 gauge	0	0.0	5	0.4	5	0.4
20 gauge	4	5.1	91	7.7	95	7.5
22 gauge	63	79.7	889	75.0	952	75.4
24 gauge	12	15.2	198	16.7	210	16.6
Laterality of the insertion site (n = 1,318)							0.365^a
Right	42	52.5	7144	57.7	756	57.3
Left	38	47.5	524	42.3	562	42.6
Insertion site (n = 1,316)							0,054^a
Forearm	40	50.0	633	51.2	673	51.1
Back of hand	13	16.3	95	7.7	108	8.2
Antecubital fossa	7	8.8	122	9.9	129	9.8
Wrist	10	12.5	135	10.9	145	11.1
Arm	10	12.5	251	20.3	261	19.8
PIC method of use (n = 1,304)							0.065^a
Intermittent	68	85.0	930	76.0	998	76.5
Continuous	12	15.0	294	24.0	306	23.5
PIC method of removal							0.184^a
96H	45	56.2	602	48.6	647	49.1
Clinical indication	35	43.8	637	51.4	672	50.9
Pain complaint							<0.001^a
No	26	32.5	984	79.4	1.010	76.6
Yes	54	67.5	255	20.6	309	23.4
Use of antibiotic therapy							0.102^a
No	22	27.5	453	36.6	475	36.0
Yes	58	72.5	786	63.4	844	64.0

Variable	Estimate	Error	p	OR	CI 95% OR
PIC method of removal	–0.31	0.23	0.185	0.74	(0.47; 1.16)
Reduced mobility	0.6	0.2	0.012	1.8	(1.14; 2.89)
VTE risk¹	0.5	0.3	0.074	1.7	(0.95; 3.09)
Family history of VTE¹	2.1	1.2	0.094	7.8	(0.7; 87.27)
Insertion site – Back of the hand	0.8	0.3	0.022	2.2	(1.12; 4.2)
Pain	2.1	0.2	<0.001	8.0	(4.92; 13.05)
Use of ATB²	0.4	0.3	0.104	1.5	(0.92; 2.52)
Amoxicillin-Potassium Clavulanate	1.9	0.6	0.002	6.5	(1.98; 21.1)
Omeprazole Sodium	0.7	0.2	0.002	2.0	(1.28; 3.2)

Variable	Estimate	Error	p	OR	CI 95% OR
PIC method of removal	–0.31	0.23	0.185	0.74	(0.47; 1.16)
Reduced mobility	0.59	0.26	0.015	1.8	(1.08; 3.00)
Family history of VTE¹	3.12	1.28	0.05	22.7	(1.84; 280.56)
Insertion site – Back of the hand	1.05	0.37	0.012	2.8	(1.39; 5.83)
Pain	2.12	0.26	<0.01	8.3	(4.98; 13.93)
Amoxicillin-Potassium Clavulanate	2.01	0.73	0.015	7.4	(1.8; 30.78)
Omeprazole Sodium	0.54	0.25	0.029	1.7	(1.05; 2.81)

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E-mail: reeusp@usp.br

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[1] Corresponding author: Adriana Moreira Noronha Simões Rua Cayowaá, 1590, Sumaré 01258-010 – São Paulo, SP, Brazil drimnoronha@gmail.com