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

当前位置： X-MOL 学术 › Ann. Intensive Care › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Risk factors for peripheral intravascular catheter-related phlebitis in critically ill patients: analysis of 3429 catheters from 23 Japanese intensive care units
Annals of Intensive Care ( IF 5.7 ) Pub Date : 2022-04-08 , DOI: 10.1186/s13613-022-01009-5
Hideto Yasuda _{1,

2} , Claire M Rickard _{3,

4,

5} , Nicole Marsh _{3,

4,

5} , Ryohei Yamamoto ₆ , Yuki Kotani ₇ , Yuki Kishihara ₁ , Natsuki Kondo ₈ , Kosuke Sekine ₉ , Nobuaki Shime ₁₀ , Keita Morikane ₁₁ , Takayuki Abe _{12,

13} ,

Affiliation

Department of Emergency and Critical Care Medicine, Jichi Medical University Saimata Medical Center, 1-847, Amanuma-cho, Oomiya-ku, Saitama-shi, Saitama, 330-8503, Japan.
Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center (CTR), Tokyo, Japan.
School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia.
School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Griffith University, Nathan, QLD, Australia.
Herston Infectious Diseases Institute; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, QLD, Australia.
Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Intensive Care Medicine, Kameda Medical Center, Chiba, Japan.
Department of Intensive Care Medicine, Chiba Emergency Medical Center, Chiba-shi, Japan.
Department of Medical Engineer, Kameda Medical Center, Chiba, Japan.
Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Division of Clinical Laboratory and Infection Control, Yamagata University Hospital, Yamagata, Japan.
Biostatistics, Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan.
School of Data Science, Yokohama City University, Kanagawa, Japan.

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).

中文翻译：

危重患者外周血管内导管相关性静脉炎的危险因素：来自日本 23 个重症监护病房的 3429 根导管分析

背景

静脉炎是外周血管内导管 (PIVC) 患者发生的重要并发症。检查了重症监护病房（ICU）中静脉炎的危险因素。

方法

对一项涉及日本 23 个 ICU 的前瞻性多中心队列研究进行了二次分析——AMOR-VENUS 研究。纳入 ICU 入院后新插入 PIVC 的年龄≥ 18 岁的连续患者。记录 ICU、患者、PIVC 的特征以及通过 PIVC 给药的药物。使用边际 Cox 回归模型来确定与静脉炎相关的危险因素。

结果

共有来自 23 个 ICU 的 2741 名连续患者接受了资格审查，导致 1359 名患者和 3429 名 PIVC 被纳入分析人群。中位停留时间为 46.2 小时（95% 置信区间 [CI]，21.3-82.9）。9.1% (95% CI, 8.2–10.1%) 的导管发生静脉炎（3.5 例/100 导管日）。多变量分析显示，增加患静脉炎风险的唯一因素是静脉注射药物。该研究包括 26 种药物，其中 4 种与静脉炎增加相关：尼卡地平（HR，1.85；95% CI，1.29-2.66）、去甲肾上腺素（HR，2.42；95% CI，1.40-4.20）、胺碘酮（HR，3.67； 95% CI, 1.75–7.71) 和左乙拉西坦 (HR, 5.65; 95% CI, 2.80–11.4)。或者，与降低静脉炎风险显着相关的因素包括：ICU 中的标准化给药措施（HR，0.35；95% CI，0.17-0.76），30≤ BMI（HR，0.43；95% CI，0.20-0.95），由医生插入导管作为护士参考（HR，0.55 ; 95% CI, 0.32–0.94)，上臂插入部位作为前臂参考 (HR, 0.52; 95% CI, 0.32–0.85)。硝酸甘油与降低静脉炎风险相关（HR，0.22；95% CI，0.05-0.92）。