Bilateral deep brachial vein thrombophlebitis due A patient had bilateral deep brachial vein thrombophlebitis in which Vibrio In vitro antibiotic disk.
Objectives To determine the incidence and factors contributing to the development of amiodarone-induced phlebitis in the coronary care unit in an academic medical center and to refine the current practice protocol.
Methods Medical records from all adult patients during an month period who received intravenous amiodarone while in the critical care unit were reviewed retrospectively. Route of administration, location, concentration, and duration of amiodarone therapy and factors associated with occurrence of phlebitis were examined. Descriptive statistics and regression methods were used to identify incidence and phlebitis factors. Pain, redness, and warmth were the most common indications of phlebitis.
Total dosage given via a peripheral catheter, duration of infusion, and number of catheters were significantly Thrombophlebitis vitro- with phlebitis. Prompt Krampfadern an den Beinen new practice protocol resulted from this study.
An outcome study is in progress. Intravenous amiodarone has been an important treatment option for patients with ventricular tachyarrhythmias since the s and more recently has improved the management of atrial arrhythmias. At Stanford University Medical Center, Thrombophlebitis vitro-, Palo Alto, California, a group Thrombophlebitis vitro- concerned cardiac care and arrhythmia nurses met to examine pharmazeutische Heilmittel für Krampfadern magnitude of the problem and modify the current practice protocol.
A retrospective study on the incidence and predisposing factors contributing to the development of phlebitis in patients given intravenous amiodarone in the cardiac care unit CCU was conducted.
The literature on amiodarone-induced phlebitis delineates the following problems: Amiodarone was first introduced in as a drug for treating angina. Amiodarone-induced thrombophlebitis was initially described in Krampfadern des Samenstrang varicocele reports.
Phlebitis or thrombophlebitis is an inflammation of the vein wall characterized by pain, tenderness, edema, erythema, and an increase in local temperature 13 — 15 Figure 1.
In a descriptive study 2 of patients treated in an inpatient unit during a 3. Other signs and symptoms included redness, tenderness, swelling, and warmth at the intravenous site. Uslusoy Menü mit Krampfadern der unteren Extremitäten Mete 2 also noted that phlebitis can cause sepsis, which requires additional diagnostic interventions and treatments, increases hospital length of stay, and increases stress and costs for patients.
Amiodarone-induced phlebitis Thrombophlebitis vitro- been attributed to the mechanical and chemical effects of the particulate matter introduced during injection.
Thrombophlebitis vitro- of amiodarone may occur at the time of administration if the solubility limits of the drug are approached during dilution and mixing in the bloodstream.
Ward et al 18 and Ward and Yalkowsky 19 examined amiodarone-induced phlebitis with thermal measurement to distinguish rates of infusion and the consequences. They found that rapid dilution of the formulation is an important variable in the determination of phlebitis.
A slow injection into a constantly flowing bloodstream or a slow injection rate into a large blood volume both produce a rapid dilution. A very slow injection especially if into a large vessel such as the femoral vein will eliminate precipitation because the drug becomes soluble before nucleation can occur.
Similarly, injection into small veins such as those of the wrist should Thrombophlebitis vitro- avoided because the low rate of blood flow would result in a high local venous concentration of drug and an increased likelihood of precipitation and purulence. A total of electronic health records of patients who received amiodarone were reviewed. Using a rabbit ear model and a thermographic camera, Thrombophlebitis vitro-, Ward and Yalkowsky 17 and Ward et al 18 were able to detect temperature changes during infusion of amiodarone.
Despite the use of a filter, precipitation within the vessel depended on the ratio of the rate of injection to the rate of blood flow. Precipitation was directly correlated with phlebitis. Yalkowsky et al 15 found a relatively high incidence of adverse reactions at the infusion site in patients receiving a continuous infusion and paradoxically found that a single dose seemed to be better tolerated than a lower dose given Thrombophlebitis vitro- several hours.
The research by Ward, Yalkowsky and their colleagues also showed that amiodarone may be a direct irritant to the vessel wall, because it can leach out plasticizers in polyvinyl chloride tubing. Leaching increases at higher concentrations and lower flow rates. Their findings clearly indicate the link between the time of amiodarone administration and the clinical findings of inflammation, redness, tenderness, Thrombophlebitis vitro-, increased temperature, edema, swelling, and a palpable cord and vein.
Thrombophlebitis is a common complication of intravenous therapy; it can cause marked pain, swelling, Thrombophlebitis vitro-, fever, and tissue loss and may increase hospital costs by increasing length of stay. Contributing factors include the material, length, and lumen size of the cannula; the skill of the person inserting the cannula; the character of the material infused; the frequency of changes of intravenous dressings; and host factors, such as age, sex, and underlying disease.
The wide variations in amiodarone-induced phlebitis most likely are due to the varied populations of patients studied, Thrombophlebitis vitro-, the small sample sizes of most of the studies, and different methods and practices of drug administration. Understanding the mechanisms and pathophysiology of the development of amiodarone-induced phlebitis and the changes in the drug solution and its delivery methods and technology cannulas, intravenous containers have not altered the occurrence of trophische Geschwüre auf Film complication to Thrombophlebitis vitro. Understanding when phlebitis occurs and its relationship to dosage and concentration of amiodarone is needed to devise improved practice guidelines, Thrombophlebitis vitro-.
The goals of this retrospective descriptive study were to determine the incidence of amiodarone-related phlebitis, Thrombophlebitis vitro-, which variables contribute to the development of phlebitis, and practice standards to minimize the risk of phlebitis. The study was conducted in the CCU at Stanford Hospital and Clinics, Stanford, California, where a large number of patients with arrhythmias are treated with amiodarone, Thrombophlebitis vitro-.
Once the study was reviewed and approved by the Stanford Thrombophlebitis vitro- board, Thrombophlebitis vitro-, a list of sequential CCU patients who received amiodarone was compiled from pharmacy records for April through January A total of 18 patients were excluded because they had sepsis, they had Thrombophlebitis vitro- received intravenous amiodarone, or the Thrombophlebitis vitro- or absence of phlebitis could not be determined.
The final sample consisted of patients. The electronic health records of the patients were reviewed. Independent variables of interest were based on a review of the literature and clinical judgment. Phlebitis, Thrombophlebitis vitro-, the dependent variable, was determined by the documented presence and degree of pain, swelling, redness, and temperature at the intravenous site and the decision of at least 2 members of the study team that the patient had phlebitis.
A code book was generated and tested for use in data collection. After data collection, the code book was reviewed for accuracy and completeness, Thrombophlebitis vitro-, and a phlebitis diagnosis was determined, Thrombophlebitis vitro-. Data were analyzed by using SAS, Version 9, Thrombophlebitis vitro-. The results provided estimates of which factors were predictive of phlebitis.
Because many of values for the continuous variables were highly skewed to the right, the log transformation approximately normalized the values, Thrombophlebitis vitro-, and the transformed values were used in the analyses.
Thrombophlebitis vitro- study sample consisted of 75 men and 30 Thrombophlebitis vitro- with a mean age of 66 years. Among the sub-sample of patients with atrial fibrillation, Thrombophlebitis vitro-, 67 Among the whole sample of patients, 32 The biodemographic Thrombophlebitis vitro- did not differ significantly between patients who had phlebitis and those who did not.
Both groups had low ejection fractions shown by echocardiography, and many had concomitant risk factors for coronary artery disease, including overweight, hypertension, Thrombophlebitis vitro-, diabetes, and peripheral vascular disease, Thrombophlebitis vitro-.
The most common reported indications of phlebitis, in descending order of frequency, Thrombophlebitis vitro- pain 45 patientsredness 31warmth 11edema 10swelling 5and hardness 4. A mean of 3 signs or symptoms was reported for each episode of phlebitis. These indications were reported in the electronic health record when a catheter was discontinued.
Factors associated with the development of phlebitis included amiodarone dosage peripheral and total and duration of amiodarone administration. The number of central and peripheral intravenous catheters inserted as a result of the phlebitis was also significantly higher in the patients who had phlebitis than in the patients who did not Figures 2 and 3.
Variables associated with amiodarone dosage included the amount delivered via a central catheter 4. All dosages except those delivered via a central catheter were significantly higher in the patients who had phlebitis than in the patients who did was mit Krampfadern Leiste zu tun. Most episodes of phlebitis occurred in patients who had a total doses of 3 g of amiodarone delivered via a peripheral catheter.
The number of days amiodarone was administered was significantly greater in patients who had phlebitis than in patients who did not. Duration of administration was defined as the time from the first intravenous dosage until discontinuation of the drug.
The longer the duration of administration, the higher the total dosage of amiodarone. The number of peripheral catheters and the Thrombophlebitis vitro- number of catheters inserted was significantly greater in the patients who had phlebitis than in the patients who did not Figure 2.
Thrombophlebitis vitro- catheters included percutaneously inserted central catheters, trialysis catheters, and catheters inserted in Verfahren für Krampfadern an den Beinen internal jugular, femoral, Thrombophlebitis vitro-, and subclavian veins. Peripheral catheters were Thrombophlebitis vitro- in the left or right forearm, the hands, and the antecubitus.
Stepwise logistic regression was used to elucidate any factors predictive of phlebitis: Logisitic regression analysis of dose delivered via a peripheral catheter and occurrence of phlebitis. An opportunity for change in a current practice protocol emerged when arrhythmia and CCU staff realized that phlebitis was a problem in patients receiving Thrombophlebitis vitro- amiodarone via a peripheral catheter even when the current recommendations for administering the drug were followed.
This retrospective study was designed to examine our then-current practice of amiodarone administration, determine if the clinical problem of phlebitis was as large as anticipated, understand factors contributing to the development of phlebitis, and refine a practice protocol to decrease this problem. Our current practice protocol calls for use of an in-line filter, delivery of the higher recommended concentrations via a central catheter, and delivery of only lower concentrations via a peripheral catheter, Thrombophlebitis vitro-.
The rate of phlebitis in our study suggests that the protocol we were using was not sufficient to prevent or even minimize phlebitis and was in need of refinement. Total dosage of amiodarone delivered via a peripheral catheter was predictive of phlebitis and reinforces the notion that local and not systemic effects of the drug cause phlebitis.
This finding indicates that amiodarone is a local irritant of vessel walls and supports the work of Ward, Yalkowsy, and their colleagues. All 42 cases of phlebitis occurred in patients who received a total dose of 3 g of amiodarone via a peripheral catheter, and 10 of the cases developed when the patients had received less than 1 g. The doses used in this study are commonly administered in the first 24 hours of loading.
Therefore the first 24 hours are a critical time to monitor a patient and plan for oral or central dosing if the drug is not tolerated or the drug will be continued longer than 24 hours. Practice guidelines include use of an in-line filter in the largest peripheral vessel and use of a central catheter after 24 hours. When an intravenous catheter was discontinued, Thrombophlebitis vitro-, signs and symptoms of phlebitis as reasons for discontinuation of the catheter were not always reported in the electronic health record, and no reliable and valid monitoring method for intravenous catheters was available or required for documentation.
This situation contributed to the inability to determine the diagnosis of phlebitis in some of the excluded patients and might explain the high number of intravenous catheters Thrombophlebitis vitro- were used in the patients who had phlebitis.
Therefore, most likely the initial occurrence of phlebitis was not diagnosed until subsequent catheters were placed and, ultimately, discontinued, Thrombophlebitis vitro-.
Nursing practice and changes in the system used for electronic health records now include mandatory assessment of peripheral intravenous catheters every 4 hours by using the phlebitis scale of the Infusion Nurses Society 21 embedded in the health records. The scale is a valid and reliable tool 22 that facilitates tracking of the sequelae of infusions and provides ongoing monitoring of phlebitis. Although not a part of our study, Thrombophlebitis vitro-, the copying and compounding of generic forms of amiodarone and their role in phlebitis may need to be examined, Thrombophlebitis vitro-.
Study limitations include the retrospective study design and the documentation problems that existed Thrombophlebitis vitro- the electronic health record. Our study was conducted in the CCU at a single site and may unfortunately reflect the ongoing phlebitis problem at other institutions. Our results have been critical in developing a multidisciplinary evidence-based practice protocol for administration of amiodarone at our facility. All members of a team of nursing practice and research clinicians from the CCUs and the arrhythmia group, critical care physicians, and personnel from Thrombophlebitis vitro- pharmacy and the informatics department are involved in the protocol revisions and education for these practice changes to reduce the incidence of amiodarone-induced phlebitis.
These guidelines include use of an in-line filter and dose recommendations for central and peripheral catheters, use of the largest peripheral vessel, change to oral amiodarone within 24 hours of administration of intravenous doses, percutaneous insertion of a central catheter if administration exceeds 24 hours, and the creation of an order set with pharmacy dose information.
Changes in nursing practice and in the electronic health record include mandatory assessment of Thrombophlebitis vitro- intravenous catheters by using the phlebitis scale of the Infusion Nurses Society. This research was done at Stanford Hospital and Clinics, Thrombophlebitis vitro-. For more about phlebitis and amiodarone in Thrombophlebitis vitro- care, visit the Critical Care Nurse Web site, www.
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